Media Coverage of Public Health Epidemics: Linking Framing and Issue Attention Cycle Toward an Integrated Theory of Print News Coverage of Epidemics

Media Coverage of Public HealthEpidemics: Linking Framing and IssueAttention Cycle Toward an Integrated

Theory of Print News Coverageof Epidemics

Tsung-Jen Shih, Rosalyna Wijaya, and Dominique BrossardSchool of Journalism and Mass Communication

University of Wisconsin–Madison

Using framing and issue attention cycle as theoretical frameworks, thisstudy examined how print media frame public health epidemics, such as madcow disease, West Nile virus, and avian flu. We found that “action” and“consequence” were the two frames journalists employed consistently toconstruct stories about epidemics in the New York Times, the newspaperused for this case study. The prominence of other frames varied with dis-eases. We also found different attention cycle patterns for each disease. Cov-erage of public health epidemics was highly event based, with increasednews coverage corresponding to important events such as newly identifiedcases and governmental actions. We found that media concerns and journal-ists’ narrative considerations regarding epidemics did change across differ-ent phases of development and across diseases. This suggests that journal-ists emphasize different narrative considerations at different stages of theissue development cycle, based on the specificity of each disease.

Mass Communication & Society, 11:141–160, 2008Copyright © 2008 Mass Communication & Society Divisionof the Association for Education in Journalism and Mass CommunicationISSN: 1520-5436 print / 1532-7825 onlineDOI: 10.1080/15205430701668121

Correspondence should be addressed to Tsung-Jen Shih, School of Journalism and Mass Commu-nication, University of Wisconsin, Madison, 821 University Avenue, Madison, WI 53706. E-mail:[email protected]

Tsung-Jen Shih is a doctoral candidate in the School of Journalism and Mass Communication atthe University of Wisconsin-Madison.

Rosalyn Wijaya is a graduate student in the School of Journalism and Mass Communication at theUniversity of Wisconsin-Madison.

Dominique Brossard is an Assistant Professor in the School of Journalism and Mass Communica-tion at the University of Wisconsin-Madison.

Since its emergence, the notion of framing has been increasingly central to mediaanalysis. This concept has been investigated through the analysis of media cover-age of political issues (e.g., Cappella & Jamieson, 1996, 1997; Iyengar, 1991;Scheufele, 2000), media coverage of technological hazards (e.g., Gamson &Modigliani, 1989), and media coverage of controversial scientific issue, such asstem cell research (e.g., Nisbet, Brossard, & Kroepsch, 2003), biotechnology (e.g.,Nisbet & Huge, 2006), and global warming (e.g., McComas & Shanahan, 1999).However, scholars have paid less attention to media framing of health-related is-sues (for recent exceptions, see Clarke, McLellan, & Hoffman-Goetz, 2006; Wallis& Nerlich, 2005). When they have paid attention, they have examined media cov-erage of health hazards in isolation (e.g., Clarke et al., 2006; Wallis & Nerlich,2005), in a cross-cultural context by comparing the coverage of the same disease indifferent countries (e.g., Luther & Zhou, 2005; Wu, 2006), or in a cross-mediumcontext by comparing the coverage of the same disease in different media outlet(e.g., Tian & Stewart, 2005). The aforementioned studies render a generalizationof the findings across epidemic diseases difficult. In other words, their findings donot explain whether the way a specific epidemic hazard is framed in the media isdue to the uniqueness of the disease or to more general patterns of media coveragetranscending disease specificity and linked to journalistic practices and mediaframing building dynamics (see Scheufele, 1999, for a discussion on the mediaframing building process).

Framing theory suggests that media framing can impact how audiences feelabout an issue (Gamson & Modigliani, 1989; Scheufele, 1999, 2000). Such fram-ing effects are often explained by the associative network model of memory, whichconceives the human brain as a mental system made up of networks of associatedcognitive nodes (Price & Tewksbury, 1997). According to this framework, the as-pects highlighted in a news story (i.e., the frames that are present in the story) willactivate certain thoughts or feelings in readers’ minds and make them more likelyto react in a somewhat predictable manner (Price, Tewksbury, & Powers, 1997).Past studies also suggested that individuals use media coverage as a form ofheuristics or as a cognitive shortcut to make sense of complex issues (Gamson &Modigliani, 1989; Scheufele & Lewenstein, 2005). This might especially be thecase for hazardous diseases with an epidemic potential, because people usually donot have direct experience in coping with them (Ball-Rokeach & DeFleur, 1976).An understanding of the way media frame specific issues is therefore a prerequisiteto an understanding of the dynamics surrounding the formation of public percep-tions of these issues.

This study attempts to build an integrated theory of print news coverage of epi-demic hazards by comparing media coverage of three health-related issues: avianflu, mad cow disease, and West Nile virus. Understanding whether there are differ-ences in media coverage of these epidemic diseases has significant implications.First, as we explained earlier, because individuals use media coverage as a cogni-

142 SHIH, WIJAYA, BROSSARD

tive shortcut to make sense of complex issues, looking for similarities or differ-ences across diseases for the dominant themes of a story could help us understandhow people perceive these issues and their possible decision to act on them.Finally, and more importantly, any similarity or difference in news coverage ofthese three diseases might provide information about the dynamics surroundingmedia coverage of epidemic hazards. Specifically, it will help us understand towhat extent factors such as journalistic values may affect the representation of haz-ardous events. In sum, our study aims to answer the following question: Do mediaframes reflect intrinsic differences among these epidemic diseases or do they tran-scend issue specificity?

