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To Your Health

by Ami Berger

Four SJMC faculty explore the connections between health and communication--and how those connections affect the public's health and well-being.

Brian Southwell, Marco Yzer, Gary Schwitzer, and Jisu HuhAmerica is a country obsessed with health. Whether it's the latest diet craze guaranteed to shed pounds and add years to your life, the blitz of prescription drug advertising on television and in magazines, or political wrangling over the rising costs of health care, we are talking more about our health--and the obstacles to staying healthy--than ever before.

But when we talk about health, do we know what we're talking about? Where do we get our health information, and how reliable is it? How does that information impact our behavior, and in what ways?

At first glance, these seem like topics for medical school researchers or public health experts. But communication and the mass media are important pieces of the national conversation about health, and understanding the connection between communication and health is critical to helping us stay healthy. What's the impact of prescription drug advertising on consumers, for example? What are the best ways for public health campaigns to change people's behavior when new health threats loom? How do issues of health intersect with social and cultural beliefs? And what's the role of the media in educating the public about health issues?

These are the questions four SJMC faculty members are helping to answer with their research. Far from being isolated in the "Ivory Tower" of academe, these professors are working on issues that have profound implications for how we get--and stay--healthy.

Jisu Huh: Prescription drugs, advertising, and the "third-person effect"

Jisu HuhAssistant Professor Jisu Huh, who joined theSJMC in 2003, is fascinated by prescription drugs--specifically, in the effect that drug advertising campaigns have on the public's health perceptions and behaviors.

Huh credits her doctoral adviser, Dr. Leonard Reid, with sparking her interest in this area of research, but she also cites a more unusual source for her work on prescription drug advertising: her landlady. While in graduate school at the University of Georgia, Huh lived with an elderly woman who had a number of health issues and, as a result, a profound interest in new prescription drugs. "Mrs. Lovell and I would watch TV together and would often talk about the drug ads," Huh recalls. "Mrs. Lovell is in her 70s and takes a number of prescription drugs every day, and she had a great interest in the advertising for new drugs coming on the market," says Huh.

Mrs. Lovell is not alone in her interest. Over the past ten years, pharmaceutical companies have drastically increased their direct-to-consumer (DTC) marketing efforts, and consumers have responded. According to Huh's research, 41% of consumers who had seen DTC ads asked their doctors about the drug, and 13% came right out and asked for a prescription. "The success of this form of advertising is directly linked to consumers," Huh says. "Consumers are increasingly more involved in their healthcare decision-making, and seem to welcome DTC ads as another source of information on medical conditions and treatment options."

Huh's research focuses on how consumers--both patients and physicians--perceive the effects of prescription drug advertising on themselves and on others. Her dissertation research at Georgia, for example, showed that consumers tend to think advertising has a greater influence on others than on themselves. This phenomenon is called the "third-person effect," and it has implications for behavior as well as perception. In her current research project, which focuses on physicians' perceptions of drug advertising on patients, Huh is finding a connection between the third-person effect and doctors' response to patient requests for new prescription drugs.

"Physicians believe that DTC ads have influence over their patients, perhaps undue influence," Huh explains. Fearing that undue influence, she says, makes doctors much less willing to prescribe the drugs the patient sees on TV. Huh's study, which is funded by the University's Graduate School Grant-in-Aid program, has made a significant connection between this effect and physicians' refusal of patient request for advertised drugs, even after controlling for physicians' demographic and attitudinal characteristics.

Huh uses her research as a teaching tool as well. She has assigned the "Purple Pill" campaign for the drug Nexium as a case study for her Strategic Communication Research course, and often uses DTC advertising as a jumping-off point for the discussion of ethical, social, and policy issues in advertising in Principles of Strategic Communication. "Surprisingly, students tend to hold very negative views of DTC advertising," she comments, noting that students tend to support stronger government regulation of pharmaceutical advertising practices. But students are always interested in the topic, she says, "because DTC advertising is so different in form and function from other types of advertising."

Huh knows that Mrs. Lovell, her landlady, would be interested in her continued work in the field as well. "She was very proud of me when I finished my research," says Huh with a smile.

