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PRELUDE

Advancing Media Research in Risk and Health Communication Contexts

H. Dan O’Hair

Disease outbreaks, terrorist acts, and natural disasters are obvious examples of contexts in which risk and health communication play a critical role. Broadcast media have found risk and health crisis events to be particularly seductive as stories that fascinate their audiences. Moreover, with digital media evolving at such a rapid rate, many audience members have taken on the role of newsmaker or reporter (Kim, Brossard, Scheufele, & Xenos, 2016)—we are not entirely certain to what effect. Digital media has proven to serve many useful functions such as operating as a conduit for warnings to the public and acting as a gauge for how messages are received and acted upon (Fraustino & Ma, 2015). On top of these dynamic conditions, many in the risk and health communication research communities find extreme events and hazardous contexts to be on the increase, and an evolving media landscape introduces both challenges and opportunities for using communication to manage these situations.

This book will address these issues as well as the research implications inherent in risk and health communication contexts. For example, how are these contexts best approached—inductively or deductively? How do researchers balance scientific finding with social and cultural issues? To what extent can media (legacy and digital) play a role in mitigating the effects of risk and adverse health events? How are potential ethical repercussions of communication disentangled from unfolding and unpredictable events? How do we study an increasingly media-savvy society with traditional research methods?

This book features chapters with leading-edge discussion by authors who offer the best available thinking and analysis on the topics of risk and health communication. To do so, the authors have selected the most salient issues associated with these contexts. Each chapter isolates a particular issue or concern and peels away the surface to expose the difficult choices and subsequent processes facing participants in the communication of risks and health issues. In addition, this book will feature analyses of new and traditional media that connect disasters, crises, risks, and public policy issues into a coherent fabric.

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How the Book Evolved

The research committee of the Broadcast Education Association approached the editor about developing one of the annual research symposiums that is held in conjunction with the annual convention. Routledge has been an important and consistent partner in publishing essays from the symposium. A review team was recruited and empaneled to help the symposium director (and the book’s editor) make competitive selections to appear at the convention. Approximately 80 percent of the essays presented at BEA were invited to be part of the book, and additional chapters were commissioned by the editor from known scholars in the areas of risk and health communication.

The unique perspectives of each author was invaluable in characterizing these contexts and their accompanying challenges. Each chapter represents the best available research in these areas with insightful notions of where current research and best practices should move in the future. In most chapters, original research findings are offered from ongoing research programs. In others, original models and frameworks are presented, capturing a wide array of constituent elements of complex processes and casting them into discernable designs worthy of consideration by researchers, practitioners, and policy makers.

To ensure that the aforementioned goals were met and that the book presents a consistent feel throughout the chapters, each author was asked to adhere to suggestions for conceptualizing and organizing chapter contents. Exceptions and modifications were attended to on an individual basis, but in general authors were asked to address the following issues in their chapters.

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Thus, the importance of this work is its ability to bring together the best minds on the topics of risk and health communication. These are vital topics that each merit the treatment that is typical of scholarly books. For several years, scholarly books have been one of the featured ways in which academics collect and organize chapters by leading scholars. These works help to establish milestones and may even serve as benchmarks for the development of literature in specific sub-disciplines.

We hope this work will be a capstone for current work in risk and health communication, and serve as a text for an increasing number of undergraduate and graduate courses in crisis communication. It can foster additional interest in risk communication and offer connections between health communication and others engaged in discussing risk and crisis. This book would bridge a substantial but sometimes disconnected body of literature.

Each chapter was reviewed with the following issues in mind.

Risk and Health Communication in an Evolving Media Environment is intended for multiple audiences, although each overlap to a large extent. The primary audience is one quite familiar to scholarly publishers and academic researchers. The book should attract interest among those communication scholars and researchers focusing on media and communication, but also those with specialties in particular aspects of disasters, risk, and crisis addressed in one of the chapters. In addition, it is expected that graduate seminars in risk communication, crisis management, policy management, and even political science will find Risk and Health Communication in an Evolving Media Environment attractive as a primary or secondary text. A third audience is likely to be found in main campus libraries and public libraries as well as libraries situated at health sciences centers. By involving multiple disciplines, it is expected that a large audience for the volume will be realized.

This volume will follow in the footsteps of other applied scholarly books that have become a vital part of the academic and professional contributions of the communication disciplines. These volumes not only offer the opportunity to capture the best thinking on a well-defined topic, but they have been extremely influential in sparking subsequent discussion and fostering the relevant research agendas. Their individual and collective impact on the field is inestimable.

