Health Campaigns, Communication in

Seth M. Noar

University of North Carolina at Chapel Hill

Health communication campaigns have long been a tool used to influence the health of the public in countries around the world. Campaigns are an organized set of communication activities to produce health effects or outcomes in a relatively large number of individuals, typically within a specified period of time. Traditionally, campaigns were thought to only be capable of raising awareness and perhaps improving the attitudes and social norms of a particular audience. More recent work, however, has provided evidence that properly designed and implemented campaigns can impact health behaviors (e.g., Hornik 2002; Snyder et al. 2004; Noar 2006; → Health Communication).

Principles of Campaign Design

Perhaps the most valuable lessons being learned in the campaign literature are the conditions under which campaigns tend to be most effective. These can be referred to as principles of effective campaign design (Noar 2006; Rogers & Storey 1987). Formative research involves two phases. The first phase focuses on gathering data regarding audience characteristics, the behavior at issue, and message channels (→ Audience Research). The second phase is focused on testing initial campaign messages with target audience members in order to gain feedback on the appropriateness and persuasive impact of those messages. No matter what the topic, formative research is thought to be crucial to truly understanding the target audience.

Theory is indispensable in campaigns and it serves as an important conceptual foundation for any health communication campaign. In fact, theories serve a number of important roles, including suggesting: (1) important behavioral determinants that campaign messages might focus on; (2) variables for → audience segmentation; and (3) variables to apply in evaluating campaigns. In the health communication campaigns area, a broad range of theories have been used, including theories of health behavior, exemplification, and agenda setting (→ Agenda-Setting Effects; Media Effects). A key consideration in any campaign has to do with defining the audience. This is accomplished by dividing the population of interest into smaller, more homogeneous groups. The ultimate purpose of segmentation is to create groups that have similar message and channel preferences, and can thus be targeted with persuasive messages specifically designed for those segments.

Once a clear audience segment (or segments) has been defined, messages can be developed and then pre-tested. There are a variety of approaches that can be used, such as: (1) fear appeals – these messages should increase levels of both fear and self-efficacy (building individuals’ confidence that they can carry out the recommended behavior; → Fear Induction through Media Content); (2) message framing – positive (gain-framed) messages are most effective in impacting preventive behaviors, while negative (loss-framed) messages are most effective in impacting screening behaviors (→ Framing Effects; Framing of the News); and (3) narrative approach –often used within entertainment education, this approach suggests that storylines that provide positive role models and reduce counterarguments are most effective (→ Storytelling and Narration).

Campaigns utilize a number of channels and strategies to reach their intended audience. These include mass communication channels such as television, radio, and print media, as well as small media such as posters, billboards, bus → signs, and other materials and outlets. Some campaigns include community-wide components such as community events, workshops, → public relations activities, and coordination with school-based programs. Campaigns are also now taking advantage of the Internet and social media as campaign channels (→ Health Communication and the Internet).

Evaluating Campaigns

Process evaluation refers to the monitoring and collection of data on fidelity and implementation of campaign activities, and it answers several questions, such as: Did campaign messages air in the channels (and specific placements within those channels) in which they were intended to air? Was a significant proportion of the target audience exposed to the campaign messages? Are there any mid-course corrections that can be made to elements of the campaign to improve reach and/or frequency of exposure to the campaign?

Outcome evaluation is concerned with assessing whether a campaign had its intended impact, and this is one of the most challenging aspects of campaigns. Unlike other kinds of health interventions, campaigns are conducted in the field and do not lend themselves to controlled evaluation designs (→ Experiment, Field). Consequently, most of the evidence for the effects of campaigns comes from research studies that leave open many threats to internal → validity (Valente 2001; Hornik 2002). Indeed, popular designs used to evaluate health communication campaigns include post-test-only designs, where a campaign is followed by a post-only → survey assessing campaign exposure and campaign-relevant variables, and pre-test–post-test designs, where a pre-test survey is given, the campaign takes place, and is followed by a post-test survey. Some campaigns use designs that are more rigorous and thus decrease threats to internal validity, such as pre-test–post-test control group designs, which include a control community for comparison purposes, and time-series designs, where multiple surveys are given both before and after a campaign is executed.