Gary Schwitzer: "Broadcast media has abdicated its role in educating viewers about health"

gary_schwitzer.gifDuring the 2004 election year, Gary Schwitzer spent a lot of time trying to see beyond the glaring lights of that campaign's hot-button issues: the war in Iraq, homeland security, and the economy of post-9/11 America. Simply put, he was looking for health.

Schwitzer is a journalist by training, and he joined the SJMC in 2001 to teach health journalism and spearhead the Health Journalism M.A. program, which debuted in 2003. He is also the author of the Association of Health Care Journalists' "Statement of Principles," which identifies the unique challenges that health care reporters face and suggests how to meet those challenges while covering health topics. His research project from January through November 2004 was a study of how health care issues were presented by local broadcast media throughout the election season, and what he found--although his findings are still being polished--astounded him.

"On any given day during that time, between forty and eighty million Americans were without health insurance," Schwitzer says, "but during that time, the most-watched TV news shows"--the 11 o'clock network news programs on three award-winning stations in Seattle, Tampa, and Chicago--"aired exactly one story on an uninsured American." And that story, Schwitzer notes, was 38 seconds long and focused on an uninsured man in Olympia, WA, who had just won the lottery. "This seems to be our solution to covering the uninsured--just have them all win the lottery!" Schwitzer says with an ironic laugh.

His research produced other disturbing findings. Over the 10 months of the project, he tracked 326 hours of newscasts. While 11.5 hours, approximately 817 stories, of that total were dedicated to coverage of a health topic, only 135 of those stories contained any mention of a substantive health policy issue such as rising health costs, the quality of health care, or medical decision-making. The remainder were focused on event-driven angles, like new prescription drugs, newfound "cures" for diseases, or "breakthrough" medical technologies and devices.

To Schwitzer, who worked throughout the 1990s at Dartmouth University's medical school creating communication tools for patient decision-making, this disconnect is unacceptable. "Broadcast news is abdicating its role in educating viewers about health, health policy, and health care," he says firmly. "Journalists have an obligation to hold a mirror up to what their viewers' informational needs are. If journalists are failing to recognize the importance of health issues to the American public--health care costs, confusion around policy and legislation, the challenge of making difficult health decisions--then their mirror is broken and needs to be fixed."

The cause of this broken mirror? According to Schwitzer, it's a symptom of news organizations' preoccupation with the bottom line. "Profit margin drives the broadcast news business," Schwitzer points out. "There's a perception in the business that the public only wants fast-paced, surface-level stories about events, and that if stories about health care policy or anything else 'deep' are shown, people will tune out and viewership will go in the tank."

But Schwitzer has also conducted research that shows the opposite effect. He and a graduate student recently worked with Twin Cities news station KSMP to research and suggest possible health policy stories for the evening news broadcast. Their goal was to have one story per month go on air. The project was a success--so much so that two of the 10 stories aired over the course of the project were half-hour specials entirely devoted to health policy issues.

"Health journalism does not have to be boring, or scary, or scholarly," Schwitzer says. "Stories about health and health policy are actually people stories--like workers who go on strike because of the rise in their health care costs, or how a family decides the best course of treatment for a family member's cancer. These are stories that people care about and need to know about, and our broadcast media need to understand that and act accordingly."

Marco Yzer: "Research needs to take into account the competition of everyday life"

Marco YzerWhile conducting research on the effects of public health messages to stop the spread of HIV/AIDS, Marco Yzer discovered something about research itself: it can make an important difference in the lives of real people. "I had always thought of research as something that is done at a university and just stays there," says Yzer, a native of the Netherlands who moved to the Twin Cities to join the SJMC in early 2005. "How wrong I was. While it's true that a single study cannot change the world, behavioral and communication theory--particularly in the HIV/AIDS domain--can make a big difference in combating real health threats."

Yzer's interest in health communication stems from his appreciation for the complexity of the issues involved, but also from his interest in behavior theory as well as communication theory. "In many cases, if we want to do something about a health problem, we need to affect a health behavior," he points out, "and to affect a health behavior, we need to use communication in order to affect the factors that are most important in guiding people's actions."

Yzer's research on the effectiveness of HIV/AIDS public health campaigns follows this line of reasoning. "We asked ourselves, what would be the most effective way to educate the public about a new health threat?" Yzer says. "We know that scaring people doesn't affect behavior in a positive way, and neither does simply informing people of the risk to their health". Yzer notes that these tactics tend to cause people to go into denial, and find reasons--often erroneous ones--why the health threat won't affect them: "For example, the straight community figured they were safe because AIDS was a 'gay disease'," he notes, "and many people thought they were safe because they didn't use intravenous drugs."