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Introduction to the Chapters

In the following paragraphs, O’Hair sets the stage for the remaining theory and research presentations by previewing the content of the chapters in the sections to follow. In Part I: Advances in Health Communication Research, four chapters address contexts that are both new and problematic for media professionals.

In Chapter 2, Shin, Miller-Day, and Hecht focus on how alcohol is handled in the media. “Media Literacy and Parent–Adolescent Communication About Alcohol in Media: Effects on Adolescent Alcohol Use” characterizes how media literacy and parent-adolescent communication can affect how young people interpret media portrayals of alcohol use. These effects lead to reports of lower lifetime use of alcohol. The study offers important implications for how messages among family members can influence key behavioral decision-making in essential life choices.

In Chapter 3, Hindman discusses legalized marijuana and unravels the uncertainty often associated with various users. In his chapter, “College Students and Legalized Marijuana: Knowledge Gaps and Belief Gaps Regarding the Law and Health Effects,” Hindman builds theoretical scaffolding from the knowledge gap hypothesis and his own work—termed the belief gap hypothesis—in order to test claims about how students (potential users of marijuana) may be affected in their thinking and knowledge about the health effects of using marijuana during the initial phases following the legalization of marijuana in Washington state. Social media and an evolving media environment play a role in how social media portrayals are linked with social identity expression and potential and the use of marijuana.

The fourth chapter, authored by Crosswell, Porter, and Sanders, “Out of Sight, Out of Mind? Addressing Unconscious Brand Awareness in Healthcare Communication,” approaches the context of pharmaceutical advertising as a means of shedding light on the visual elements used during message campaigns by pharmaceutical companies. By focusing on how potential consumers perceive the prominence of branding and how it is used to promote awareness of the message, the authors discover that study participants who fixated more on the visual elements of branding had more skeptical views of the communication campaign. Importantly, the idea of “unconscious awareness” was introduced as a critical variable to be considered in future work of this kind, particularly as researchers attempt to make sense of the divide between conscious versus unconscious brand awareness in communication campaigns.

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Tai, Zhang, and Deng wrap up Part I with their chapter, which focuses on a national context. In “Communicating Health-Related Risk and Crisis in China: State of the Field and Ways Forward,” the authors provide a critique to the image of China as a country with unparalleled growth and prosperity for the past 30 years. Attendant to these changes are the presence of natural disasters and hazards, environmental degradation such as water and air pollution and the depletion of natural resources that bring diseases, significant risk, and health issues. This chapter, different from those in this section or elsewhere in the book, first describes an overview of the field of risk communication in China and offers some paths moving forward. In subsequent sections, Tai et al. illuminate many of the challenges facing risk and health communication, in particular nuclear power. Their proposed general strategy for risk and health communication management involves an integrated approach melding research and perspectives from the natural and general sciences, government administrators, and the general public.

In Part II: Communicating and Educating the Public and Media About Risk and Science, four chapters take up issues dealing directly with how messages are formed, crafted, conveyed, and then evaluated for public use. In the first chapter of this section, Scholl, Bogaert, Forrester, and Cunningham, approach risk and health communication from focused and pragmatic viewpoints. As scientists from the National Institute for Occupational Safety and Health (NIOSH), the authors marry theory with innovative tactics to offer compelling methods for translating research into practice. In their chapter, “Risk Communication in Occupational Safety and Health: Reaching Diverse Audiences in an Evolving Communication Environment,” they forward the argument that the workplace, like many other communicative contexts, is an evolving media home to multiple messages about risks and illnesses perpetrated by chemical and environmental hazards. The chapter takes care to focus attention on the influence of new and emerging media and offers suggestions for how best practices can be developed for use by risk and health communication professionals interested in the occupational safety context.

In the chapter that follows, Rowan and her colleagues present research that explores the influence of television weathercasters on ideas and impressions of climate change. Climate change is presented as a particularly difficult hazard given the slow onset of attendant problems (and contested scientific results). “Best Practices of ‘Innovator’ TV Metereologists Who Act as Climate Change Educators” extends our understanding of media as a tool for informing viewers about science as it affects our lives through weather and climate. In particular, the authors offer a number of different venues and platforms from which to send climate change messages (e.g., blogs, TV, parks, etc.) that would appeal to targeted audiences.

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Extending the notion of how media plays a critical part of our education about risk and health, Ratcliff, Jensen, Christy, Crossley, and Krakow discuss how news coverage of serious diseases—in this case cancer—can influence viewership levels of uncertainty that can lead to decision-making about the disease. Their chapter, “News Coverage of Cancer Research: Does Disclosure of Scientific Uncertainty Enhance Credibility?”, provides robust findings of the connection between what is presented as scientific news and how viewers are able to generate confidence in that which is reported.