Directions for Campaign Research

Perhaps the most compelling current issue is the changing media environment and the implications of this for health communication campaigns. Recent work by media and health communication scholars has described the transformation of the world wide web from a technology to deliver one-way, simple communications to a technology that engages participants as active agents in the creation and dissemination of information and messages, or Web 2.0 (Thackeray et al. 2008). This has profound implications for campaigns, as it has the potential to change campaign audiences from passive recipients of messages to active agents in the campaign itself (→ Interactivity, Concept of). Practitioners are also increasingly using such new media in attempts to extend both the reach and impact of their campaigns, and researchers are studying how such technologies can be best harnessed for effective health communication (→ Communication Networks).

References and Suggested Readings

1. Hornik, R. C. (ed.) (2002). Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum.
2. Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11, 21–42.
3. Rogers, E. M. & Storey, J. D. (1987). Communication campaigns. In C. R. Berger & S. H. Chafee (eds.), Handbook of communication science. Thousand Oaks, CA: Sage, pp. 817–846.
4. Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., & Proctor, D. (2004). A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. Journal of Health Communication, 9(1), 71–96.
5. Thackeray, R., Neiger, B. L., Hanson, C. L., & McKenzie, J. F. (2008). Enhancing promotional strategies within social marketing programs: Use of Web 2.0 social media. Health Promotion Practice, 9(4), 338–343.
6. Valente, T. W. (2001). Evaluating communication campaigns. In R. E. Rice & C. K. Atkin (eds.), Public communication campaigns, 3rd edn. Thousand Oaks, CA: Sage, pp. 105–124.

Health Communication

K. Viswanath

Harvard University

Health communication is the study and application of the generation, creation, and dissemination of health-related information, health-related interactions among individual social actors and institutions, and their effects on different publics including individuals, community groups, and institutions. The challenges inherent in disease prevention and health promotion warrant a multidisciplinary and multilevel approach that examines the role of distal factors such as social and economic policies and health policies, near-proximal factors such as neighborhoods and health-care organizations, and proximal factors such as individual lifestyles to explain individual and population health. Some have argued that communication is one thread that could connect the distal and proximal factors to explain individual and population health. Given this charge, health communication, though primarily a derivative field, draws from and contributes to such fields as mass communication, journalism, communication studies, epidemiology, public health, health behavior and health education, medicine, sociology, and psychology, among others.

Organization of the Field

There is no simple or complete way to organize the field of health communication, though several sub-fields have existed depending on one’s research interests, as well as adventitious and historical circumstances. At the individual level, the focus is twofold: (1) how health cognitions affect, and behaviors influence and are influenced by, health communications; and (2) how interpersonal interactions between patients, family members, and providers, and with members of their social network, influence health outcomes. At the organizational level, some have studied the role of communication within health-care systems and how organization of the media and the practices of media professionals may influence population and individual health.

Finally, at the societal level, the focus is on large-scale social changes and the role of communication with such changes. For example, one might examine how → strategic communications as well as natural diffusion of information impact individual and population health; or how communication mediates and is influenced by social determinants such as social class, neighborhood, social cohesion and conflict, social and economic policies, and how that impacts individual and population health.

Even as these levels provide a useful organizing framework, two caveats are warranted. First, policymaking and research related to health may affect more than one level. Second, interest in a level of analysis and pursuit of work at one level is not inconsequential. Locating a problem at one level, and studying it at that level, have implications for the kind of policy or practice that is likely to emerge from that research.

Interpersonal Communication

Extensive attention has been given to understanding the consequences of communication between physicians and patients on patient satisfaction, adherence, and quality of life. One theme is who controls the interaction between providers and patients, known as ‘relational control.’ A second theme focuses on the outcomes of patient–provider interactions. Extensive research has documented that patient–provider communication influences patient satisfaction which, in turn, is related to patient adherence and compliance to treatment regimens, ease of distress, physiological response, length of stay in the hospital, quality of life, and health status, among others. Third, researchers have documented stark differences in patient preparation and access, and in care received and health outcomes, between social classes as well as racial and ethnic groups.

The implications of interpersonal interaction in the context of families, friends, co-workers, and voluntary associations on health outcomes have become one of the most dynamic areas of research in health communication. This topic has been pursued from diverse theoretical viewpoints by researchers focusing on social networks, social support, family communications, and social capital based on the researcher’s disciplinary origins and research interests. In addition to social support, social networks can accelerate or decelerate diffusion of new information, and also influence how it is interpreted (Himelboim & Han 2014). Members within networks can serve as role models for lifestyle behaviors such as smoking and obesity. The emergence and spread of the Internet have broadened the scope of interpersonal interaction and its influence in health communication by moderating the limits of geography.

