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Susan Mello
a
Mass media play a central role in providing environmental health information to the public.
Despite several decades of environmental and health communication research, the nature of
environmental health information available to one of the most vulnerable populationsnew
and expecting mothershas received limited attention. To address this gap, this study poses
two questions: (1) How prevalent is information related to prenatal and pediatric environmental health (PPEH) in the media, and (2) how much coverage do the most concerning chemical
threats to PPEH receive? A content analysis of 2,543 texts in popular media sources (i.e.,
the Associated Press [AP], parenting magazines, and parenting websites) from September
2012 to February 2013 revealed that roughly three pieces of PPEH information were made
available to mothers daily. Prior research has shown that media coverage of environmental
health issues has decreased over the years; however, these results suggest that at-risk populations are likely to encounter this type of information in the media. Also, while certain chemicals
received ample coverage (i.e., pesticides, cigarette smoke, mercury), other issues deemed concerning by federal agencies did not (i.e., lead, phthalates). This study also introduces a novel
method for harvesting online content encountered incidentally. Implications of these findings
for communication research and practice are discussed.
The U.S. public health agenda has recently begun to prioritize prenatal and pediatric environmental health (PPEH;
American Academy of Pediatrics Council on Environmental
Health, 2012; Trasande & Liu, 2011). In 2000, Congress
authorized the planning and implementation of the National
Childrens Study, the largest long-term research study ever
conducted in the United States into the effects of environmental influences on childrens health and development
(Eunice Kennedy Shriver National Institute of Child Health
& Human Development, 2012).
Health experts contend that American children are currently facing a new pediatric morbidity (Landrigan et al.,
1998). Patterns of childhood illness have shifted dramatically in the past century, away from infectious diseases
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risk factors (e.g., diet and exercise). One of the more extensive content analyses that focused exclusively on media
coverage of environmental cancer risks from 1972 to 1992
(Lichter & Rothman, 1999) revealed that media paid more
attention to human-made chemicals (i.e., industrial solvents,
chemical wastes, plastics manufacturing) than to any other
category of environmental carcinogen (e.g., sunlight).
More recent work paints a different picture of the information environment. Although causes of cancer remain one
of the more prominent topics in cancer-related news (Slater,
Long, Bettinghaus, & Reineke, 2008), a later analysis by
Jensen and colleagues (2010) comparing coverage in 2003 to
Freimuths earlier findings showed that lifestyle had become
the most frequently mentioned risk factor, receiving twice
the amount of coverage as environmental cancer risk factors. Another study on issue dynamics in Swedish public
television news (Djerf-Pierre, 2012) found that coverage of
chemicals, such as biocides, toxic waste, hazardous chemicals, and metals, has declined over the past 50 years to 1% of
total news coverage after peaking at 14% during the 1960s,
the era of Rachel Carson and DDT.
Two additional content analyses focusing on how news
media portray breast cancer (Atkin, Smith, McFeters,
& Ferguson, 2008; Brown, Zavestoski, McCormick,
Mandelbaum, & Luebke, 2001) partially support Jensen
and colleagues results. Paying special attention to coverage of the risks of controllable environmental exposures
(i.e., contaminants, hormone replacement therapy, secondhand smoke, pesticides) and preventive behavior (i.e., diet,
exercise), very few news items were found to address risks
of exposure to contaminants (chemicals, pesticides, secondhand smoke) and even fewer stories made reference to
avoiding them. Brown and colleagues (2001) did show, however, that womens magazines in particular had a higher
percentage of breast cancer articles referencing environmental factors, suggesting at least some key differences in
coverage volume contingent on target audience.
METHOD
Study Population
Specific media sources were selected on the basis of what is
consumed by and available to new and expecting mothers
two key factors in generating an externally valid sampling
frame (Jordan & Manganello, 2009). First, insights for defining the study population parameters based on consumption
rates were drawn from an online pilot survey of 64 new and
expecting mothers.1 According to respondents, PPEH information was most commonly encountered in the following
sources: websites, magazines, and general news.2
To further narrow the scope of the study population, publicly available statistics reporting the availability of key media sources were consulted (Alliance for
Automated Media, 2012; Compete, 2012), a commonly recommended purposive sampling technique (Weare & Lin,
2000). Parenting websites with the highest traffic rates during the prior year were Babycenter.com (53 million unique
visitors) and Parents.com (26.5 million unique visitors). The
parenting magazines with the highest circulation rates during the prior 6 months were Parenting and Parents (both
2.2 million). Finally, Lexis-Nexis was used to identify relevant general news stories from the Associated Press (AP)
domestic wire services (both state and local). The 6-month
time frame ranged from September 1, 2012, to February 28,
2013.