Rather than allow people to go into denial about their own risk, Yzer theorized that the answer to changing behavior was to give people information about the threat as well as information about how to protect themselves. The experiment he conducted involved four groups of women, each of whom were given different sets of information. The first group was told they were at risk for HIV/AIDS, but given no other information. Group 2 was told they were at risk and given information about how to protect themselves by using condoms with their sexual partners. The third group was given no information about their risk but received information about how to protect themselves, and the fourth group was given no information about risk or protection at all.

The groups were then tracked, and their tendency to use condoms measured. The results of the experiment were clear: group 2--the women who were told they were at risk and given information about how to protect themselves--had a much higher statistical tendency to use condoms. "This was the first time we had empirical evidence that people really do require both risk information and self-efficacy--feeling able to protect themselves--in order to change behavior," Yzer says.

Yzer's current research project takes on another provocative subject: smoking cessation. He's evaluating the Dutch national "stop smoking" campaign for the Dutch Foundation on Smoking and Health, which in turn will make recommendations to the Dutch government about the success of the campaign. One of the factors at play in this study, Yzer says, is "reactance theory," which could also be described as the "if you tell me what to do, I'll do the opposite" phenomenon. "There's a feeling in the Netherlands--and of course in other countries as well, including America--that the government shouldn't tell individuals what to do or how to live their lives," Yzer says.

The challenge, he says, is in crafting messages that will have an effect on both individual minds and collective norms. "We don't live in a vacuum," he points out. "We need to try to understand how mass communication interacts with the lives people lead and the multiple other messages they receive. Our theories and research always need to take into account the competition of everyday life."

Brian Southwell: "Health communication offers some of the toughest intellectual challenges we face"

Brian SouthwellAssistant professor Brian Southwell sees health communication research as more than an interesting area of study: to him, it's a chance to bridge some of the gaps that exist in the communication discipline as a whole. "I view the health arena as a microcosm in which we can look at a range of communication issues and questions," Southwell says. "For example, how can we explain behavior in terms of information availability? What explains an individual's memory for certain media messages but not others? What's the role of conversation in mass communication campaigns?"

Southwell has spent the past decade applying these questions to a wide range of health-related research projects: he has studied adolescent reaction to anti-drug public service announcements (PSAs), the effectiveness of campaigns encouraging colorectal cancer screenings in older adults, and factors involved domestic violence intervention and prevention, to name a few. He also spent time at the Center for Disease Control in Atlanta, GA, working on campaign development and evaluation. "Health communication offers some of the toughest intellectual challenges we face and so is fascinating from that perspective," he says. "With much conventional strategic communication, you are attempting to shift someone from one brand preference to another. In the area of health, you often are faced with the challenge of persuading people to initiate or cease a behavior altogether, or to engage information from which they might derive little enjoyment."

Southwell's research on colorectal cancer screening is a perfect example of that last challenge. Although this form of cancer is second only to lung cancer in the number of Americans who die from it each year, the rates of screening and early diagnosis are relatively low because of the public's lack of understanding about the disease and negative attitudes towards screening methods. But research conducted by Southwell, along with several colleagues from the CDC, shows that there are communication
tools that may help counteract these challenges, such as automatic chart reminders for physicians to talk to their older patients about the disease, mailed reminders to patients about screening, and timely follow-up.

This combination of abstract thought and practical action illustrates another of Southwell's beliefs about health communication research: that it can be a great jumping-off point for classroom discussion, particularly with undergraduates. "That connection to real-world application of theoretical ideas has given me a lot of fodder for classroom discussion," he says. "I think we make a mistake in attempting to separate theory and practice. There's nothing as practical as a good theory that's been well-articulated in terms that most people can understand."

Engaging students in discussion about issues of health and science communication is especially important to Southwell, since he sees a real need for it in the professional world. "I think that many health and other non-profit organizations are starved for people who can think coherently and strategically about journalism, or advertising, or public relations," he says. "If I can help students find a path from Murphy Hall to a future position of which they are proud, then I feel like I've done an important part of my job."