BLACK NEWSPAPERS AS A TOOL FOR CANCER EDUCATION IN AFRICAN AMERICAN COMMUNITIES

 
BLACK NEWSPAPERS AS A TOOL FOR CANCER EDUCATION
IN AFRICAN AMERICAN COMMUNITIES

Background. Despite the long history, wide         Charlene A. Caburnay, PhD, MPH; Matthew W. Kreuter, PhD, MPH;
reach and unique influence of Black newspa-         Glen Cameron, PhD; Douglas A. Luke, PhD; Elisia L. Cohen, PhD;
pers in many African American communities,
no national studies have examined how these        Lillie McDaniels, MPH; Monica Wohlberg, MHA; Paul Atkins, MHA
newspapers cover health and cancer issues, or
reader perceptions of their coverage.
                                                   INTRODUCTION
Design and Participants. A two-year national
sample of Black newspapers (n524) and                                                              This paper examines how
community-matched general audience news-
                                                       Cancer is the second leading cause
papers (n512) was reviewed, and 8,690              of death among African Americans,               Black newspapers report
health and cancer stories were identified and      accounting for 21.5% of all deaths.1
content analyzed. A survey of 783 Black            Although racial disparities have de-
                                                                                                   cancer information and how
newspaper readers in the same 24 communi-
ties assessed reading frequency and percep-
                                                   creased from 1997–2007, African                 readers of these newspapers
                                                   Americans continue to suffer from
tions of reporting for both types of newspapers,
                                                   cancer at a higher rate relative to other       perceive the coverage.
as well as readers’ health concerns and cancer
screening behaviors.                               groups.1 This paper examines how
                                                   Black newspapers report cancer infor-
Results. As a proportion of total health           mation and how readers of these                 local Black communities.5–7 Because
coverage, Black newspapers published more
                                                   newspapers perceive the coverage. Our           Black newspapers are especially attentive
cancer stories than general audience newspa-
pers, and their stories were more likely to        study’s aims were to: 1) summarize what         and responsive to local issues,8 they are
contain localized information, address dispar-     is known about Black newspapers’                often viewed as a voice of the local Black
ities, focus on prevention, include calls to       influence and reach; 2) describe and            community9,10 and accorded the same
action for readers and refer readers to cancer     compare the amount and nature of                status as other social institutions like
information resources (all P,.001). Black
newspaper readers identified cancer as the
                                                   cancer coverage in Black and general            schools and churches.11,12
health issue that concerned them most, yet
                                                   audience newspapers from 24 US cities;              Although Black newspapers cannot
rated it the fourth most important health          and 3) describe and compare percep-             match the reach of general audience
problem affecting African Americans.               tions of cancer coverage in both types of       newspapers, they serve a large proportion
                                                   newspapers and health concerns in a             of the US Black population. The National
Conclusions. Black newspapers hold promise         sample of Black newspaper readers from          Newspaper Publishers Association (the
for helping to eliminate cancer disparities by
increasing cancer awareness, prevention, and
                                                   the same 24 cities.                             ‘‘Black Press of America’’) and others
screening among African Americans. (Ethn Dis.                                                      report there are over 200 Black weekly
2008;18:488–495)                                   Social significance, reach and use              newspapers across the United States, with
                                                   of Black newspapers                             a combined circulation of 6 to 15 million
Key Words: Black Newspaper, African
                                                        Black newspapers were originally           readers.13,14 From 1965–2000, such
Americans, Cancer Disparities, News
                                                   established to enhance the quality of           community newspapers saw a threefold
                                                   life of American Blacks by providing a          increase in circulation —a direct contrast
                                                   mechanism for public dialogue within            to the stagnation of daily newspapers’
                                                   Black communities, a counterpoint to            circulation15,16 as verified by recent data
                                                   negative representations of Blacks, and         from the Audit Bureau of Circulations17
    From Health Communication Research             an outlet for stories of unique interest or     and other studies.18,19 A 2005 survey of
Laboratory, George Warren Brown School             concern to Black communities.2,3 As             media use among ethnic American adults
of Social Work, Washington University in St.       stated in an editorial in the 1827              found that Black newspapers reach at least
Louis, St. Louis, MO (CAC, MWK, DAL, LM,
                                                   opening issue of Freedom’s Journal, the         25% of all African Americans.20 Because
MW, PA); Department of Communication,
University of Kentucky (EC), and Missouri          nation’s first Black newspaper: ‘‘We            most Black newspapers are free and
School of Journalism, University of Missouri-      wish to plead our own cause. Too long           widely accessible in Black communities,
Columbia, Columbia, MO (GC).                       have others spoken for us.’’4 Black             they are often passed on to be reread by
                                                   newspapers still serve certain functions        others,21 suggesting that reach may be
    Address correspondence and reprint
                                                   that general audience newspapers do             higher than circulation numbers indicate.