Fourteen PPEH chemical topics were selected as the focus
of the content analysis based on the U.S. EPA TEACH
summaries and mothers concerns reported in the pilot
survey. These included arsenic, lead, mercury, bisphenol
A (BPA), polychlorinated biphenyls (PCBs), phthalates,
pesticides (2,4-D, atrazine, DEET, dichlorvos, pyrethriods,
permethrin, resmethrin), drinking water quality (atrazine,
nitrates/nitrites, trichloroethylene [TCE]), outdoor air pollution (particulate matter [PM], polyvinyl chloride [PVC],
smog, benzene, formaldehyde), cigarette smoke (benzene,
benzo[a]pyrene [BaP], formaldehyde), flame retardants
(polybrominated diphenyl ethers [PBDEs]), cleaning supplies (e.g., bleach), food additives (e.g., dyes, preservatives,
1 In January 2013, a brief pilot survey was fielded using the Survey
Sampling International online panel. To be eligible for the study, female
panelists in the United States must have been pregnant and/or have had at
least one child under age 7 years. The survey was completed by 63 respondents and asked a series of open- and closed-ended questions to determine
from which sources new and expecting mothers acquire information about
chemicals in the environment that may be harmful to childrens health.
Mothers were also asked open- and closed-ended questions to ascertain
which chemicals they believe are most concerning to childrens health. The
study was approved by the universitys institutional review board.
2 General news was operationalized as news from television, radio,
and newspapers. In closed-ended questions, respondents were instructed
to exclude news from newspaper, radio, and television websites from
their responses to website-specific questions in an effort to keep response
categories mutually exclusive and exhaustive.
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Parents.com
Accessibility
Level
1 click
2 clicks
My Pregnant
Body
My Pregnant
Life
3 clicks
Pregnancy
Nutrition
Pregnancy
Beauty
Toddlers &
Preschoolers
Babies
Pregnancy
Blogs
Health
Safety
Health
Safety
Asthma
Lead
Poisoning
Asthma
Lead
Poisoning
Pregnancy
Health
Autism
Nursery
Safety
Autism
Toy
Safety
Is It Safe?
Down
Syndrome
Parents
News Now
Parenting
Better
Parenting
Toy Recalls
Green
Parenting
Food
Healthy
Eating
Kids
Nutrition
Parents
Nutrition
Nutrition
Home
cleaning
Vaccines
FIGURE 1 Example of website content sampling procedure using three-click hierarchy for Parents.com.
Sampling methods employed in earlier studies focusing purposively on the most popular parenting magazines (e.g., Foss
& Southwell, 2006; Manganello et al., 2012) were adapted
to determine the eligibility of magazine articles and advertisements for this study. Perhaps most importantly, the time
frame used for magazine sampling was 1 month longer
than for the other two sources in this study (September
2012March 2013). This decision was based on the unique
publishing norms in the magazine industry. Magazine cover
dates are unlike newspapers and websites in that their dates
of publication do not perfectly reflect when information is
released for public consumption. It is standard practice for
monthly magazines to display a cover date that is 1 full
month into the future from the actual publishing or release
date (e.g., an issue dated March 2013 will appear on store
shelves in February 2013). This practice allows magazines
to maintain a current appearance while accounting for time
lags due to shipping and distribution. Because magazines
have a relatively longer shelf life and tend to linger in homes
and doctors offices, it also seemed appropriate to include
September 2012 in the sample, even though it was released
in August 2012. The final magazine sample included a total
of 13 issues: seven issues of Parents and six issues of
Parenting.
Once the issues were collected, each table of contents
was reviewed for signifiers of an environmental health article such as the words toxic, environment, chemical, safety,
or health. Next, the full text of the article was examined to
determine whether it centered on environmental health as
indicated by the headline and/or lead paragraph. Articles
that contained at least one statement about any PPEH-related
toxic threats were eligible for inclusion. Health questionand-answer articles were also reviewed for relevant content
following the same procedure.