The three health issues (avian flu, mad cow disease, and West Nile virus) ana-lyzed for this study are all epidemic hazards that had an initial outbreak outside ofthe United States and have the potential for major outbreaks within the UnitedStates. Because prior research has suggested that journalists tend to focus onevents (i.e., specific instances of hazardous situations and short-term conse-quences) rather than on issues when reporting on risk issues (Singer & Endreny,1994), media coverage of the three issues is likely to follow comparable trends. Forinstance, when reporting on these three diseases, journalists might highlight in asimilar manner the number of casualties, the number of cases worldwide, and pos-sible consequences for a community.

However, as we explain in detail in a subsequent section, avian flu, mad cowdisease, and West Nile virus differ substantially for other aspects. First, althoughthey could all possibly spread within the United States, the potential for that spreadis of different magnitude for each disease (Centers for Disease Control and Preven-tion [CDC], 2007; World Health Organization [WHO], 2002a, 2002b, 2006). Sec-ond, they differ in terms of the seriousness of their consequences for human health.Finally, the mechanisms related to their transmission and infection are not alwayswell understood. Although West Nile virus is relatively well understood, mad cowdisease is still a scientific puzzle (CDC, 2005a; WHO, 2002b). The extent to whichthe aforementioned differences might translate into different patterns of mediacoverage is, however, unclear.

We rely on two theoretical frameworks for our comparative analysis: mediaframing and issue attention cycle. The combination of the two frameworks is nec-essary because media frames (i.e., the journalistic tendency to draw attention tocertain features of an issue while minimizing attention to others; Cappella &Jamieson, 1997) tend to change as an issue evolves. For instance, media coverageof global warming was shown to highlight different narrative themes at differentphases of the issue attention cycle (McComas & Shanahan, 1999). Similarly, me-dia frames have been shown to significantly differ across stages of policy and sci-entific development for the issue of stem cell research (Nisbet et al., 2003).

As elaborated in the next section, mad cow disease, West Nile virus, and avianflu began to generate media coverage at different points in time and are currently at

EPIDEMICS, FRAMING, AND ISSUE ATTENTION CYCLE 143

different stages of development as public issues. In light of the research just high-lighted, and to be able to perform a meaningful comparison across these issues, wecompare media framing of each disease when they are at same stage of issue atten-tion cycle. Before discussing our theoretical frameworks in greater details, wehighlight in the following section the major characteristics of the diseases exam-ined in this case study.

MAD COW DISEASE, WEST NILE VIRUS,AND AVIAN FLU

The background information on the three epidemics under study is, unless refer-enced otherwise, based on information provided by WHO (2002a, 2002b, 2006)and the CDC (2005a, 2005b, 2007).

Mad cow disease, or Bovine Spongiform Encephalopathy (BSE), is a neurolog-ical disorder found in cattle that is still largely not understood, more particularly asfar as the dynamics surrounding its transmission and infection. However, researchhas concluded that consumption of BSE-infected meat might be associated withCreutzfeldt-Jakob disease (vCJD) in humans. Media attention to BSE was there-fore sparked by the announcement of the presence of a fatal variant of vCJD in hu-mans in 1996. According to WHO (2002b), from October 1996 to November2002, 129 cases of vCJD have been reported in the United Kingdom and 6 inFrance. Only 1 case was ever reported in Ireland, Italy, Canada, and the UnitedStates (in December 2003).

Unlike mad cow disease, the threat of a West Nile virus outbreak in NorthAmerica is much more real. West Nile virus was first isolated in the West Nileprovince of Uganda in 1937, with human and equine outbreaks periodically beingreported in Africa, southern Europe, and Asia since then. The first “domesticallyacquired” human cases of West Nile encephalitis appeared in the United States in1999. By the end of 2002, the CDC’s surveillance of West Nile virus had reported4,156 human cases, 16,741 dead birds, 6,604 infected mosquito pools, and 14,571equine cases of West Nile virus infections. West Nile virus is considered a seasonalepidemic, emerging in the summer and fading in the fall.

Compared to mad cow disease and West Nile virus, which both came into viewas health threats in the late 1990s in the United States, avian flu has only recentlyemerged as a potential pandemic hazard worldwide. Since 2003 (which markedthe beginning of the current outbreak) 256 human cases have been confirmed and151 fatalities reported worldwide. In recent years, a particularly vicious strain ofthe virus, known as H5N1 virus, has caused severe outbreaks in poultry, notably inSoutheast Asia. Many countries have been simultaneously affected, resulting inthe loss of many birds. Human-to-human transmission has not been confirmed, butthe hazardous nature of the disease has caused tremendous amounts of concern.


Although there have been no human cases of avian flu in the United States, the dis-ease is prompting media and public attention. On November 1, 2005, PresidentBush unveiled a $7.1 billion plan to prepare for the possibility of a flu pandemic.

The three epidemic hazards just described share a number of similarities but arealso different in some interesting respects. The goal of this study is to analyze andcompare media coverage of these three diseases to identify potential patterns thattranscend issue specificity while linking framing theory and media issue attentioncycle.

FRAMING

Numerous definitions of frames and framing have been put forward (e.g., Entman,1993; Gamson & Modigliani, 1989; Scheufele, 1999). Entman’s widely cited defi-nition stated that “to frame is to select some aspects of a perceived reality and makethem more salient in a communicating text” (p. 20). Similarly, Gitlin (1980) con-ceptualized frames as “the principles of selection, emphasis and presentation com-posed of little tacit theories about what exists, what happens, and what matters” (p.6). The ideas of selection and salience suggest that framing is a way to draw atten-tion to certain features of an issue while minimizing attention to others (Cappella& Jamieson, 1997).