requests to Charlene A. Caburnay, PhD,
MPH; 700 Rosedale Ave, Campus Box                  not, including addressing health and            In an age of increasing use of the Internet
1009; St. Louis, MO 63112; 314-935-3703;           other issues that are especially important      for news and declining readership of
314-935-3757; ccaburnay@wustl.edu                  and relevant to African Americans and           traditional newspapers, the success of

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community papers has been attributed to       deciding what issues to report on and         papers and randomly selected 12 of the
their ability to target selected audiences,   how those issues will be presented to the     same communities to include their
focus on local news, and provide different    public, the press influences what people      largest circulation general audience
kinds of information than found in            think about and how they think about          newspapers. Details of the sampling
general audience daily newspapers.16,19,22    it.31–33 According to agenda setting          frames have been previously reported.36
                                              theory, if cancer prevention and control      Analyses were conducted with SPSS
Studies of health and cancer                  issues were consistently and prominent-       v.13.0.37
coverage in Black and general                 ly covered in the news media, those
audience media                                exposed to the coverage would be more         Identifying Health and Cancer Stories
     Empirical studies of health and          likely to perceive cancer prevention and           Each Black newspaper issue
cancer coverage in Black media have           control as an important issue.34 When         (N52,190) was read in its entirety to
been relatively rare. Many African Amer-      cancer-related issues are perceived by        identify health- and cancer-related sto-
icans perceive that general audience media    the public as important, we would             ries. Health-related stories were those
present an unbalanced portrayal of their      generally expect greater individual,          pertaining to health promotion, well-
racial group. Studies of news coverage        community, and political support for          ness, disease prevention, well-being,
provide empirical support for this be-        cancer prevention and control activi-         lifestyle, and any mental, physical or
lief.23–25 Studies have also shown that       ties,35 potentially reducing cancer dis-      spiritual aspects of health. Cancer-relat-
Black media sources are trusted, valued,      parities.                                     ed stories contained within the headline
and preferred by African Americans.20,26          In summary, a relatively limited          or first 2 paragraphs cancer key words
     A 2002 study examined HIV/AIDS           research literature suggests news cover-      (eg, cancer, tumor, lump). Inter-coder
coverage in five African American             age in general audience media is              reliability for story identification was
newspapers from 1991 to 1996.27 Of            perceived by many African Americans           high (mean kappa50.87).
the 201 stories that framed HIV/AIDS          as racially biased and not adequately              For general audience newspapers,
as a health issue, one-third (33%)            addressing health issues important to         we used a ‘‘constructed week’’ sam-
contained mobilizing information,             African Americans. In contrast, Black         pling approach in order to minimize
50% discussed any type of prevention.         newspapers reach large numbers of             the costs (ie, time, personnel) of
Hoffman-Goetz et al (1997) tracked the        African Americans with coverage that          analyzing daily newspapers.38 Using this
number and type of cancer-related             is community- and race-specific. De-          method, sample dates are stratified by
stories in three Black magazines –            spite the apparent promise of Black           day of the week to account for system-
Ebony, Essence, and Jet – from 1987–          newspapers as a channel for cancer            atic variation. Each month, a construct-
1994. In 596 total issues, only 84 stories    information to reduce disparities, sur-       ed week was selected for each of the 12
focused on cancer (13% of health              prisingly little is known about their         general audience newspapers. Each
articles).28 In a study of 25 ethnic          actual coverage of health and cancer          newspaper issue comprising the con-
minority newspapers in Canada pub-            issues, and about their readers’ knowl-       structed week was read for health and
lished in 2000, a total of 27 cancer          edge, awareness and perceived impor-          cancer stories using the definitions
articles were printed.29 Of these, only 3     tance of cancer. This study helps fill        above.