Mass Media and Health

The incidental and routine use of media for → news and entertainment serves four functions in health. (1) The informational function is served when casual use of media for news or other purposes may expose the audience to developments on new treatments or new drugs, alert them to risk factors, or warn them of impending threats such as avian flu; (2) media serve an instrumental function by providing information that facilitates action; e.g., in times of natural disasters the audience may learn about places where they should take shelter, and information of this kind allows for practical action; (3) media defines what is acceptable and legitimate, performing a social control function; (4) the communal function is served when media provide social support, generate social capital, and connect people to social institutions and groups.

Information seeking, as a construct, has gained greater currency in recent times as more information on health has become routinely available because of greater coverage of health in the media, the spread of health-related content on the world wide web, or the consumerist movement in health that promotes informed or shared decision-making (→ Information Seeking). It is widely assumed that under certain conditions some people actively look for health information to seek a second opinion, make a more informed choice on treatments, and learn in greater depth about a health problem that afflicts them or their friends or family members.

The most visible and popular means of strategic communications is through health campaigns which have become a critical arsenal in health promotion. A typical health campaign attempts to promote change by increasing the amount of information on the health topic, and by defining the issue of interest in such a way as to promote health or prevent disease. Recent reviews of the vast literature on health campaigns have identified conditions under which health campaigns can be successful (e.g. Noar 2006; Randolph & Viswanath 2004).

Emerging Challenges/Dimensions

First, the combined impact of computers and telecommunications on society has been transformative, impinging on almost every facet of human life including art, culture, science, and education. Consumer informatics integrates consumer information needs and preferences with clinical systems to empower patients to take charge of their health-care, bring down costs, and improve quality of care. For example, the integration of electronic medical records with communications should facilitate communications between patients and providers, send automatic reminders to patients to stay on schedule, and help patients navigate the health-care system (→ Mobility, Technology for). Second, technological developments are coinciding with the consumerist movement in health-care. The paternalistic model that characterized the physician–patient relationship is slowly being complemented by alternative models such as shared/informed decision-making models (SDM/IDM) or patient-centered communication (PCC). Third, the significant investments in biomedical research enterprise in the developing world, and movement toward more evidence-based medicine, have led to calls for translation of the knowledge from the laboratory to the clinic and the community. Lastly, an urgent and a moral imperative in health is addressing the profound inequities in access to health-care and the disproportionate burden of disease faced by certain groups.

References and Suggested Readings

1. Epstein, R. M. & Street, R. L., Jr. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. NIH Publication no. 07–6225. Bethesda, MD: National Cancer Institute.
2. Glanz, K., Rimer, B., & Viswanath, K. (eds.) (2008). Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass.
3. Himelboim, I. & Han, J. Y. (2014). Cancer talk on twitter: Community structure and information sources in breast and prostate cancer social networks. Journal of Health Communication: International Perspectives, 19(2), 210–225.
4. Hornik, R. (ed.) (2002). Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum.
5. McCauley, M., Blake, K., Meissner, H., & Viswanath, K. (2013). The social group influences of U.S. health journalists and their impact on the newsmaking process. Health Education Research, 28(20), 339–51.
6. Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11, 21–42.
7. Obregon, R. & Waisbord, S. (eds.) (2012). The handbook of global health communication. Oxford: Wiley Blackwell.
8. Parker, J. C. & Thorson, E. (2008). Health communication in the new media landscape. New York: Springer.
9. Randolph, W. & Viswanath, K. (2004). Lessons learned from public health mass media campaigns: Marketing health in a crowded media world. Annual Review of Public Health, 25, 419–37.
10. Snyder, L. B. & Hamilton, M. A. (2002). A meta-analysis of U.S. health campaign effects on behavior: Emphasize enforcement, exposure, and new information, and beware of secular trend. In R. Hornik (ed.), Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum, pp. 357–383.
11. Viswanath, K. (2005). The communications revolution and cancer control. Nature Reviews Cancer, 5(10), 828–835.