In developing our framing typology, we focused on journalistic emphasis ondramatic and substantive aspects of issues. Media pay the greatest attention to is-sues that are most easily dramatized through emphasis of crisis, individual event inthe past or future, and conflicts (Bennett, 2001). This tendency was recently illus-trated in the context of stem cell research–related media coverage. Frames withdramatic potential, such as “strategy/conflict” and “ethics/morality,” were themost prominent frames in elite newspapers’ coverage (Nisbet et al., 2003). Whenpresent, the “strategy/conflict” frame was a dominant or lead frame. In subsequentframing research examining print news coverage of biotechnology, dramaticframes (ethics/morality, uncertainty, strategy/conflict) were also found to be pre-dominant (Nisbet & Huge, 2006).

In light of the aforementioned research, our study focuses on the analysis of me-dia use of dramatic frames. However, because some evidence has shown that jour-nalists tend to downplay risks related to hazardous issues when these issues impacttheir own community (Griffin, Dunwoody, & Gehrmann, 1995), we also includeda “reassurance” frame. This is pertinent because these diseases have direct impacton people’s health, food industry, and the nation’s economy. The government andrelated industries may try to minimize loss by trying to maintain people’s confi-dence through an influence on the media agenda and indirectly its frames. Thusconflict, uncertainty, and reassurance frames might be important components ofmedia coverage of epidemics. We did not include the “ethics/morality” frame iden-


tified by previous research (Nisbet et al., 2003) because it was derived mainly fromthe context of stem cell controversy in which the use of human embryos is deemedunethical. We did not see an ethical dimension in our epidemics.

Journalists may also focus on substantive aspects of an issue (Cappella &Jamieson, 1997). In the case of epidemics, these aspects can include informationrelated to the emergence of the hazards (i.e., the point where the disease begins togain significant presence in the media, often followed by attention from the publicand researchers to gain “new evidence” and better understanding of the diseases),the impact of the diseases (i.e., the “consequences” of the diseases: human casesand casualties, economic and social impact), and on how to respond to the hazards(i.e., “actions” to be taken against the diseases, often led by the government). Thus,consequence frame, action frame, and new evidence frame might also be importantcomponents of stories related to epidemic hazards.

We therefore put forward the following research questions:

RQ1: What frames, if any, appear consistently across diseases?RQ2: Does the relative importance of a specific frame vary across diseases?

Cognizant of the dynamic nature of the news construction process and newsdiscourse, it is meaningful to look into how frames used to report on these epi-demic hazards may evolve over time (Gamson & Modigliani, 1989; McComas &Shanahan, 1999; Nisbet & Huge, 2006). The concept of issue attention cycleseems appropriate for this analysis.

ISSUE ATTENTION CYCLE

Contending that the media and the public rarely focus on certain issues for a longperiod, Downs (1972) proposed the idea of “issue-attention cycle,” which refers tothe ups and downs of attention an environmental issue receives either from thepublic or from mass media. The “cycle” proposed by Downs involves five stages.First is the preproblem stage in which an issue has not captured a lot of public at-tention. Often, only a small proportion of people, such as experts or interestgroups, are aware of it. The issue then proceeds to the second stage in which publicawareness is raised. Public discovery of the issue, however, is often accompaniedby the optimistic belief that, by taking some measures, the problem will be solved.When people begin to realize that the cost (i.e., money, social benefits, etc.) tosolve the problem is beyond their estimation or the extent to which they are willingto tolerate, the issue will find itself in the third stage. The gradual decline in publicinterest in the problem characterizes the fourth stage, followed by the postproblemstage. In this final stage, an issue has been replaced by other concerns and is sub-ject to “spasmodic recurrences of interest” (Downs, 1972, pp. 39–40).


Although Downs’s explanations for the causes of the media issue attention cy-cle have been challenged by various scholars (see Hansen, 1991; Hilgartner &Bosk, 1988; Ungar, 1992, 1995), the cyclical nature of media attention to a varietyof issues has been clearly demonstrated, at least in the United States. Scholars haveattempted to look at this cyclical pattern from a variety of theoretical perspectives.

For instance, Nisbet and colleagues (Nisbet et al., 2003; Nisbet & Huge,2007) examined the issues of biotechnology and stem cell research in terms ofits variation in the prominence of frames across different stages of issue devel-opment. They found that when the issue remained within the administrative con-text, frames such as new scientific research and scientific background dominatedthe media discourse. Stories emphasizing ethics/morality and policy backgroundtook over when the issue attracted more media attention. When the issue reachedits peak of news coverage, the strategy/conflict frame surged. Their findings sug-gest that the cyclical pattern of media attention is due to reporting strategiesrather than the intrinsic characteristics of the issue covered, as suggested byDowns.

The influence of journalistic values and reporting strategies in shaping cyclicalpatterns of media coverage has been explored by cross-cultural studies. Brossard,Shanahan, and McComas (2004) compared media coverage of global climatechange in France and in the United States. Although news coverage in the UnitedStates revealed a cyclical pattern, its French counterpart did not. Their results sug-gest that journalistic practices, which were different within each cultural context,were the major determinant of the cyclical nature of the coverage.