articles were published in Black/Carib-       these gaps by reporting findings from
bean newspapers from 1,549 total pages        the first national study of cancer            Coding Health and Cancer Stories
searched. In a study of 565 cancer            coverage in Black newspapers.                     Cancer-related stories were coded
stories from a sample of 283 English-                                                       for journalistic and public health vari-
language newspapers in the Ethnic                                                           ables; non-cancer health-related stories
NewsWatch database, cancer stories in         METHODS                                       were coded for journalistic variables
ethnic newspapers were written at lower                                                     only. Inter-coder reliability measured
literacy levels and were more likely to       Sample of Black newspapers                    as intraclass correlation coefficient
discuss cancer prevention, awareness,             All health and cancer-related stories     (ICC) or kappa follows each variable.
and education compared to stories in          published in 24 Black weekly newspa-
general audience newspapers.30                pers and 12 community-matched gen-               Journalistic Variables. Total area
                                              eral audience daily newspapers for two        was measured by summing the square
Theoretical basis for media                   full years (Jan. 2004–Dec. 2005) were         inches of text in a story, not including
effects through newspapers                    identified and content analyzed. We           headlines or graphics (ICC50.89).
   News media are an important part           selected for inclusion in the study 24        Location of the story was classified as
of the information environment. By            communities with weekly Black news-           above or below the fold (kappa50.90).

                                              Ethnicity & Disease, Volume 18, Autumn 2008                                         489
BLACK NEWSPAPERS FOR CANCER EDUCATION - Caburnay et al

Visual elements (yes/no) included pho-      criteria (1,085 ineligible due to not           sonally. First they were asked to indicate
tographs or other graphics (ICC50.62).      reading the local Black newspaper; 546          which three health problems – from a
Local angle (yes/no) was defined as         were , 21 years old; 2,470 did not              list that included HIV/STDs, high
information specific to the newspaper’s     identify as African American; 1,200             blood pressure, heart disease, stroke,
local audience (kappa50.83).                were not household members). Of the             violence, cancer, and diabetes – they
                                            remaining eligible individuals, 1,585           felt most affected Blacks. Respondents
    Public Health Variables. Disparity      (4.7%) initially agreed to participate          were then asked an open-ended ques-
information in a story (yes/no) required    and provided contact information for            tion about what health issue had
reporting differences in the incidence,     another phone call to complete the              concerned them the most in the last
prevalence, mortality, or burden of         survey. Of these, a total of 783                12 months.
diseases (kappa50.93). Mobilization         (49.4% of all eligible contacts) com-
(yes/no) was measured separately for        pleted the reader survey and received a              Cancer Screening Behaviours. Based
individuals (‘‘personal mobilization’’;     $15 gift card or check.                         on respondents’ age and sex and in
kappa50.72) and the community                                                               accord with US Preventive Services Task
(‘‘community mobilization’’; kap-           Measures                                        Force guidelines,40 respondents were
pa50.56) and identified explicit recom-         The 20-minute survey included the           asked if they had ever had specific
mendations to improve one’s own             following items:                                screening tests and if so, when (in
health or that of the community,                                                            months) they last had the test. For
respectively. Prevention focus was mea-         Use of Newspapers. Use of both              each screening type, interviewers
sured as the highest level of prevention    Black and general audience newspapers           first presented respondents with a lay
(highest: primary, lowest: tertiary) dis-   was measured by the number of times             description of the test followed by
cussed in the story (kappa50.62).           per month the respondent read the local         specific questions (eg, A sigmoidoscopy
Cancer site was defined as the primary      Black/general audience newspaper.               is an exam of the lower colon and the
cancer location (kappa50.88). Referral                                                      rectum using a thin, lighted tube called a
to resources (yes/no) included detailed         Perceptions of Reporting in Black           sigmoidoscope. Have you ever had a
contact information for obtaining can-      Newspapers. In four separate items,             sigmoidoscopy?)
