The American Journal of Managed Care March 2006
Medical News for the Public to Use? What's on Local TV News
Background: Local television news is the number 1 source of information for most Americans, and media health reporting has increased significantly during the past 10 years.
Objective: To evaluate the health topics and reporting characteristics of health stories on local television news across the United States.
Study Design: Content analysis of full-length broadcasts of local television news from a representative sample of the top 50 US media markets (122 stations).
Methods: Two trained coders evaluated all health stories for topics and reporting characteristics. Any discrepancies were resolved by a third independent coder.
Results: Among 2795 broadcasts reviewed, 1799 health stories were aired. Seventy-six percent of all stories were about medical conditions. The median story airtime was 33 seconds. Breast cancer and West Nile virus were the 2 most common topics reported on. Among 1371 stories about disease, few gave recommendations, cited specific data sources, or discussed prevalence. Egregious errors were identified that could harm viewers who relied on the information.
Conclusions: Local television news devotes significant airtime to health stories, yet few newscasts provide useful information, and some stories with factually incorrect information and potentially dangerous advice were aired. Regularly reaching 165 million people, local television news has the power to provide health information to most Americans. It is crucial that television reporting of health news be improved and that reporting errors be eliminated.
(Am J Manag Care. 2006;12:170-176)
Improving the public's health depends on effectively communicating health information.1 Health professionals have limited time in which to disseminate health information,2 and such personal patient communication does not reach persons who do not visit or who lack access to healthcare providers. As the number of uninsured people continues to increase and as the time physicians have to spend with patients continues to decrease, providers need to consider how health information is being disseminated to the public.
One important means of dissemination is the mass news media, which have been shown in several areas to reach almost every segment of the American public and to influence what Americans know and what they consider important.3,4 Health news coverage influences health knowledge and behaviors.5-9 Television news, in particular, has an important influence that may be underappreciated by the medical profession. For example, following Katie Couric's 2000 discussion of colon cancer screening on NBC's Today Show, colonoscopies increased by 27%.10 However, most Americans' main source of information is not national network news but local television news.11,12 According to the Pew Research Center,13 57% of Americans regularly watch local television news, outpacing all other media sources by a margin of almost 2 to 1. Americans rate television as their primary source of health information, and more than 76% report acting on health information obtained from the mass media.14,15
Although studies16-20 have evaluated how health news is reported in the print media, little is known about what health topics reach most of the public through local television news. Understanding the health information disseminated to most of the public via local television news allows managed healthcare professionals to anticipate questions, concerns, and resource needs for their patients and communities. With local television news being Americans' single most important news source, the objective of this study was to evaluate in a systematic way the health topics commonly reported on and the characteristics of this reporting on local television news for a specific period.
This study was a content analysis of local television news health information reported during October 2002. The data source was the top 50 media markets (122 stations) in the United States.
There are archives of many newspapers going back more than 100 years, and there is an archive of national network news broadcasts at Vanderbilt University, Nashville, Tenn. Although there have been scattered case studies of local news broadcasts in particular media markets for short periods, there has been no systematic national collection or archiving of local television news broadcasts, to our knowledge. In 2002, the NewsLab at the University of Wisconsin-Madison coordinated the archiving of more than 20 000 local television news broadcasts from a representative sample of 122 stations in the nation's top 50 media markets (reaching 66% of the nation's population) during September and October. To our knowledge, these data represent the largest, most systematic, and most representative sample of local television news coverage collected to date.
Originally intended to assess local television coverage of American politics, full broadcasts were archived 7 days per week for 7 weeks. NewsLab provided DVD recorders to volunteers in each of the 50 media markets. We used this representative national sample of broadcasts to understand better how health information is reported on local television news across America. For the month of October, we studied the late local news programs, usually at 10 pm or 11 pm. These were typically the top-rated news broadcasts for all 122 stations. When only a 30-minute broadcast was aired during this time, we archived the full broadcast. When the broadcast lasted 60 minutes, we recorded the highest-rated 30-minute segment (the first 30 minutes or the last 30 minutes of the broadcast). Of the 3205 late local television news broadcasts aired during October 2002, NewsLab archived 2795 (87%). The missing 13% were not collected because of malfunctions in DVD recorder timers, human errors, or technical issues. Among the missing broadcasts, there was no pattern in terms of media markets, times, or dates, and there was no indication of any sort of systematic bias introduced into the data set of health stories by their absence.