Researchers have also examined the cyclical pattern of the issue of global cli-mate change with the idea of narrative considerations (McComas & Shanahan,1999). Global climate change did not receive much media attention until the late1980s. Media attention to the issue peaked in 1989 and declined afterward. Basedon the amount of newspaper coverage as measured by story frequencies,McComas and Shanahan categorized this issue attention cycle into three stages—the waxing phase, the maintenance phase, and the waning phase, finding differ-ences in narratives salience for each of these phases. For instance, they found that“consequences” and “implied danger” related to global climate change were themost prominent aspects of media coverage in the waxing phase (the phase in whichmedia attention increases). In contrast, stories in the maintenance phase (for whichmedia attention remained relatively constant) focused more on controversy amongscientists.

Our study examines the patterns of media attention to avian flu, West Nile virus,and mad cow disease to identify potential similarities and differences. The amountof attention the media paid to the three diseases can be expressed in terms of prom-inence of news stories. Prominence refers to the hierarchy of stories or story im-portance cues offered by editors (Graber, 1988). We therefore are interested in thefollowing research questions:


RQ3: How much attention did media pay to the three epidemic hazards understudy?

RQ4: How did media attention shift over time for each of the three epidemic haz-ards under study?

Our last research question focuses on the analysis of frame prominence acrossdiseases and across stages of issue attention cycle.

RQ5: Is there any difference in frame prominence between the different stages ofissue attention cycle for each disease under study?

METHODS

This study employed content analysis to analyze how mad cow disease, WestNile virus, and avian flu were framed in print news coverage and how coverageevolved over time. Content analysis allows researchers to identify what exists inthe text as well as the trends occurring over long periods (Wimmer & Dominick,1994).

Because this study is exploratory in nature and is intended to generate com-parison of news coverage across diseases and not across media outlets, we fo-cused on one media outlet. Any differences in our results is therefore attributedto differences between diseases rather than to the differences in journalistic prac-tices between different media outlets. We chose the New York Times for our anal-ysis because it is considered the most influential media organization in theUnited States. The New York Times not only has the ability to reach Americanleaders and citizens but also has the potential to impact news coverage producedby other national or regional newspapers (Malek, 1997; McCombs, Einsiedel, &Weaver, 1991).

Each news story was the unit of analysis for this study. News stories were iden-tified through a search in the online academic database LexisNexis. The wordsmad cow, West Nile, avian, bird, and flu were used as keywords to search headlinesand lead paragraphs of news stories from the first occurrence of coverage of eachdisease to the end of 2005 in the New York Times. Based on the aforementioned cri-teria, our sample included 688 news stories (n = 311 for mad cow disease, n = 251for West Nile virus, n = 126 for avian flu), published between January 1996 andDecember 2005. It should be noted that we assessed the universe (or the entire cor-pus) of what the New York Times published on mad cow disease, West Nile virus,and avian flu during the selected periods. It is therefore appropriate to use descrip-tive data rather than analytical statistics.


Variables

Frames. As discussed in our literature review, we based our identification ofpossible frames on previous framing-related research (e.g., Cappella & Jamieson,1997; McComas & Shanahan, 1999; Nisbet et al., 2003; Nisbet & Huge, 2006).The six frames identified are listed in Table 1. Frames were coded as “not pres-ent/minor” (0) or “dominant frames appearing in the lead” (1), with the lead de-fined as the first paragraph of the story.

Prominence and issue attention cycle. We assessed prominence bymeasuring the number of words in each story and the number of stories at cer-tain point in time. We also applied McComas and Shanahan’s (1999) approachto categorizing media attention phases. As explained earlier, they defined a wax-ing stage as a period when news coverage increases, a maintenance stage as a


TABLE 1A Framing Typology for Media Coverage of Epidemic Diseases

Frames Definitions

Consequence The consequences of the diseases, such as human life (victims), social impact, oreconomic impact (cost), are the focus of the story. In addition to damages, italso includes any phenomenon, social/ political issues, events, or discussiongenerated by the occurrence or spread of diseases. For example, the discussionof flu vaccine or drugs, although indirect, is considered as a consequence ofavian flu because the “talk” derives from the potential outbreak of the flu.

Uncertainty This frame is characterized by uncertainties in any aspect(s) of the epidemicsincluding the cause, the cure, the possible spread, etc. Also included isportrayal of the disease as something unknown that is in need of moreexploration or examination by the experts or governments.

Action The story stresses any action(s) against the disease, including prevention,potential solutions, or strategies. The ban against British beef is one example.

Reassurance The story expresses the idea that the public should not be worried about theeffects of the disease. Stories that emphasize the readiness and/or successes ofauthorities in combating the disease are also included.

Conflict The story focuses on the difference in opinions as well as outrightarguments/disagreements among news sources. It could be a debate about howto effectively combat the diseases, disagreement about how diseases willevolve and how serious it will affect people, or dispute over theappropriateness or legitimacy of actions. Conflict story is constructed asantagonism between opposing opinions or stances

New evidence This frame refers to new findings/ results of research efforts or discovery of newevidence that help advance the understanding of the diseases or the ability toquell the diseases. Included in this frame are: discovery of new strains of thedisease, new way of spreading/ transmitting, new methods toprevent/cure/treat the disease, development of new medicine, and so on.

period when news coverage reaches its peak and then stays constant, and a wan-ing stage when news coverage starts to decline. According to this logic, a year inwhich media coverage about a disease outnumbers that of the previous year wascategorized as a “waxing” phase; a year in which there is a decline in media cov-erage was included in a “waning” phase. An “other” phase was created to con-tain all other years in which the amount of media coverage did not change con-spicuously. These were not categorized as a maintenance phase because ouranalysis did not find 2 or more consecutive years that had similar number of sto-ries for these epidemic diseases. To sum up, years 2000, 2003, and 2004 werecategorized as waxing for mad cow disease, with 1997, 2002, and 2005 as wan-ing. For West Nile virus, although 2000 and 2002 were waxing, 2001, 2003, and2004 were categorized as waning. For avian flu, the waxing phase included theyear 2004 and 2005.

