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15

IT’S NOT PREVENTABLE, YET YOU ARE RESPONSIBLE

Media’s Risk and Attribution Assessment of the 2012 West Nile Outbreak

Nan Yu, Robert Littlefield, Laura C. Farrell, and Ruoxu Wang

Health events such as large-scale disease outbreaks naturally attract journalistic attention because of people’s general interest in medical events (Pew Research Center, 2009). News media have closely followed these pandemics year after year and shifted their approaches of doing so throughout the decades (Blakely, 2003; Koteyko, Brown, & Crawford, 2008). The news coverage of public health events is important in that, through these reports, people can develop a concept of a disease and prepare for a potential health risk accordingly (Blakely, 2003; Roche & Muskavitch, 2003).

Many disease pandemics have impacted human societies throughout history. Pandemics such as the 1918 Spanish flu, the 1957 Asian flu, the 1958 Hong Kong flu, and more recently the 2003 SARS and the 2009 H1N1 have all caused severe economic, social, and health consequences in various countries (Blakely, 2003; Hume, 2000; Luther & Zhou, 2005; Yu, Frohlich, Fougner, & Ren, 2011). Among these pandemics, West Nile has been a severe health threat in the US for years (Sifferlin, 2015). Over 30,000 American people have been infected with the West Nile virus since 1999—the year that the first case of West Nile was found in New York (“West Nile virus,” 2013). The year of 2012 was unique for West Nile because the infected cases were found in 48 states in the country and the disease caused 286 deaths—making it the largest pandemic of its kind since 2003 (CDC, 2013).

Research on news media’s portrayal of disease outbreaks has attracted wide scholarly attention (Blakely, 2003; Dudo, Dahlstrom, & Brossard, 2007; Hume, 2000; Roche & Muskavitch, 2003; Yu et al., 2011). Much of the prior research concentrates on whether media has accurately presented health risks in the news or whether the preventive strategies have been communicated properly (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). This project intends to extend this line of research by examining the portrayal of the 2012 West Nile outbreak in American media with an emphasis on the depictions of risk, preventability, and attribution of responsibility.

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Literature Review

Media coverage of disease outbreaks has transformed significantly over the past century. Blakely (2003), through an investigation of influenza coverage during the 1918 Spanish flu, 1957 Asian flu, and 1968 Hong Kong flu, suggests that the development of science in curbing transmitted diseases has modified the ways that pandemics were depicted. When science became a possible solution to pandemics, media started to shift their focus from public anxiety to scientific preventive methods, attempting to provide answers to these dangerous public health issues (Blakely, 2003). Scholars argue that, beyond presenting the risk and magnitude of a pandemic, media should share the responsibility of providing answers to the “so what” question that is commonly raised by general audience and satisfy the need to know how to reduce the chances of being affected by a health risk (Roche & Muskavitch, 2003). Therefore, this project includes the analysis of risk representations as well as the evaluation of attributions of disease and responsibility in the media.

News Media’s Risk Assessment

Risk assessment is of great interest to media scholars because journalists’ risk assessment of disease outbreaks shapes how dangerous or threatening the outbreak actually is (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). Inaccurate risk assessment in media portrayals can be problematic: exaggeration of actual risk in media coverage may induce feelings of panic or hopelessness from individuals, whereas underestimating the actual risk can have serious consequences if people do not take the necessary precautions to protect themselves (Dudo et al., 2007; Roche & Muskavitch, 2003).

Some scholars indicate that media coverage on pandemics can lack quality and often present inaccurate or insufficient information (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). For example, Roche and Muskavitch (2003) examined the precision of the presentation of the 2000 West Nile outbreak in American major newspapers. Their results suggested that the risk information of West Nile was presented with a low degree of contextual precision. Specifically, the risk magnitude of the outbreak was often described by using qualitative words (e.g., dangerous, deadly, a severe outbreak) and when numerical information was presented, it often lacked contextual background (e.g., the population size).

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The depiction of risk magnitude has often been used to assess the accuracy and precision of risk presentation in the media. Risk magnitude information varies along a continuum of contextual precision: a low degree of contextual precision contains little informational value for the public, whereas a high degree of contextual precision holds greater value because it offers a comparison of risk compared to the general population (Griffin, Dunwoody, & Neuwirth, 1999; Resnik, 2001). Prior research has identified three key strategies news media can use to portray the magnitude of a health risk (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). These strategies include: 1) qualitative risk, 2) quantitative risk—numerator (e.g., 5 people died), or 3) quantitative risk—number/population (e.g., 0.02 percent of individuals who were infected died).