In addition, all advertisements in the selected issues were
assessed using the same criteria. For the purposes of this
study, an advertisementdefined as a sponsored image
or text appearing in the magazine specifically for the purpose of selling a product or promoting a specific behavior
(Foss & Southwell, 2006, p. 4)was included if it pertained to prenatal or pediatric environmental health. The
inclusion of magazine advertisements was necessary for
two reasons. First, time-series analyses have shown that
magazine advertisements may influence parents subsequent
health behaviors (Amin & Harrison, 2009; Berry et al., 2011;
Gray et al., 2011), even more so than editorial content (Foss
& Southwell, 2006). Second, ads for eco-friendly products were noticeably common in these outlets. A preliminary
search through less popular parenting magazines distributed
by the same publishers of Parenting and ParentsBabyTalk
and American Baby, respectivelyrevealed that relevant
advertisements actually outnumbered relevant editorial content. Because the volume and availability of risk information
in the media are key drivers in the social amplification of
risk (Kasperson et al., 1988), the significant proportion of
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across source type, article source was recoded into a threecategory variable (1 = AP; 2 = websites; 3 = magazines).
To address RQ1, the first set of coding procedures identified how much coverage PPEH issues received during the
study period across sources. For website and AP sources,
this variable was coded and counted electronically. Magazine
coverage was hand coded.
To address RQ2, the second set of coding procedures
identified which of the 14 chemical topics examined in this
study were covered most often. Twelve of the topics coded
included at least one chemical cited in the U.S. EPA TEACH
Summaries. In the pilot survey, mothers expressed particular concerns about food additives and cleaning supplies
two topics not included in the TEACH Summaries. That
being said, it seemed prudent to include these two topics in the content analysis for exploratory purposes. For
all sources, this variable was hand coded. A final category labeled other captured additional PPEH topics (e.g.,
PFOAs, carbon monoxide).
Analytic Procedure
To address RQ1, a period prevalence rate was calculated
based on the number of relevant media content units identified across each source over the six-month period. In this
study, the period prevalence rate (a term often used in epidemiology) provides an estimate of the amount of PPEH
information available during a specified period of time.
Descriptive analysesprimarily basic frequency analyses
and 2 analyseswere also performed to address RQ2.
All analyses were performed using the statistical software
package SPSS Statistics 20 (IBM Corp., 2012).
RESULTS
Prevalence of PPEH Information in the Media
Between September 1, 2013, and February 28, 2013, the
sampling procedure yielded 2,606 hits. Of these, 2,543
(97.6%) were determined to be relevant.4 The period prevalence rate can be loosely interpreted as the amount of
PPEH information available to mothers across the five
media sources during the 6-month period. Here, that figure is 509 pieces of PPEH information, given five sources
in the universe of texts and 2,543 relevant content units.
On average, this would equate to roughly 2.83 pieces of
4 This figure could be characterized as inflated for two reasons. First,
every magazine article sampled (n = 85) was determined to be relevant
as this was a pre-condition in the sampling procedure itself. Second, Webbased content was likely to be relevant, given that it (a) focused exclusively
on pregnant women and young children living in the United States and
(b) underwent an extensive sampling process that filtered out a significant
portion of content unrelated to PPEH before coding even began. By comparison, only 65.8% (n = 194) of stories from the Associated Press were
determined to be relevant.
AP
Chemical topic
Arsenic
Lead
Mercury
Bisphenol A (BPA)
Indoor air quality
PCBs
Pesticides
Phthalates
Cleaning supplies
Food additives
Drinking water quality
Outdoor air pollution
Cigarette smoke
Flame retardants
Other topic
Total
Parentsa
Babycenter.comb
Parents.comb
3
6
15
7
0
4
17
1
0
12
3
48
23
1
54
198
2
3
8
4
0
2
9
1
0
6
2
25
12
1
28
0
0
0
2
3
0
2
2
7
16
0
0
2
0
0
35
0
0
0
6
11
0
6
6
20
46
0
0
6
0
0
2
0
1
1
2
0
3
6
5
23
0
1
3
0
3
50
4
0
2
2
4
0
6
12
10
46
0
2
6
0
6
30
49
138
110
11
13
156
60
24
217
88
47
295
19
60
1, 317
2
4
10
8
1
1
12
5
2
16
7
4
22
1
5
7
84
184
48
24
0
86
19
77
144
4
7
143
0
120
947
1
9
19
5
3
0
9
2
8
15
0
1
15
0
13
Note. Other topic included asbestos, carbon monoxide (excluding references in the context of cigarette smoke), dichlorophenol,
PFOA/polytetrafluoroethylene (PTFE)/Teflon, perchloroethylene (perc), radon, styrene/styrofoam, paint fumes, and volatile organic compounds (VOCs).