Clipping of Health Stories
Clipping was the process of identifying individual health stories within each 30-minute local television news broadcast. Media assistants received a 2-day training session with us (JMP, KMG, EFF) and viewed each broadcast to identify health stories.
We used a broad definition of a health story. We included any story contained within a franchised health segment (ie, a segregated news segment with a recurring health title) and any story that discussed a health topic or a health issue. We excluded stories that reported a death, homicide, suicide, injury, or bioterrorism event but did not discuss it from a medical or a public health perspective. For example, a story about a firearm homicide was not included unless it discussed issues such as the epidemiology of gun injury or prevention. We also excluded stories about medical malpractice.
Because of possible variations in resources throughout the sample, station demographics were gathered to assess health topic and reporting characteristics with respect to station location and media market size. Each health story was specified by station information, date aired, length of airtime, and network affiliate. Another media assistant independently clipped a 5% random sample of full-length local news broadcasts to assess clipping reliability and demonstrated 95% agreement.
Coding of Health Stories
Two media assistants independently coded each health story for all topics other than the identification of health topics and provided written descriptive summaries. Any discrepancies were resolved by a third independent coder, and final data were based on agreement of at least 2 coders.
Five independent health professionals with an MPH or MD degree also reviewed the original broadcasts and coded the health topics by classifying them into 1 of 17 categories (the complete data are available in an appendix from the author). Sixteen categories were based on the International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) classification system, and 1 category was for health stories discussing health information unrelated to a medical condition. We combined 2 medical conditions (congenital and perinatal) into 1 category in Table 1. Before the study, all 5 independent health professionals coded 58 health stories to allow for interrater reliability testing. We tested the interrater agreement for multiple raters and for multiple rating categories according to the method by Fleiss.21 The κ value was 0.64 (P < .001), representing good interrater agreement. Within the full data set, each story was independently coded by the chief coder and by at least 1 other coder. We determined interrater agreement for each pair of health professional coders, calculating κ values for 2 raters and for more than 2 categories according to the method by Fleiss.21 The κ values for the 4 rater pairs were 0.76, 0.80, 0.68, and 0.77. This represents good-to-excellent agreement. We tested the hypothesis that the agreement was not better than chance and found P < .001 in each case. For all health topic discrepancies among pairs, a third health professional independently recoded all health topic codes that were discrepant after the initial coding, and the final data were based on agreement between at least 2 health professional coders.
After each story was coded into 1 of 17 categories, the descriptive summaries for each health story were used to subdivide these general medical conditions into specific health topics. For example, within the general category of cancer, the descriptive summary enabled us to note under specific health topics the type of cancer that was the main focus of the story. If a single story discussed multiple health topics, the health topic receiving the largest proportion of time was coded as the main focus.
Finally, because the same health story was at times reported on many local news broadcasts, we evaluated the entire sample for specific health stories that were repeated. This was accomplished by grouping all stories with similar descriptive titles under the same general medical condition category. Once this was done, each repeated story was viewed a second time to determine whether the story was in fact reporting on the same health issue. The story was defined as repeated if identical video was aired, if the story referenced the same source, or if identical statistics were reported. An independent health professional evaluated a 30% random sample of stories, with 95% agreement for identifying specific health topics and repeated health stories. Repeated stories that aired in more than 10 media markets were termed pervasive health stories.
We described the characteristics of health reporting on local television news. These included health story length, stories reported within a franchised health segment, whether medical research was referenced in the story, and whether the story discussed prevalence, interviewed a health professional, or provided recommendations.
The health topics were ranked by general medical condition and by a more specific health topic categorization within each general category. In addition, stories that aired in at least 10 media markets were ranked to demonstrate the most pervasive health stories.
To determine whether exposure to certain health topics differed systematically by location, we compared the health topics and the characteristics of local television news health reporting by media market size (by quartile) within 4 geographic areas. These included the East, Midwest, South, and West; the data are available in an appendix from the author.
Among 2795 local news broadcasts analyzed, 1799 health stories were aired. Forty percent of broadcasts reported at least 1 health story, and those stories comprised 11% of airtime on local television news that was nonsports related and nonweather related. Twenty-six percent of health stories on local television news gave specific recommendations, and 12% of all health stories reported prevalences of disease. The median health story airtime for local television news was 33 seconds; 40% of stories were part of franchised health segments. Only 27% of all stories interviewed a health professional.