When depicting the outbreak as a qualitative risk, news reports often use qualitative phrases to portray the severity of the disease such as “a large threat,” “a worse outbreak,” or “a fatal disease,” to name a few. This is seen as the least precise way to depict a health risk because the judgment of these words could be objective (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). The precision level of risk magnitude depiction can be improved by using numerical information (i.e., numerator, or number/population), such as “two died” or “one out of two hundred people will develop symptoms.” The latter is seen as even more accurate because it offers the public a context when analyzing and evaluating the health risk (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011).

As a source of information about health risks, the news media are essential because many members of the public base their impressions about risks on information presented in the media (Fischhoff, 1995; Kitzinger & Reilly, 1997). Accurate risk presentations allow the public to assess risk in a rational manner (Dudo et al., 2007), and help readers make personal decisions required to reduce overall personal risk while minimizing personal cost (Roche & Muskavitch, 2003). Therefore, news media share an important responsibility to report accurate risk assessment of disease outbreaks so the public has a realistic understanding of their susceptibility and relevance to an illness. Therefore, we proposed the following question:

RQ1: How was risk magnitude portrayed in the 2012 West Nile coverage?

Many scholars have suggested that solely presenting risk information related to a disease outbreak without providing a solution is considered insufficient (Dudo et al., 2007, Yu et al., 2011). Thus, it is expected that media also report preventive methods associated with a disease which are important for the enhancement of personal protection (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). Hence, in this project, in addition to the examination of risk magnitude of the West Nile disease, we intend to investigate how news media have depicted the preventability of the disease, as well as prevention responsibility shared by different parties during the West Nile outbreak.

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Preventability of the West Nile Pandemic

Preventability is considered one of the key characteristics of illnesses. It is defined as the degree to which a disease or its consequences can be prevented or predicted and is considered an important concept related to illness attributions (Lucas, Lakey, Alexander, & Arnetz, 2009a; Lucas, Alexander, Firestone, & Lebreton, 2009b).

Some illnesses can be perceived as more preventable than others (Lucas et al., 2009a; Weinstein, 1984). The concept of preventability is vital for a disease pandemic such as West Nile because whether or not a disease is preventable can directly influence the magnitude of public fear and anxiety caused by a transmitted virus. For example, the SARS epidemic in 2003 caused worldwide panic because the disease was mysterious and untreatable with an unknown preventative strategy at that time (Hung, 2003).

When it comes to the issue of West Nile, avoiding mosquito bites is the only way to prevent being infected. Activities that can help avoid mosquito bites, including minimizing outdoor activities and draining standing water around residential houses, are frequently recommended as effective methods in reducing the risk of being infected with the West Nile viruses (“West Nile virus,” 2013). However, many have raised questions regarding the possibilities of avoiding mosquito bites completely (Fox, 2013).

When applying the concept of preventability to the context of media coverage about the 2012 West Nile outbreak, we tried to identify whether West Nile has been portrayed as preventable (e.g., predictable, vaccination option) or unpreventable (e.g., not enough information is known, the spread of illnesses is unpredictable). These types of messages may play an integral role in molding people’s perception of whether they can or cannot do something to protect against a virus (Lucas et al., 2009a). Therefore, we proposed the following research question:

RQ2: How was disease preventability portrayed in the media coverage of the 2012 West Nile outbreak?

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Ascribing Responsibility of the West Nile Prevention

Framing theory has been used as a theoretical guideline for researchers studying the selection and omission of certain aspects of an issue, especially with regard to causes and responsibility (Iyengar, 1991; Kim, 2015). The existing framing literature shows how the ascribing of responsibility has been presented in the media covering a variety of social and health issues, such as trans fats (Jarlenski & Barry, 2013), autism vaccinations (Holton, Weberling, Clarke, & Smith, 2012), depression (Wang & Liu, 2015), lung cancer (Major, 2009), obesity (Kim & Willis, 2007), and poverty (Jang, 2013). When reporting social problems or health problems, it is common for media to attribute responsibility to different parties such as individuals, community, government, and social organizations, just to name a few. The attribution of societal- or personal-level responsibility may affect policy-making process, judgment of others, and social interactions (Weiner, 1995).