In the last chapter of this section, Kreps and Alpert place emphasis on how online information is assessed in “Evaluating Online Health Information Systems.” The authors organize their chapter according to three major evaluation programs: (a) formative evaluation (initial analysis often involving needs assessment and audience analysis); (b) process evaluation (message tracking and assessing user feedback); and (c) summative evaluation (tracking key indicators and costs associated with the ongoing program). The chapter explains how various methods can be used to provide the process for conducting evaluations for the various stages of a communication program or campaign.

In Part III: Situating Theory in Risk and Health Communication Contexts, the book places additional emphases on a number of theoretical frameworks that add clarity to risk and health communication contexts.

Haigh, in her chapter “Examining Print Coverage of the Keystone XL Pipeline: Using the Social Amplification of Risk Framework,” investigated the newspaper coverage associated with the famous Keystone Pipeline in the critical period of its development, 2008–2015. Haigh used analytics techniques to determine tone, frame, and depiction of coverage of the two principal players in the environmental controversy: US government agencies and the energy industry. Her work discovered that different frames were used by the media in depicting the crisis, in particular a focus on environmental risk factors instead of spotlighting economic and human factors. Implications from the study offer compelling recommendations for investigating such environmental crises that are portrayed in the media.

In the following chapter, entitled “Terrorism, Risk Communication, and Pluralistic Inquiry,” Macy-Ayotte argues for a more nuanced and tolerant approach to studying contexts involving terrorism. Macy-Ayotte challenges other scholars to consider “disciplinary pluralism” where multiple perspectives and disciplines are considered during analyses of risk contexts, especially that of terrorism. Macy-Ayotte asks for more recognition of rhetorical approaches that heretofore have been neglected in many risk analyses.

The authors of the next chapter, Bowen and Li, placed ethics and professionalism front and center during considerations of risk and health messages. In their chapter, entitled “Communication Ethics for Risk, Crises, and Public Health Contexts,” the authors make convincing arguments that ethical communication is a prerequisite for situations where communicators must provide information about circumstances where people are given choices as part of a decision-making context. Their chapter takes up the challenge of evolving media and how communication can take multiple paths. Grounded in three theoretical schools of thought, the authors suggest an integrated framework for decision-making that can be employed to investigate a risk or health problem.

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In the final chapter of this section, Ivanov, Parker, and Dillingham explore inoculation theory as a means for understanding risk and health communication contexts. Aptly entitled “Inoculation as a Risk and Health Communication Strategy in an Evolving Media Environment,” this chapter melds together two large bodies of work that have generally only existed independently. Specifically, the chapter offers special consideration for how risk and health communication scholars and practitioners can take advantage of the rich history and theoretical background of inoculation-based strategies in service of communication directed to risk and health circumstances.

In Part IV: Exploring Messages and Media During Extreme Events, the book explores the research associated with the challenging issues of communicating before, during, and after extreme events such as tornados, health emergencies, and outbreaks. Bruce, Clark, and Hodgson begin this section by examining the possible effects of weather broadcaster messages on viewers’ perceptions, and potential cautionary behavior. The chapter, “First Alert Weather: Local Broadcasters' Communication During Weather Emergencies,” takes a close look at the role meteorologists play in educating broadcast viewers about the nuances of severe weather. The authors note that the Federal Communication Commission has required broadcasters to serve their local communities in a forthright way in order to qualify for their license. In recent years, the channels and evolving media available to both broadcasters and their viewers has expanded significantly. Using the CDC’s Crisis and Emergency Risk Communication model, the research reported in this chapter interviews broadcasters to determine the strategies they utilize during three severe weather outbreaks (two tornados and one hurricane).

In the following chapter, Yu, Littlefield, Farrell, and Wang explore the 2012 West Nile Outbreak as a context from which to investigate information and decision-making in an extreme event. The chapter, entitled, “It’s Not Preventable, Yet You Are Responsible: Media’s Risk and Attribution Assessment of the 2012 West Nile Outbreak,” creates some interesting tensions that are not easily unpacked in this particular context. The authors present something of a conundrum where the media portrays the West Nile virus as unpreventable while at the same time recommending that individuals and communities take precautions to ward off potential infection. The chapter concludes with a series of practical implications for how the media can cover pandemic disease outbreaks in an evolving media environment.

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In the final chapter in this section, Getchel and colleagues present the chapter “Competing and Complimentary Narratives in the Ebola Crisis,” where narrative theory is the focus of the contextual analysis within the highly volatile Ebola crisis. Once the authors make the case for the critical importance of narrative theory for risk and health communication situations, they make a convincing argument for the literal competition that different players in the contexts engage in using narratives as the basis for their claims. The multifaceted nature of narratives becomes more problematic during lengthy crises, as possible interpretations become more plentiful. The authors recommend that a narrative convergence process be invoked in order to reduce uncertainty and move to a point of greater understanding for the different viewpoints being advanced.