a 2 (10, n = 85) = 9.64, p = .472.
b 2 (14, n = 2,264) = 302.01, p < .001.
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FIGURE 2 Total average percentage of PPEH information across media sources, by chemical topic (N = 2,543): 2 (28, n = 2,543) = 474.84, p < .001.
DISCUSSION
This study offers a systematic content analysis of prenatal and pediatric environmental health information covered
in the mass media and most likely consumed by new and
expecting mothers. The study had two primary objectives:
(a) to estimate the prevalence of PPEH information in the
media, and (b) to determine how much media coverage
the most concerning chemical threats to PPEH receive.
Here, the findings reported above are summarized, followed
by a discussion of the studys strengths, limitations, and
implications.
Prevalence of PPEH Information in the Media (RQ1)
Results showed that during the study period, roughly three
pieces of PPEH information were made available to mothers across these sources daily. The period prevalence rate
was based on the fact that there were just over 2,500 relevant articles across five sources between September 2, 2012,
and February 28, 2013. Overall, the amount of PPEH information available to mothers was most prevalent on parenting
websites, followed by stories from the Associated Press, and
then parenting magazines. Because the Internet serves as a
primary source of health information for new and expecting mothers (Bernhardt & Felter, 2004; Plantin & Daneback,
2009; Stern et al., 2012), this difference in coverage volume
across sources may have important implications for which
health issues mothers learn about and prioritize.
10
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REFERENCES
Adam, B., Allan, S., & Carter, C. (1999). Environmental risks and the
media. New York, NY: Routledge.
Alliance for Automated Media. (2012). Total circulation of consumer magazines on parenthood - 2012. Retrieved from http://abcas3.auditedmedia.
com/ecirc/magform.asp
American Academy of Pediatrics Council on Environmental Health. (2012).
History and growth of pediatric environmental health. In R. A. Etzel
(Ed.), Pediatric environmental health (3rd ed., pp. 512). Elk Grove, IL:
American Academy of Pediatrics.
Amin, M. S., & Harrison, R. L. (2009). Understanding parents oral health
behaviors for their young children. Qualitative Health Research, 19, 116
127. doi:10.1177/1049732308327243
Associated Press. (2013). Frequently asked questions. Retrieved from http://
www.ap.org/company/faqs
Atkin, C. K., Smith, S. W., McFeters, C., & Ferguson, V. (2008). A comprehensive analysis of breast cancer news coverage in leading media
outlets focusing on environmental risks and prevention. Journal of Health
Communication, 13, 319. doi:10.1080/10810730701806912
Beck, U. (1992). Risk society: Towards a new modernity. London, UK:
Sage.
Bellows, J. (1998). Newspaper frames of childhood lead poisoning. Issue,
5, 18.
Bernhardt, J. M., & Felter, E. M. (2004). Online pediatric information
seeking among mothers of young children: Results from a qualitative
study using focus groups. Journal of Medical Internet Research, 6(1),
e7. doi:10.2196/jmir.6.1.e7
Berry, N. J., Jones, S. C., & Iverson, D. (2011). Relax, youre soaking in
it: Sources of information about infant formula. Breastfeeding Review,
19(1), 918.
Brown, P., Zavestoski, S. M., McCormick, S., Mandelbaum, J., &
Luebke, T. (2001). Print media coverage of environmental causation of breast cancer. Sociology of Health & Illness, 23, 747775.
doi:10.1111/1467-9566.00274
Carter, B. (2007). Parenting: A glut of information. Journal of Child Health
Care, 11(2), 8284. doi:10.1177/1367493507079621
Cohen, J. (1960). A coefficient of agreement for nominal scales.
Educational and Psychological Measurement, 20, 3746.
doi:10.1177/001316446002000104
Compete. (2012). Website traffic statistics - US data only. [Data file].