Kim and Willis (2007) analyzed over 300 news reports from American newspapers and TV programs and found that while media emphasized personal causes and solutions rather than societal responsibilities for obesity in general, television news was more likely to mention personal solutions than newspapers. In another study, Kim, Carvalho, and Davis (2010) discovered that media were more likely to attribute society to overcome the problem of poverty and less likely to put the burden on individuals. In another study, Holton et al. (2012) discovered that news media focused on ascribing the responsibility to one guilty individual—Andrew Wakefield—when covering the MMR-autism controversy. Yu and Xu (2016) discovered that social media users frequently blamed scientists and government when things went wrong with genetically modified foods.

The different presentations of responsibility attribution can help lead or mislead audience to determine the causes and solutions for social problems (Holton et al., 2012; Iyengar, 1991; Jang, 2013; Kim & Willis, 2007; Yu & Xu, 2016). For example, Ben-Porath and Shaker (2010) found that the images of victims portrayed in the news significantly impacted people’s perceptions of government responsibility in the wake of Hurricane Katrina.

Scholars have been concerned that when social issues are reduced to individual-level matters, societal-level responsibility can be neglected (Wallack, Dorfman, Jernigan, & Thema, 1993). For most pandemic-related health issues, individuals are naturally the responsible parties because when getting infected, individual health consequences can be severe or deadly (such as Ebola or SARS). However, for communicative diseases, one’s health condition can also affect people nearby. This makes large-scale disease outbreaks more than just a health problem—they are a threat to the entire family, community, and society at large. For example, the 2003 SARS outbreak in China created societal panic and instability, causing nation-wide shutdowns (e.g., schools and shops closed) (Yu, 2004).

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In the face of a health pandemic, media coverage may touch on who is responsible for taking preventive measures. Therefore, one of our goals in this project is to understand how responsibilities were attributed toward each individual, a community, or a society at large. In addition to the investigation of how responsibility was covered in the news reports of the 2012 West Nile outbreak, we also examined whether the preventability of this disease (i.e., West Nile being preventable or unpreventable) was linked to a call for preventive actions in the media. Individuals are more likely to assume responsibility when an event is preventable, but responsibility is not typically assumed when something is unpreventable (Weiner, 1995).

Thus, the following research question was proposed:

RQ3: What is the relationship between the portrayal of preventability and the depiction of responsibility in the media coverage of the 2012 West Nile outbreak?

Method

Sampling

This study collected local and national media coverage of the 2012 West Nile virus over the progression of the outbreak. Articles were collected daily (at a consistent time of day) by doing a Google News search using keywords such as “West Nile virus,” “West Nile outbreak,” and “West Nile cases.” The top five articles appearing in the search results were selected for each day. The first case of West Nile virus in humans was detected in Dallas County, Texas, on June 20, 2012, denoting the beginning of the epidemic. By December of 2012, the West Nile virus affected a total of 48 states. A total of 15 weeks of coverage was collected between late July and early November of 2012. After the sample was collected, duplicate stories were eliminated prior to coding. The total sample for this study included 450 stories.

About 83 percent of the sample was from local or regional media outlets, 14.7 percent was from US national media outlets, and 2 percent was from international media outlets. Over 46 percent of the sample was newspaper stories, followed by TV stories (32.9 percent), online media stories (14.4 percent), radio stories (4.0 percent), magazine stories (1.8 percent), and news agency stories (0.4 percent). Even though all articles were collected online, we recorded the original media outlet that produced the article. For example, a story that appeared on WFAA.com was coded as an article from a local/regional TV because WFAA-TV is a local TV station that serves the Dallas-Fort Worth area in Texas.

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Coding Scheme

Risk Magnitude. The coding of the presentation of risk magnitude related to West Nile followed the coding strategies used in previous research analyzing coverage of infectious disease outbreaks (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). The presence of qualitative risk was coded based on a set of qualitative words and phrases depicting the health risk of the West Nile virus. Examples of the words include “large threat,” “threatening,” “severe outbreak,” and “fatal disease,” to name a few. The presence of quantitative risk depictions was coded as: 1) numerator (e.g., 30 people died); 2) numerator/population (e.g., 30 out of 1,000 people died, or 2 percent developed symptoms). The difference between these two categories is that the latter offers contextual information, which allows readers to put the numbers into a population context when evaluating the health risk.