Health Communication and the Internet

Heinz Bonfadelli

University of Zurich

‘E-Health’ is a relatively new term used to describe a heterogeneous set of phenomena associated with health applications (health informatics) and provision of health care or health communication in general via the Internet and Web 2.0 and also via mobile phones. For Eysenbach (2001), “the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.”

The Internet offers several advantages but also some challenges to health communication. Its possibility for interactive communications similar to interpersonal communication can be used to target and customize the information to the user’s needs, to foster motivation, and to strengthen impact (→ Health Literacy). Internet-based health services have the capacity to economically reach unlimited and geographically widespread audiences, thereby increasing efficiency and decreasing costs. Furthermore, the Internet can be used flexibly anywhere and at any time. In contrast to traditional mass media, the quantitative capacity of the Internet in terms of information abundance, as well as the depth and specialization of health information provided, is almost unlimited.

Besides these opportunities and strengths, there are limitations and threats as well. First, the fact that people need to be motivated to actively search for information may limit its reach, as it is usually the more educated and more active who access the Internet (→ Digital Divide). Second, the reliability and trustworthiness of health messages offered on the Internet can become an issue because information providers or sources behind the information are not clear. As a consequence, it is not easy for users to estimate the credibility of a source. Another concern is privacy issues regarding E-Health users and patient records.

There are an enormous and ever-growing number of public and private providers of health information on the Internet at local, state, and international level. The range of health content provided by them includes news (e.g., outbreaks of disease), statistics, lifestyle advice and health tips, health promotion, and disease prevention. Besides, there are even more health providers in the private area, such as insurance companies, health advisory services, and pharmaceutical firms. Last, a large number of health communities in form of discussion groups and forums exist where many different health-related topics are discussed and personal health experiences are exchanged. The use of the Internet supports traditional health services and applications, but new services have also been created in recent years in the areas of e-content (e.g., health information and orientation, medical databases), e-commerce (e.g., online pharmaceutical providers), e-connectivity (intranets of hospitals), e-computer applications, and e-care (e.g., telehealth monitoring, telesurgery).

Eysenbach et al. (2002) provide a meta-analysis of empirical studies assessing the quality of the health information provided online. Most frequently valuated criteria are: accuracy, completeness, readability, design, disclosure, and references provided. Most of the studies included found significant quality problems, and criticized, among other things, the lack of completeness or accuracy and difficulty in finding high-quality sites.

It is difficult to estimate the number of users of E-Health but a survey conducted in the US (Pew Internet 2011) estimates that 80 percent of internet users and 59 percent of the total population look for health information online, and looking for health information is the third most popular online activity. A study by Andreassen et al. (2007) reports slightly lower levels in seven countries in Europe. In general, younger people between the ages of 18 and 49, women, whites, and adults with college education and/or living in higher-income households are using E-Health more. It seems that most of the users of online health information are satisfied with the content they are looking for, and rate the searched information as helpful, giving new insights, and even believe it (Ayantunde et al. 2007). Besides usage research, there are a growing number of studies analysing the effectiveness of purposeful internet interventions (Webb et al. 2010). But up to now, there is only limited evidence concerning the far-reaching consequences of the Internet as a new information source and service provider in the field of health communication.

References and Suggested Readings

1. Andreassen, H. K., Bujnowska-Fedak, M. M., Chronaki, C. E., Dumitru, R.C., Pudule, I., Santana, S.,Voss, H., & Wynn, R. (2007). European citizens’ use of E-health services: A study of seven countries. BMC Public Health, 7(53). At http://www.biomedcentral.com/content/pdf/1471-2458-7-53.pdf, accessed September 2, 2014.
2. Ayantunde, A. A., Welch, N. T., & Parsons, S. (2007). A survey of patient satisfaction and use of the internet for health information. Journal of Clinical Practice, 61(3), 458–462.
3. Eysenbach, G. (2001): What is e-health? Journal of Medical Internet Research, 3(2), e20.
4. Eysenbach, G., Powell, J., Kuss, O., & Sa, E.-R. (2002). Empirical studies assessing the quality of health information for consumers on the world wide web: A systematic review. Journal of the American Medical Association, 287(20), 2691–2700.
5. Pew Internet. (2011). Health Topics. 80% of internet users look for health information online. At http://www.pewinternet.org/Reports/2011/HealthTopics.aspx, accessed August 6, 2014.
6. Webb, Th., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, at www.jmir.org/2010/1/e4/, accessed August 6, 2014.