Intercoder reliability was assessed by coding 10% of the total population ofnews stories (n = 32 for mad cow, n = 26 for West Nile virus, n = 10 for avian flu)and calculating a Scott’s pi coefficient for each variable. This measure of inter-coder reliability corrects for chance agreement and thus is a relatively conservativeway of measuring reliability (Scott, 1955). We obtained an average coefficient of.85. Table 2 lists reliability for each of the frames analyzed in this study.

RESULTS

Frames

Our first research question asked what frames, if any, appeared constantly acrossdiseases. Our results indicated that action and consequence were the two most sa-lient frames appearing in all three diseases. The action frame was dominant inabout one third of the stories on mad cow disease and West Nile virus (34.4% and32.7%, respectively) and in about two fifths of the stories covering avian flu. The


Table 2Intercoder Reliability

Frame: Scott’s pi coefficient

Consequence .79Uncertainty .74Action .74Reassurance 1Conflict .88New Evidence .93Mean .85

consequence frame was dominant in about one fourth of the stories on mad cowdisease (27%) and in about one third of the West Nile virus and avian flu stories(31.9% and 35.7%, respectively).

Beyond the two most common frames, this study also examined the relative sa-lience of other frames across diseases, as our second research question postulated.In stories about mad cow disease, conflict was the third most salient frame, fol-lowed by new evidence (6.8%), uncertainty (4.2%), and reassurance (4.2%). InWest Nile virus news coverage, new evidence (8.8%) outnumbered uncertainty(6.8%), conflict (5.6%), and reassurance (1.2%). In avian flu stories, journalistsappealed to uncertainty (4.8%) more frequently than new evidence (4%), conflict(3.2%), and reassurance (2.4%).

Prominence

Our third research question asked how much attention media paid to the three epi-demic hazards under study. In terms of word count, stories about mad cow disease(n = 311; M = 759.59, SD = 420.86) were generally longer than stories about WestNile virus (n = 251; M = 659.31, SD = 450.92) and avian flu (n = 126; M = 690.98,SD = 769.46).

Concerning the location of stories, about three fourths of the stories about madcow disease (72.4%) and avian flu (75.4%) appeared in the first section, whereasthe bulk of the stories about West Nile virus (71.3%) appeared in the latter sec-tions, especially in the Metro section (42.2%). However, stories about West Nilevirus (19.5%) were slightly more likely than those about mad cow disease (14.8%)and avian flu (13.5%) to appear on front pages, although most of the front-pagestories were in the inner sections. About one tenth of the West Nile virus stories(10.36%) appeared in the front page of the Metro section, as opposed to less than1% for stories about mad cow disease and avian flu.

Issue Attention Cycle

Our fourth research question asked how media attention shifted over time for eachof the three epidemic hazards under study. The results showed two major surges ofstories on mad cow disease, as the first human death linked with mad cow diseasewas identified in 1996 (see Figures 1 and 2). The first surge of media coveragecame in 2001, and the second surge occurred in 2004.

For West Nile virus, which was first found in North America in 1999, the “twinpeak” pattern also held, with the first peak in 2000 and the second peak in 2002.However, by looking at the story frequency distribution by month, we found thatthe intensity of news coverage corresponded to the seasonal nature of the disease(see Figure 3). The time frame with the greatest concentration of West Nile viruscoverage was August to October, when the virus is the most active. This cyclical


pattern was not obvious for the issue of avian flu perhaps because it is still in itsemerging stage. News coverage of the disease did not increase until 2004 and keptincreasing in 2005, although less drastically (see Figure 4).

In addition to examining the shift of story prominence, this study also investi-gated the possible shift of frames in relation to the temporal development of the ep-idemics. Therefore, our fifth research question asked whether there was any differ-ence in frame prominence between the different stages of issue attention cycle for


FIGURE 1 The frequency of stories on the three epidemic hazards in the New York Timesfrom 1996 to 2005. Note. WNV = West Nile virus.

FIGURE 2 Timeline and issue attention cycle for mad cow disease.

each disease under study. Although we do not compare news coverage of avian fluacross stages, we present the frame distribution in its waxing stage because the dis-ease is an emerging concern.

In stories about mad cow disease, action (25%–39.1%) and new evidence(2.3%–17.4%) were the only two frames that had a more salient status in a waningstage (n = 46) than in a waxing stage (n = 132). Frames, such as consequence(27.3% in a waxing stage and 19.6% in a waning stage), uncertainty (6.1% and


FIGURE 4 Timeline and issue attention cycle for avian flu.

FIGURE 3 Timeline and issue attention cycle for West Nile virus (WNV).

2.2%), and conflict (13.6% and 8.7%), appeared more frequently in a waxing stagethan in a waning stage. Reassurance had about the same salience in both phases(4.5% and 4.3%).

The shift of frames in stories about West Nile virus revealed a different pattern.Journalists framed the disease more frequently as uncertainty and action in a wax-ing stage (n = 150, 9.3% for uncertainty; 40.7% for action) than in a waning stage(n = 65, 3.1% and 12.3% respectively). On the contrary, journalists emphasizedconsequence and new evidence more in a waning stage (33.8% for consequenceand 9.2% for new evidence) than in a waxing stage (30.7% and 6.7%, respec-tively). The reassurance frame never appeared in a waning stage, although it wasused in 1.3% of stories in a waxing stage. Our results indicated that frequency ofconflict did not change much between phases (about 6% in each stage).