Preventability. Coders coded West Nile as preventable if there was information about the disease being preventable or the risk being predicable. The portrayal of West Nile was coded as unpreventable if the article expressed that the disease could not be prevented, predicted, or treated, or the article conveyed that ways to control the situation were uncertain or unknown.

Responsibility. The coding of responsibility was separated into: 1) individual responsibility and 2) community responsibility. Individual responsibility was coded when an article mentioned and advocated individual actions, such as: 1) avoiding mosquito bites (e.g., better screening for windows and doors, reducing outdoor activities, water draining, or wearing insect repellents); 2) cooperating with authority (e.g., reporting dead birds or neglected pools, or supporting community preventive actions); and 3) enhancing awareness and knowledge (e.g., seeking for more information about West Nile). Community responsibility was coded if an article reported community efforts in combating the disease, such as: 1) resource provision (e.g., preparing chemicals, mosquito traps); 2) mosquito-control actions (e.g., aerial spraying); and 3) surveillance and education (e.g., monitoring and educating the public about the spread of the virus).

Besides coding of these primary variables, sources of the article were also coded (i.e., local/regional or national media) and the media types (i.e., newspaper, TV, radio, magazine, news agency, and online). The coding book was refined and revised by several rounds of discussions and testing using a small portion of the sample.

Inter-Coder Reliability Test and Coding

Once the codebook was completed, two coders were trained through coding practices and discussions. A mutual understanding of codebook was achieved before the inter-coder reliability test. Two coders completed the inter-coder reliability test. The two coders were both female—one was Caucasian and the other was Asian American. The two coders independently coded 10 percent of articles that were randomly selected from the sample. For all categories that were mentioned in the coding scheme (i.e., source, media types, preventability, responsibility), the percentages of agreement ranged from 92 percent to 100 percent, Krippendorff’s α ranged from .78 to 1, and Cohen’s κ ranged from .80 to 1. Therefore, the overall reliability was satisfactory.

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After the inter-coder reliability test was completed, three female coders finished the coding of the entire sample. The whole coding process took approximately three weeks.

Results

Depictions of West Nile Risk

About 6.2 percent of news coverage did not contain any information about risk magnitude associated with the West Nile outbreak. About 9.8 percent portrayed the risk used only qualitative depictions of the disease. For example, the 2012 West Nile outbreak was frequently depicted as “one of the worst outbreaks since 2003.” Many articles described the disease as “deadly” and “fatal.” Coverage using quantitative risk depictions accounted for 84 percent in total (i.e., presence of numerical information). The articles that used numerator (45.7 percent) or number/population (38.3 percent) to depict the mortality or illness exceeded those that used qualitative depictions of risk only (9.8 percent), as well as those that contained no depictions of risk magnitude (6.2 percent), [χ² (3, N = 450) = 214.4, p < .001] (see Table 15.1). The depiction of the risk magnitude with number/population, the most precise and accurate way to portray risk magnitude, appeared in 38.3 percent of the total stories. Slightly more articles (45.7 percent) presented the risk with the actual number of people that were affected or died without providing a context of the overall population. This difference is not statistically significant though [χ² (1, N = 378) = 3.1, p = .08].

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Preventability of West Nile

RQ2 examined how the media portrayed West Nile regarding whether the disease is preventable or not. The analyses found significantly more articles depicting West Nile being unpreventable (41.4 percent) than those portraying it being preventable (6.4 percent) [χ² (1, N = 214) = 113.7, p < .001]. About 52 percent of the articles did not mention the preventability of the disease at all. In other words, over 93 percent of the articles analyzed either omitted the discussion of preventability of West Nile or clearly indicated the random nature of this disease—the virus is transmitted by infected mosquitoes and avoiding mosquito bites cannot be easily guaranteed. In the articles depicting West Nile as being unpreventable, some mentioned there are currently no medications that treat West Nile or a vaccination to prevent the disease. Some claimed that it is too early to monitor the epidemic because the factors associated with West Nile remain unclear (see Table 15.2).

Preventive Responsibility

Individual responsibility. About 51 percent of the coverage mentioned individual responsibility. Specifically, the preventive method of avoiding mosquito bites appeared in 42.4 percent of the articles, enhancing individual awareness and knowledge was presented in 20.3 percent of the articles, and cooperating with authority was mentioned in 8.9 percent of the articles.