Health Literacy

Emily Zobel Kontos

Harvard School of Public Health

Health literacy can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy focuses on the interaction between individual-level skills and structural factors such as health-sector demands.

In one of the earliest attempts to examine health-related literacy tasks (HALS), researchers identified 191 health-related tasks among the National Adult Literacy Survey (NALS) and International Adult Literacy Surveys (IALS) (→ survey) and analyzed the health literacy of US adults (Rudd et al. 2004). They found that some 12 percent (23 million of US adults) are estimated to have skills in the lowest level on the HALS, while an additional 7 percent (13.4 million) are not able to perform even simple health-literacy tasks such as locate dosage information on a medicine label.

A variety of health-related materials have been assessed over the years and researchers report that an overwhelming majority of the materials score at reading-grade levels that far exceed the reading ability of the average adult. International assessments of health materials, focused mainly on informed consent documents, echo these findings.

Researchers also investigated the association between health literacy and health outcomes. For instance, with the development of health-specific reading assessment tools such as the Rapid Estimate of Adult Literacy in Medicine (REALM), they were able to assess patients’ health-related reading skills and then correlate the readability/literacy levels with health outcomes in a clinical setting. Both correlated strongly. In addition to the ill effects on the individual patient, limited health literacy places a burden on health-care systems which in turn impacts the overall economic consequences to society.

As the field of health literacy evolves more research is required to rigorously examine the full breadth of the construct as illustrated in its definition: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

References and Suggested Readings

1. Jordan, J. E., Buchbinder, R., Briggs, A. M., Elsworth, G. R., Busija, L., Batterham, R., & Osborne, R. H. (2014). The Health Literacy Management Scale (HeLMS): A measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. Patient Education and Counseling, 91(2), 228–235.
2. Kutner, M., Greenberg, E., & Baer, J. (2005) National assessment of adult literacy: A first look at the literacy of America’s adults in the twenty-first century. Washington, DC: US Department of Education.
3. Nielsen-Bohlman, L., Panzer, A. M., & Kindig, D. A. (eds.) (2004). Health literacy: A prescription to end confusion. Washington, DC: Institute of Medicine.
4. Rudd, R, Kirsch, I., & Yamamoto, K. (2004). Literacy and Health in America: Policy Information Report. Princeton, NJ: Educational Testing Service.

Hermeneutics

John Durham Peters

University of Iowa

Samuel McCormick

San Francisco State University

‘Hermeneutics’ comes from the name of the Greek messenger-god, Hermes – the patron of travelers, rogues, liars, and thieves. As the carrier of messages between gods and mortals, Hermes had to be fluent in both of their idioms. It was his task to build and maintain an interpretive bridge between alien worlds. Since he was also a trickster who could deliver messages in garbled form, the Greek verb hermeneuō meant to decipher cryptic or obscure meanings, and, more generally, to explain, translate, and express (Gadamer 1971). The term hermeneutics descends from this root, via the Latin hermeneutica, and has been used in English and German since the late seventeenth century.

Today hermeneutics has two main senses: the art of reading texts, and the philosophy of textual interpretation and human understanding (→ Text and Intertextuality). Wherever there is unintelligibility, there is a hermeneutic problem. Hermeneutics, like communication, is the general theory of dealing with problematic → meanings. It aims to decipher lost sense with an almost therapeutic mission of liberating meanings that have been frozen into muteness or madness by the passage of time or culture.

Hermeneutics has enjoyed some recognition in the field of communication studies (→ Communication as a Field and Discipline). It received a particularly warm welcome in the 1970s, due in large part to the philosophical support it lent to → qualitative methodology. With a greater interest in power since the 1980s, communication scholars tended to turn to critical and poststructuralist theories (→ Critical Theory), though interest in hermeneutics persists as a key to understanding the curiously distanced communicative situation of broadcasting, and abiding questions in rhetorical theory (Hyde 2001; → Rhetorical Studies). If communication is fundamentally a matter of distance and its bridging, and human existence is fundamentally interpretive, then hermeneutics holds a key to understanding communication in general. Whether taken strictly or broadly, hermeneutics still has much to say about basic communication problems.