We also compared the frames appearing during summers, when the West Nilevirus is most active, and during winters, when the virus is inactive. Our results sug-gested that consequence (n = 134, 36.4% in the waxing months, and n = 21, 28.3%in the waning months) and action (30.6% in the waxing months and 33.2% in thewaning months) were the two most salient frames in both waxing and waningmonths, although the ranking of their salience was different. In addition, uncer-tainty (6.7%) and new evidence (10%) were more salient in “hot” seasons. On thecontrary, reassurance (3.8%) and conflict (8.2%) were employed more by the jour-nalists when the threat receded.

Our results illustrated a different scenario for avian flu, which is still at the epi-center of the media agenda and therefore can be considered to be in a waxingphase. Again, action (n = 106, 34.9%) and consequence (33%) received more at-tention than the other frames. New evidence (4.7%) was the third-most-prominentframe, followed by uncertainty (3.8%), conflict (3.8%), and reassurance (2.8%).

DISCUSSION

Our study aimed to conduct a comparative analysis of print media coverage ofthree epidemic hazards to propose an integrated theory of media coverage that tookinto account media framing and media issue attention cycle. As we discuss, ourfindings showed that these health-related risk issues, while sharing some charac-teristics, led to specific media coverage in terms of frames, story prominence, andissue attention cycle—results that have important implications.

Frames

In response to our first research question, we found that action and consequencewere the dominant frames in the coverage of the three epidemic hazards understudy. The fact that some frames appeared consistently across diseases’ coverage


resonates with the argument that journalists tend to use the same themes for storiesof similar nature (Bennett, 2001). The predominance of the action and conse-quence frames also suggest that journalists concentrate their attention on substan-tive aspects of epidemic hazards. This is not the case for controversial scientific is-sues such as stem cell and biotechnology that seem to be dramatized throughjournalistic reporting (Nisbet et al., 2003; Nisbet & Huge, 2006). This inconsis-tency in findings can be attributed to the event-oriented nature of epidemic hazardscoverage, with updates on infected cases (consequence) and actions taken by theauthorities (action) being the staple of news coverage. This can be contrasted tocoverage related to genetic engineering and biotechnology. Although this cover-age more or less reflected the social climate, the nature of these issues is quite dif-ferent from epidemic hazards. As of now, biotechnology and genetic engineeringhave not exerted an immediate acute impact on people and have not required im-mediate governmental responses.

Nuances in terms of frame salience in the coverage of each disease were alsoidentified, which provided answers to our second research question. We focus ourdiscussion on reassurance and conflict because these two frames registered largedifferences in terms of proportion of appearance among diseases. Conflict wasused more often in stories about mad cow disease than in stories about the othertwo diseases. Although this can be attributed to the failure of officials or scientiststo reach a consensus regarding how to define a sick cow and what testing methodsto adopt, such a finding should be understood with the acknowledgment that madcow disease had turned out to be a political issue. Countries with infected cowsstrived hard to network and negotiate with other nations with expectation that eco-nomic bans could be lifted. This bargaining process in the policy arena, a featurethat the other two diseases did not possess, might have also driven up the salienceof the frame.

Similarly, the reassurance frame, which might have aimed to resurrect people’sconfidence in eating beef and to alleviate the possible public panic, was also moresalient in stories about mad cow disease. The attempts of the government and thebeef industry to minimize the economic impact caused by this disease may haveprompted the reassurance frame. Although avian flu also affects the poultry indus-try, its outbreak is mainly outside the United States. Fewer reassurance frameswere therefore found in coverage related to avian flu. This finding suggests thatnews values may have played an important role in determining the theme of a story.It is the proximity value that made reassurance more salient in mad cow stories thanin avian flu stories.

Prominence

With respect to how much attention media paid to these three epidemic hazards, asour third research question addressed, we showed that West Nile virus stories


tended to appear in the inner sections, especially the Metro section, whereas theother two diseases had the majority of their stories in the first section. Our findingssuggest that the New York Times determined the location of stories about epidemichazards based on the value of proximity. Although both mad cow disease and avianflu occurred throughout the world, initial outbreaks of the West Nile virus weremainly located in New York State and therefore were more strongly emphasized inthe Metro section. In other words, our results showed that journalistic norms androutines were, again, important determinants of the location of the coverage forthese epidemic issues; that is, issues of greater impact tend to appear at a promi-nent location (the front section), whereas issues of greater proximity tend to appearin the Metro or local section, as Gans (1979) suggested.

Issue Attention Cycle

In response to the fourth research question, which explored the potential cyclicalpattern of media attention to these diseases, our analysis showed that coverage ofthe epidemic diseases was highly event based. The amount of news coverage re-flected the number of infected cases and the type of governmental actions taken.For mad cow disease, the first surge of media coverage occurred in 2001 as theUnited States banned imports of protein products from Europe, as the EuropeanUnion heightened the threshold of disease testing, and as Japan reported its firstcase of the disease. In December 2003, the discovery of an infected cow on aWashington State farm marked the first and only case of mad cow disease in theUnited States, driving the second wave of intense media coverage.

For West Nile virus, initial outbreaks in New York City spurred the first mediahype, which culminated in 2000 when the number of stories on West Nile virus ex-ceeded 100. The second surge in media coverage in 2002 was attributable to theconfirmation of human infections in Canada.