The preventive methods suggested by the media include reducing outdoor activities at dawn and dusk, eliminating open water surrounding the house, keeping windows or doors shut, wearing long sleeves and long pants, using insect repellent, or seeking more information regarding West Nile. Individuals were also encouraged to report dead birds to authority or support community mosquito-control programs.

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A 2 X 3 chi-square analysis detected a significant relationship between the portrayal of preventability and individual responsibility [χ² (2, N = 450) = 19.1, p < .001, V* = .21]. Among the articles that depicted West Nile as preventable, significantly more stories (72.4 percent) mentioned individual responsibility of preventing West Nile than those that lacked such information (27.6 percent) [χ² (1, N = 29) = 5.8, p < .05].

When analyzing the stories portraying West Nile being unpreventable, the same pattern emerged. Significantly more articles contained individual responsibility of preventing West Nile (70.8 percent) than those with no such information (29.2 percent) [χ² (1, N = 185) = 32.1, p < .001, V* = .21]. This finding suggests that even though the disease was depicted as unpreventable, media still advocated for individuals to take actions to prevent the disease (see Table 15.3).

Community Responsibility. About 44 percent of the coverage presented the community efforts in combating West Nile. Mosquito-control actions (e.g., aerial spraying, encouraging temporarily shutting down of outdoor businesses) appeared in 30.2 percent of the articles. Surveillance and education in the community was presented in 20.4 percent of the articles. Over 8 percent of the stories mentioned community resource provision (e.g. offering test labs, providing chemicals for mosquito control).

A 2 X 3 chi-square analysis detected a significant relationship between the portrayal of preventability and community responsibility [χ² (2, N = 450) = 7.36, p < .05, V* = .13]. Specifically, when the articles contained no information of preventability, significantly more stories mentioned community responsibility (61.4 percent) than those that did not (38.6 percent) [χ² (1, N = 236) = 12.4, p < .001]. The findings revealed that news articles continued to report community actions to prevent the spread of the West Nile virus even when they were unclear about the preventability of the disease (see Table 15.4).

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Discussion

Precision of Risk Depictions

One of the key questions we investigated in this study was the precision of the risk depiction in the West Nile coverage. Given that the West Nile outbreak in 2012 was referred to as “the worst outbreak in the past decade” (CDC, 2013), media were expected to accurately and precisely convey the severity and the magnitude of this health risk to the public.

Quantitative risk presentation is believed to be more accurate when compared to using just qualitative risk depictions because it offers more numerical information for audiences to make objective evaluations (Dudo et al., 2007; Roche & Muskavitch, 2003; Yu et al., 2011). The results of the present study suggest the majority of the articles (84 percent) adopted this approach. This can be viewed as a significant improvement from the West Nile coverage in 2000 when limited quantitative information was presented in the news coverage (Roche & Muskavitch, 2003).

Roche and Muskavitch (2003) suggested that coverage of the West Nile outbreak in 2000 generally lacked precision because 89 percent of the articles had no information at the number/population level. A slight improvement was detected in this study. Over 38 percent of the articles included the number of people who were at risk or died of the West Nile virus and also provided an overall population context in the coverage (e.g., 1 in 100 people may develop severe symptoms).

We recommend that journalists continue using this approach when covering health risks in the future because providing a precise context of the risk magnitude can offer an integrated, holistic picture of a health risk and allow individuals to make reasonable and accurate judgments of susceptibility (Dudo et al., 2007; Roche & Muskavitch, 2003). This type of improvement is especially meaningful in a quick-changing media environment, in which information of health risks can be spread quickly through digital media platforms such as online news media or social media (e.g. Twitter, Snapchat, or Facebook).

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In a recent report released by the Pew Research Center (Fox, 2014), 72 percent of Internet users reported that they have searched online for health information. When a significant health risk (e.g., Ebola, Zika, or West Nile) approaches, individuals will rely on both the mass media and their personal networks (face-to-face or online) to receive reliable health information. Journalists will face the challenge of reporting health risks promptly and accurately through digital media outlets as more and more traditional media are moving toward fully digitized platforms (Risi, 2016). Therefore, the precision of the risk depictions of large-scale pandemics becomes tremendously important because an inaccurate report of the risk may generate unnecessary fear or anxiety. We hope that news reporters can continually improve their coverage of health risks by presenting both the numeric depictions and the context of the population.