These chapters paint a unique picture of how risk and health communication is studied in various contexts. One unmistakable trend is how online communities are forming rapidly to address risk and health issues. Increasingly, individuals are influencing one another through social media, and as a result, they are influencing public opinion (Kim et al., 2016). In a general sense, social networking services (SNS) have proven to be useful for improving health behaviors. One of the key reasons for this phenomenon, according to Namkoong, Nah, Record, and Stee (2017), is that online messages create space for participants to contribute personally to the risk and health management processes (especially campaigns). A slightly different perspective is how online health and risk communities rapidly form on the Internet in order to improve the understanding of the disease or the disaster the participants are facing; it gives people a chance to interact with like-minded individuals (Willis & Royne, 2017). A term has even been constructed—cybercoping—to describe how blogs are used as a form of dealing with issues (Donovan, Nelson, & Scheinfeld, 2017). Cybercoping involves online communication activities such as describing experiences, seeking information, gaining insight into coping strategies, and developing relationships with fellow online users.

Other uses of emerging media include personalized health records, which can become more useful when made more interactive with personalized alerts. When personalized health records included a communication dimension with a patient’s provider, the context stimulated the patient to be more proactive with their healthcare provider (Rief Hamm, Zickmund, Nikola, . . . Roberts, 2017). Even physicians are getting in on the act. Research by Allport and Womble (2016) reported that more physicians are using Twitter as a means of communicating better with patients, reviewing new research, and connecting with colleagues. Physician tweeting is likely to increase even more as providers are able to overcome their concerns of privacy and time constraints. Emerging media has also created opportunities for physicians and patients to construct virtual visits through online communication. Jiang and Street (2017) reported that many more physicians would like to be involved in virtual visits with their patients, again, if they can overcome concerns about privacy, security, and the thought that they may be delivering less personalized care.

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Taken together, the chapters in this book and the research reported above echo what Heath and O’Hair (2009) argued regarding the challenges of risk and health communication: It can be difficult to base judgments on science, values, and policy while crafting communication messages that are simultaneously competent and understandable. Emerging media is a key mechanism for surmounting these challenges.

References

Allport, J. M., & Womble, F. E. (2016). Just what the doctor tweeted: Challenges and rewards of using Twitter. Health Communication, 31, 824–832.

Donovan, E. E., Nelson, E. C., & Scheinfeld, E. (2017). Cyberframing cancer: An exploratory investigation of valenced cybercoping on cancer blogs. Health Communication, 32, 1–10.

Fraustino, J. D., & Ma, L. (2015). CDC’s use of social media and humor in a risk, campaign—“Preparedness 101: Zombie Apocalypse.” Journal of Applied Communication Research, 43, 222–241.

Heath, R. L., & O’Hair, H. D. (2009). The significance of risk and crisis communication. In R. Heath & H. D. O’Hair (Eds.), Handbook of risk and crisis communication (pp. 5–30). New York: Routledge.

Jiang, S., & Street, R. L. (2017). Factors influencing communication with doctors via the Internet: A cross-sectional analysis of 2014 HINTS survey. Health Communication, 32, 108–188.

Kim, J., Brossard, D., Scheufele, D. A., & Xenos, M. (2016). “Shared” information in the age of big data: Exploring sentiment expression related to nuclear energy on Twitter. Journalism & Mass Communication Quarterly, 93, 430–445.

Moon, T., Chih, M., Shah, D. V., Yoo, W., & Gustafson, D. H. (2017). Breast cancer survivors’ contribution to psychosocial adjustment of newly diagnosed breast cancer patients in a computer-mediated social support group. Journalism & Mass Communication Quarterly, 94, 486–514.

Namkoong, K., Nah, S., Record, R. A., & Stee, S. K. V. (2017). Communication, reasoning, and planned behaviors: Unveiling the effect of interactive communication in an anti-smoking social media campaign. Health Communication, 32, 41–50.

Rief, J. J., Hamm, M. E., Zickmund, S. L., Jikolajski, C., Lesky, D., Hess, R., Fisdcher, G. S., Weimer, M., Clark, S., Zieth, C., & Roberts, M. S. (2017). Using health information technology to foster engagement: Patients’ experiences with an active patient health record. Health Communication, 32, 310–319.

Willis, E., & Royne, M. B. (2017). Online health communities and chronic disease self-management. Health Communication, 32, 269–278.