References and Suggested Readings

1. Gadamer, H.-G. (1971). Hermeneutik [Hermeneutics]. In J. Ritter (ed.), Historisches Wörterbuch der Philosophie [Historical dictionary of philosophy]. Basle: Schwabe, pp. 1061–1073.
2. Hyde, M. (2001). Hermeneutics. In T. Sloane (ed.), Encyclopedia of rhetoric. Oxford: Oxford University Press, pp. 329–337.

Historic Key Events and the Media

Rudolf Stöber

University of Bamberg

Historic key events are genuine events with historical importance. Four factors are important to consider in this regard: (1) historic key events have a short and distinct duration; (2) historic key events have a significant impact on later times; (3) historic key events are not primarily created for media attention; (4) historic key events are ambiguous and subjective in many ways. On the one hand, the mass media cover key events; on the other hand, media routines can be used for political or other purposes. The ambiguous status of a key event is due to the point of view.

Historic key events have to be distinguished clearly from media events or ‘pseudo-events’ that exist only in anticipation of the news media’s coverage (Boorstin 1962; → Media Events and Pseudo-Events). In historical perspective, some key events, when they happened, did not receive media coverage at all. However, under normal circumstances, the coverage of historic key events by the media is one indicator of the importance of the event in itself and leads to follow-up coverage of minor similar events (Kepplinger & Habermeier 1995), for example, even small incidents involving airplanes attracted greater media attention after 9/11. The status of an event as ‘historic’ and ‘key’ depends on its specific importance, which is relative, not absolute. For instance, many historic key events are only important for a particular nation. The status of a key event also is related to the bias of the significant effects of the event in history. Many key events have positive effects for one interest group but create negative effects for others. The bias of the media coverage depends on the varying points of view (→ Bias in the News).

Historic key events become emblematic by way of the attribution of importance to them, which may be biased, and media coverage plays an important part in forging the symbolism. The concentration of the distinct event in a short historic moment at a given place makes both media coverage and forging the symbol easy. The assassination of Archduke Franz Ferdinand in 1914, which led to World War I, was the symbolic end of the nineteenth and the beginning of the twentieth century. The murder of John F. Kennedy marked the end of the American dream of ‘Camelot’ in 1963. The raising and tearing down of the Berlin Wall marked the climax and the end of the Cold War in 1961 and 1989, respectively. The terrorist attacks of 9/11 upon symbols of America's strength started the worldwide ‘war on terror’ in 2001.

Media coverage does overload some historic key events with symbolic significance. The landing on the moon in 1969 serves as an example: Its significance for improving life on earth or men’s relationship to the universe is still unclear. The most impressive key event of recent years, the terrorist attacks of September 11, confounds the rule that every historic key event is a ‘genuine’ and not a ‘mediated’. The symbolic nature of the attacks underlines its character as a media event: the Twin Towers as a symbol of US high finance, the Pentagon of its military strength, and the Capitol or White House of its political system indicate that 9/11 was arranged for the media. The attacks on America's symbols may not have been so choreographed in former times, when there were no TV networks or video cameras (→ Mediated Terrorism; Propaganda). In history media coverage of key events has followed some general trends: (1) the time delay between event and media coverage has been reduced dramatically; (2) media involvement in historic key event coverage has expanded; (3) the impact of the news media's coverage of key events on the audience has increased; (4) key events are illustrated with the most impressive material. All these trends are related to changes in the media system itself.

At present the principal methodology employed in research in historic key event coverage is content analysis, which has been used to study isolated events (→ Content Analysis, Qualitative; Content Analysis, Quantitative). Future research should take into account a combination of content analysis, reception research, media structure analysis, and historical criticism.

References and Suggested Readings

1. Boorstin, D. J. (1962). The image; or, what happened to the American dream. New York: Atheneum. Couldry, N. (2003). Media rituals: A critical approach. London: Routledge.
2. Emery, M., Emery, E., & Roberts, N. L. (2000). The press and America: An interpretative history of the mass media, 9th edn. Harlow: Pearson Education.
3. Kepplinger, H. M. & Habermeier, J. (1995). The impact of key events on the presentation of reality. European Journal of Communication, 10(3), 371–390.