Preventability and Responsibility

Our study discovered that the news stories covering the 2012 West Nile outbreak primarily depicted the disease as unpreventable or simply neglected the discussion of the preventability of the disease entirely. Only 6.4 percent of the stories were optimistic about the preventability of West Nile. Given that there is no vaccine or treatment for West Nile at this time, this pattern of coverage seems reasonable. The small amount of articles that portrayed the disease as being preventable or predictable focused primarily on scientific research about developing models to monitor the spread of the virus. Many of these articles emphasized connecting weather conditions to the breeding patterns of the mosquitoes that spread the virus. These articles conveyed a signal that the West Nile outbreaks may be predicted or prevented in the near future.

However, over 52 percent of the articles did not mention the preventability of the disease and 41 percent suggested the difficulties of preventing the West Nile virus. The majority of the coverage revealed that the come-and-go of the virus was largely unpredictable and the disease was generally unpreventable.

Based on the attribution theory, responsibilities are unlikely to be assumed when risks are unpreventable (Weiner, 1986, 2006, 2010). Therefore, the depiction of disease preventability is meaningful because it may influence whether individuals can be motivated to take precautionary actions. For a disease like West Nile, preventability is largely uncertain because there is no vaccine or treatment for the West Nile virus at this time (Sifferlin, 2015); therefore, the call for actions to protect oneself narrowly focused on avoiding mosquito bites. This preventive strategy, however, carries its own natural uncertainty. It is true that exposure to infected mosquitoes may be decreased by preventive actions such as reducing outdoor activities, using insect repellent, draining standing water, or applying aerial spray in the community (CDC, 2016). However, no one can completely avoid or control mosquito bites realistically. The mosquito population can also surge due to warm and humid weather. The complete elimination of mosquitoes seems impossible (“West Nile virus,” 2013).

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Our study suggested that the media coverage of the 2012 West Nile outbreak represented a theoretical and practical paradox. Based on the attribution theory, an unpreventable risk is unable to motivate preventive actions. But media have suggested otherwise—the West Nile outbreak was largely unpreventable, yet preventive strategies for individuals and communities were encouraged.

Even though the media coverage consistently portrayed the spread of the West Nile virus as unpreventable, a significant portion of the reports frequently advocated individual preventive actions and highlighted community efforts in combating the disease. The media coverage of West Nile conveyed an unrealistic or false hope to the public—the risk may be minimized by certain preventive actions yet the disease is scientifically unpreventable and unpredictable.

Future Directions

Our study has created some new directions for future research regarding the relationship between media, audiences, and large-scale pandemics. First, given that the accuracy assessment of upcoming health risks is essential, it is meaningful to continue evaluating the performance of different types of media outlets in an evolving media environment. Traditional and online news reporters both carry important responsibilities in precisely communicating health issues such as West Nile to the public. Second, it is also important to investigate peoples’ attitudes and perceptions about West Nile to understand how individuals will react to a risk when there is no scientifically approved treatment or vaccine. Third, scholars can also experimentally test the persuasiveness of health messages that advocate preventive behaviors with different portrayals of preventability or responsibility of West Nile. Overall, this study provides research findings that may be useful to investigate other national or international pandemics. Future research can also examine how a disease outbreak has been discussed on social media.

Conclusion

Through the lens of media coverage of the 2012 West Nile outbreak, we found that news stories frequently used the quantitative approach to depict the risk magnitude of the West Nile outbreak. The precision of the coverage of the risk was largely improved compared to the previous coverage of West Nile (Roche & Muskavitch, 2003). The findings of this study revealed that West Nile was often portrayed as unpreventable and media frequently encouraged individuals and communities to engage in preventive actions. This type of coverage may create a conflicting image for the West Nile prevention because individuals were encouraged to perform precautionary actions yet their effectiveness or usefulness remained unknown.

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We also suggest future reporters should continue to improve their writing by accurately assessing the risk and responsibility of disease outbreaks so that the public can have a realistic understanding of their relevance to an illness and how to protect themselves.

This study has gone beyond the investigation of the traditional media and their role in reporting a disease outbreak and covered an extensive range of media outlets including national, international, print, broadcast, and online news outlets. This research also tested the attribution theory amongst the news coverage of West Nile, an approach that has linked a social-psychology theory to media studies. As a whole, this study provides valuable theoretical and practical implications for an important venue of research in health and risk communication.

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