Retrieved from https://www.compete.com/
Djerf-Pierre, M. (2012). When attention drives attention: Issue dynamics
in environmental news reporting over five decades. European Journal of
Communication, 27, 291304. doi:10.1177/0267323112450820
Eunice Kennedy Shriver National Institute of Child Health & Human
Development. (2012). The national childrens study. Retrieved from
http://www.nationalchildrensstudy.gov
Fan, D. P. (1988). Predictions of public opinion from the mass media. New
York, NY: Greenwood Press.
Fan, D. P., & Holway, W. B. (1994). Media coverage of cocaine and
its impact on usage patterns. International Journal of Public Opinion
Research, 6, 139162. doi:10.1093/ijpor/6.2.139
Fan, D. P., & Tims, A. R. (1989). The impact of the news
media on public opinion: American presidential election 19871988.
International Journal of Public Opinion Research, 1, 151163.
doi:10.1093/ijpor/1.2.151
Fink, R., Roeser, R., Venet, W., Strax, P., Venet, L., & Lacher, M. (1978).
Effects of news events on response to a breast cancer screening program.
Public Health Reports, 93, 318327.
Foss, K. A. (2010). Perpetuating scientific motherhood: Infant feeding discourse in Parents magazine, 19302007. Women & Health, 50,
297311. doi:10.1080/03630242.2010.480905
Foss, K. A., & Southwell, B. G. (2006). Infant feeding and the
media: The relationship between Parents Magazine content and
breastfeeding, 19722000. International Breastfeeding Journal, 1, 10.
doi:10.1186/1746-4358-1-10
11
Soumerai, S., Ross-Degnan, D., & Kahn, J. (2002). The effects of professional and media warnings about the association between asprin use in
children and Reyes syndrome. In R. C. Hornik (Ed.), Public health communication: Evidence for behavior change (pp. 265288). Mahwah, NJ:
Lawrence Erlbaum Associates.
Stang, J., Hoss, K., & Story, M. (2010). Health statements made in infant
formula advertisements in pregnancy and early parenting magazines: A
content analysis. ICAN: Infant, Child, & Adolescent Nutrition, 2(1), 16
25. doi:10.1177/1941406409359806
Stern, M. J., Cotten, S. R., & Drentea, P. (2012). The separate spheres of
online health: Gender, parenting, and online health information searching in the information age. Journal of Family Issues, 33, 13241350.
doi:10.1177/0192513X11425459
Stern, P. C., Dietz, T., & Kalof, L. (1993). Value orientations, gender,
and environmental concern. Environment and Behavior, 25, 322348.
doi:10.1177/0013916593255002
Stryker, J. E., Moriarty, C. M., & Jensen, J. D. (2008). Effects of newspaper coverage on public knowledge about modifiable cancer risks. Health
Communication, 23, 380390. doi:10.1080/10410230802229894
Stryker, J. E., Wray, R. J., Hornik, R. C., & Yanovitzky, I. (2006). Validation
of database search terms for content analysis: The case of cancer news
coverage. Journalism & Mass Communication Quarterly, 83, 413430.
doi:10.1177/107769900608300212
Trasande, L., & Liu, Y. (2011). Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008. Health
Affairs, 30, 863870. doi:10.1377/hlthaff.2010.1239
U.S. Environmental Protection Agency. (2011). Toxicity and exposure
assessment for childrens health (TEACH). Retrieved from http://www.
epa.gov/teach/index.html
Warner, D., & Procaccino, J. D. (2007). Women seeking health information:
Distinguishing the Web user. Journal of Health Communication, 12, 787
814. doi:10.1080/10810730701672090
Weare, C., & Lin, W. (2000). Content analysis of the World Wide Web:
Opportunities and challenges. Social Science Computer Review, 18,
272292. doi:10.1177/089443930001800304
Yanovitzky, I., & Blitz, C. L. (2000). Effect of media coverage and
physician advice on utilization of breast cancer screening by women
40 years and older. Journal of Health Communication, 5, 117134.
doi:10.1080/108107300406857
Yanovitzky, I., & Stryker, J. E. (2001). Mass media, social norms,
and health promotion efforts: A longitudinal study of media effects
on youth binge drinking. Communication Research, 28, 208239.
doi:10.1177/009365001028002004