Hollywood

Jan-Christopher Horak

University of California, Los Angeles

Hollywood is the metaphoric, if not exactly the geographic, center of the American film, television, cable, music, and digital media industry. Ripe with symbolic meaning for media consumers across the globe, Hollywood exists almost purely in the collective imagination, since it is neither incorporated as a city, nor definable by strict borders as a geographic location within the city of Los Angeles. Even in terms of its real geography, Hollywood was only one of several industry centers, and of the major film studios, only Paramount, RKO, and Columbia maintained production facilities directly in Hollywood. Nevertheless, millions of tourists flock each year to ‘Hollywood,’ which has also had its ups and downs as a piece of real estate.

It was merely sunshine and the diversity of topographies that lured filmmakers from New York and New Jersey to southern California. In the early days of the film industry, producers shot on outdoor stages in natural light, rather than utilizing electric light, so that dependable sunshine was a must. Southern California’s mixture of seascapes, mountains, desert, and other topographies in a relatively limited area was thus a plus. The first permanent film studio in Hollywood was established by David Horsely’s Nestor Film Company in 1911. Within months, 15 other film production companies had established production facilities in Hollywood. By 1913, then, Hollywood had over 8,000 inhabitants, many of them working in the budding movie industry.

The 1920s saw Hollywood and the American film industry dominate the world market by structuring itself as a vertically and horizontally integrated industry. Since the huge American market allowed companies to amortize their product domestically, they could undersell the foreign competition abroad. ‘Hollywood’ became a worldwide → brand name. In 1927 the first Oscars were staged at the Roosevelt Hotel. In its classical phase from the 1920s to the 1950s, Hollywood was a monolithic economic system, a multinational monopoly of corporations, whose structure of film production, distribution, and exhibition was based on laws of scientific management, an intense division of labor, the pioneering use of modern advertising techniques, and complete control of the market (→ Concentration in Media Systems).

Hollywood’s → discourse always supported a romantic mythology, because the very commodity this industry produced was fantasy and fictional narratives (→ Fiction). Film images sought to transport an audience from the real world into a universe of myth, where audience desires could find at least partial satisfaction (→ Uses and Gratifications). In terms of film technique, this meant utilizing a system of ‘invisible editing’ that would hide the breaks between individual shots, creating a seamless visual flow. Dramatically, films had to traverse an arch from exposition to the building of conflict to a resolution through a happy ending, with heterosexual union being the driving narrative force of practically every film story. The star system had evolved in the decade 1911–1920, just as Hollywood was ascending. It soon became apparent that selling ‘stars’ was the most efficient means of selling films.

In 1916, landmark Supreme Court decision held that the production and distribution of movies was a business, rather than a matter of communication, and therefore, unlike the theatre or newspapers, not subject to First Amendment guarantees of free speech. This ruling was not overturned until the 1970s, leading to a period of liberalization in sexual and social content, yet even today a rating system, enforced by the Motion Picture Producers and Distributors Association, restricts access to the commercial media market (→ Censorship, History of; Freedom of Communication).

It took a few decades, but Hollywood eventually reinvented itself as a group of transnational, multimedia conglomerates that dominate all forms of media: Walt Disney Company (→ Disney), Paramount Pictures (Viacom), Sony Pictures, Universal Studios (General Electric), and Warner Brothers (AOL/Time Warner) control film, television networks, cable channels and providers, digital media, Internet portals, recorded music, billboards, newspapers, and radio stations.

By the first decade of the twenty-first century, income from digital media far outstripped that of the box office, so that the industry once again evolved structurally. The big companies dominate virtually all public communications media (→ Culture Industries; Media Conglomerates). At the same time, the rise of digital media delivery to cinemas and the Internet and those media’s infinite reproducibility have led to significant loss of ability to control content (→ Internet Law and Regulation). It remains a central question and issue of communications research to ascertain whether and, if it does so, just how the democratic process can or does survive, given the massive domination of virtually all communications media by a handful of gatekeepers.

References and Suggested Readings

1. Biskind, P. (1998). Easy riders, raging bulls: How the sex-drugs-and-rock-’n’-roll generation saved Hollywood. New York: Simon and Schuster.
2. Friedrich, O. (1997). City of nets: A portrait of Hollywood in the 1940s. Berkeley, CA: University of California Press.
3. Powdermaker, H. (1979[1950]). Hollywood, the dream factory. New York: Arno Press.
4. Schatz, T. (1996). The genius of the system: Hollywood filmmaking in the studio era. New York: Henry Holt.