In regards to avian flu, the initial outbreaks in Hong Kong in 1997 drew littlemedia attention in the United States. Coverage of the bird influenza rocketed in2004 when many Southeast Asian countries reported cases of infected humans andfowls. The amount of coverage continued to increase, although less drastically, in2005 with the disease spreading westward to European countries.

Unlike environmental issues, which tend to follow a clear cyclical pattern(Downs, 1972), the epidemics hazards under study were mainly event based. Thusthe amount of news coverage covariated with the number of infected cases andwith the type of governmental actions taken.

More importantly, our results suggest that different stages in the media attentioncycle reflected different narrative considerations and that this pattern varied withdisease. In general, the new evidence frame tended to be important when overallmedia coverage of these epidemic diseases subsided. On the contrary, the impor-tance of the uncertainty frame was high when media attention to the issues was on


the rise. No recognizable shift pattern can be identified for other than these twoframes.

CONCLUSION

Through the analysis of 688 news stories published in the New York Times over a10-year period (1996–2005), this study examined what pictures the media has cre-ated for citizens’ understanding of epidemic hazards. Before concluding our find-ings, we want to outline some limitations of our study. First, we made no attempt togeneralize our findings to other newspapers at this stage because the goal of ourstudy was to compare coverage across diseases and not across media outlets. Thesimilarities and differences between avian flu, mad cow disease, and West Nile vi-rus coverage made our study interesting as an exploratory context for mass com-munication research.

Through a comparison of the use of media frames in the coverage of three epi-demic diseases, this study reached important conclusions. Although journalistsemphasized the consequence and action frames consistently across diseases, theyalso took into account the specificity of each disease by giving different levels ofimportance to other frames in relationship to the epidemic hazard under consider-ation. In addition to showing that narrative considerations varied by diseases, wealso found that these narrative themes vary across stages of development. It shouldbe worthwhile for future research to look into how these apparent differences mayaffect public perception of epidemic hazards.

Our results also indicate that media coverage of epidemic hazards followed pat-terns of media attention that were different from those observed for the coverage ofenvironmental issues. Our findings added to the understanding of “issue attentioncycle” by showing that the cyclical patterns can vary not only with culture(Brossard et al., 2004) but also with issues of different nature. Coverage of epi-demic hazards was so event oriented that the decrease in media attention did notnecessarily mean the resolution of the problems. Events such as the reports of newcases, the announcement of policies, and the discovery of new scientific evidenceabout diseases seemed to be driving the amount of news coverage.

This study also shed light on the relationship between frames and the nature ofan issue. For instance, we found that the more political an issue was, the moreprominent the conflict frame in media coverage. Coverage of mad cow disease,which is tinted with politics, contained more conflict frames than coverage of theother two diseases. These results resonated with Nisbet and Huge’s (2006) find-ings that conflict played an increasingly important role when an issue such as bio-technology evolved from the narrow administrative sphere to the more open politi-cal and business sphere.


Furthermore, this study contributed to communication theory by linking theideas of framing and issue attention cycle. We found that media concerns and jour-nalists’ narrative considerations regarding epidemic hazards did change across dif-ferent phases of development and across diseases. This suggests that journalistsemphasize different narrative considerations at different stages of the issue devel-opment cycle, based on the specificity of each disease.

Given bountiful evidence suggesting the impact of news frames on people’sperceptions of the risks associated to particular issues, it would be interesting tojuxtapose our findings with public opinion data measuring public perceptions ofrisks related to the three diseases. Another intriguing question to ask is, How muchof the salience of the issues was accounted for by media coverage? For example,are people actually aware of the severity of the diseases, or are their perception andsubsequent attitudes toward the diseases mainly influenced by what is available inthe media? These are questions worth exploring in future studies.

REFERENCES

Ball-Rokeach, R., & DeFleur, C. (1976). Dependency model. Communication Research, 3, 6–17.Bennett, L. W. (2001). News: The politics of illusion. New York: Addison Wesley Longman.Brossard, D., Shanahan, J., & McComas, K. (2004). Are issue-cycles culturally constructed? A Com-

parison of French and American coverage of global climate change. Mass Communication and Soci-ety, 7(3), 359–377.

Cappella, J. N., & Jamieson, K. H. (1996). News frames, political cynicism, and media cynicism. An-nals of the American Academy of Political and Social Science, 546, 71–84.

Cappella, J. N., & Jamieson, K. H. (1997). The spiral of cynicism: The press and the public good. NewYork: Oxford University Press.

Centers for Disease Control and Prevention. (2005a). About BSE. Atlanta, GA: Author. Retrieved De-cember 8, 2005, from Hhttp://www.cdc.gov/ncidod/dvrd/bse/

Centers for Disease Control and Prevention. (2005b). Avian influenza. Atlanta, GA: Author. RetrievedDecember 8, 2005, from http://www.cdc.gov/flu/avian/.

Centers for Disease Control and Prevention. (2007). Chapter 4—Prevention of specific infectious dis-eases. Bovine Spongiform Encephalopathy and Variant Creutzfeldt-Jakob disease. Atlanta, GA:Author. Retrieved May 23, 2007, from http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=madcow.htm

Clarke, J. N., McLellan, L., & Hoffman-Goetz, L. (2006). The portrayal of HIV/AIDS in two popularAfrican American magazines. Journal of Health Communication, 11(5), 495–507.

Downs, A. (1972). Up and down with ecology—The “issue-attention cycle.” The Public Interest, 28,38–51.

Entman, R. M. (1993). Framing: Toward clarification of a fractured paradigm. Journal of Communica-tion, 43(4), 51–58.

Gamson, W., & Modigliani, A. (1989). Media discourse and public opinion on nuclear power: A con-structionist approach. American Journal of Sociology, 95, 1–37.

Gans, H. J. (1979). Deciding what’s news: A study of CBS evening news, NBC nightly news, Newsweekand Time. New York: Vintage.


Gitlin, T. (1980). The whole world is watching: Mass media in the making and unmaking of the new left.Berkeley: University of California Press.

Graber, D. (1988). Processing the news: How people tame the information tide. New York: Longman.Griffin, R. J., Dunwoody, S., & Gehrmann, C. (1995). The effects of community pluralism on press

coverage of health risks from local environmental contamination. Risk Analysis, 15, 449–458.Hansen, A. (1991). The media and the social construction of the environment. Media, Culture, and

Society, 13, 443–458.Hilgartner, S., & Bosk, C. L. (1988). The rise and fall of social problems: A public arenas model. Amer-

ican Journal of Sociology, 94(1), 53–78.Iyengar, S. (1991). Who is responsible? Chicago: The University of Chicago Press.Luther, C. A., & Zhou, X. (2005). Within the boundaries of politics: News framing of SARS in China

and the United States. Journalism & Mass Communication Quarterly, 82(4), 857–872.Malek, A. (1997). News media and foreign relations. Norwood, NJ: Ablex.McComas, K., & Shanahan, J. E. (1999). Telling stories about global climate change: Measuring the

impact of narratives on issue cycles. Communication Research, 1, 30–57.McCombs, M., Einsiedel, E., & Weaver, D. (1991). Contemporary public opinion: Issues and the news.

Hillsdale, NJ: Lawrence Erlbaum.Nisbet, M .C., Brossard, D., & Kroepsch, A. (2003). Framing science: The stem cell controversy in an

age of press/politics. Harvard International Journal of Press/Politics, 8(2), 36–70.Nisbet, M. C., & Huge, M. (2006). Attention cycles and frames in the Plant Biotechnology Debate:

managing power and participation through the press/policy connection. Harvard International Jour-nal of Press/Politics, 11(2), 3–40.

Nisbet, M. C., & Huge, M. (2007). Where do science debates come from? Understanding attention cy-cles and framing. In D. Brossard,C. Nesbitt,& J. Shanahan (Eds.), The media, the public, and agri-cultural biotechnology (pp. 193–230). Oxford, UK: CABI.

Price, V., & Tewksbury, D. (1997). News values and public opinion: A theoretical account of mediapriming and framing. In G. A. Barnett & F. J. Boster (Eds.), Progress in communication science, 13(pp. 173–212). Greenwich, CT: Ablex.

Price, V., Tewksbury, D., & Powers, E. (1997). Switching trains of thought: The impact of news frameson readers’ cognitive responses. Communication Research, 24, 481–506.

Scott, W. A. (1955). Reliability of content analysis: The case of nominal scale coding. Public OpinionQuarterly, 19, 321–325.

Scheufele, D. A. (1999). Framing as a theory of media effects. Journal of Communication, 29,103–123.

Scheufele, D. A. (2000). Agenda-setting, priming, and framing revisited: Another look at cognitive ef-fects of political communication. Mass Communication & Society, 3, 297–316.

Scheufele, D., & Lewenstein, B. (2005). The public and naotechnology: How citizens make sense ofemerging technologies. Journal of Nanoparticle Research, 7(6), 659–667.

Singer, E., & Endreny, P. M. (1994). Reporting on risk: How the mass media portray accidents, dis-eases, disasters and other hazards. Risk: Health, Safety, and Environment, 5(3), 261–270.

Tian, Y., & Stewart, C. M. (2005). Framing the SARS crisis: A computer-assisted text analysis of CNNand BBC online news reports of SARS. Asian Journal of Communication, 15(3), 289–301.

Ungar, S. (1992). The rise and (relative) decline of global warming as a social problem. The Sociologi-cal Quarterly, 33, 483–501.

Ungar, S. (1995). Social scares and global warming: Beyond the Rio convention. Society and NaturalResources, 8, 443–456.

Wallis, P., & Nerlich, B. (2005). Disease metaphors in new epidemics: The UK media framing of the2003 SARS epidemic. Social Science & Medicine, 60(11), 2629–2639.


Wimmer, R. D., & Dominick, J. R. (1994). Mass media research: An introduction (5th ed.). Belmont,CA: Wadsworth.

World Health Organization. (2002a). Epidemic and pandemic alert and response—West Nile Virus.Geneva, Switzerland: Author. Retrieved December 12, 2005, from http://www.who.int/csr/don/2002_11_27/en/index.html

World Health Organization. (2002b). Variant Creutzfeldt-Jakob disease (Fact Sheet No. 180). Geneva,Switzerland: Author. Retrieved December 10, 2005, from http://www.who.int/mediacentre/factsheets/fs180/en/

World Health Organization. (2006). Epidemic and pandemic alert and response—Avian influenza.Geneva, Switzerland: Author. Retrieved September 10, 2006, from http://www.who.int/csr/dis-ease/avian_influenza/en/

Wu, M. (2006). Framing AIDS in China: A comparative analysis of US and Chinese wire news cover-age of HIV/AIDS in China. Asian Journal of Communication, 16(3), 251–272.


Documents

Media Coverage of Public Health Epidemics: Linking Framing and Issue Attention Cycle Toward an Integrated Theory of Print News Coverage of Epidemics