cer-related resources (kappa50.89).         respondents indicated how strongly
                                            they agreed or disagreed (5-point scale)            Cancer History. Respondents were
Reader Survey                               with statements about the reporting             asked in a single item if they or any of
    The primary objective of the reader     and influence of the local Black news-          their brothers, sisters, parents, children,
survey was to better understand Black       paper.                                          or other close family members ever had
newspaper readers’ use and perceptions                                                      cancer.
of Black and general audience newspa-           Comparisons of Black and General
pers as well as their knowledge, atti-      Audience Newspaper Coverage. Respon-                Demographics. Respondents’ age,
tudes, beliefs and behaviors related to     dents indicated how strongly they               years of education, household income,
cancer. The survey was conducted from       agreed or disagreed (5-point scale) with        employment and marital status were
September 2005 through April 2006,          the fairness and balance of the reporting       recorded.
in the same 24 communities whose            in the local Black newspaper/general
Black newspapers were selected for the      audience newspaper and the coverage of
study. We obtained sets of random           certain issues and events in both types of      RESULTS
telephone numbers from census tracts        newspapers. We also used items from
with .60% African American popula-          the National Cancer Institute’s Health          Content Analysis
tion, stratified into lower, middle, and    Information National Trends Survey                  A total of 2,190 weekly Black
higher median income. Eligible re-          (HINTS).39 In separate items, respon-           newspaper issues and 4,364 daily gen-
spondents were those 21 years of age        dents were asked how much they would            eral audience newspaper issues were
or older, living at the location of the     trust (4-point scale: a lot to a little)        reviewed. Of these, 1,391 Black news-
dialed number, having read the local        information about cancer from six               paper issues (63.5%) and 1,302 general
Black newspaper at least once in the        different sources.                              audience newspaper issues (29.8%)
past four weeks, and self-identifying as                                                    contained at least one health story.
African American.                              Health Concerns. Respondents were            Black newspapers contained a total of
    Of 39,016 individuals reached,          asked about their health concern for            4,158 health stories, and general audi-
5,301 (13.6%) did not meet inclusion        Blacks generally, and themselves, per-          ence newspapers contained 4,352 health

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                                             and averaged 50 years old (SD5                Black newspaper does a good job
Of these health stories, 14.4%               15 years). Because the sampling frame         reporting on issues relevant to the Black
                                             was stratified by household income, this      community and covers issues and events
of those in Black newspapers                 variable is normally distributed. Most        not covered in the general audience
were cancer-related (n5598),                 respondents were either currently em-         newspaper, (93% and 92%, respective-
                                             ployed (46%) or retired (23%). Using          ly). After doctors or other healthcare
compared to 10.4% of stories                 guidelines for cancer screening and           professionals, Black newspapers were
(n5472) in general audience                  respondents’ self-reported time of last       the most frequently cited media source
                                             screening, 86% of women ages 40               respondents reported turning to for
newspapers (P,.001).                         and older (n5436) were up-to-date             health or medical information.
                                             on use of mammography; 89% of all
                                             women (n5595) were up-to-date on              Health Concerns
                                             Pap testing; and of all respondents               The health problems most likely to
stories, or an average of 1.9 and 1.0
                                             .50 years of age and older (n5398),           be listed by respondents as among the
health stories per issue, respectively. Of
                                             51% were up-to-date on fecal occult           ‘‘top three’’ health problems affecting
these health stories, 14.4% of those in
                                             blood testing, and 45% were up-to-date        African Americans were high blood
Black newspapers were cancer-related
                                             on use of sigmoidoscopy. A majority of        pressure (chosen by 65% of respon-
(n5598), compared to 10.4% of stories
                                             respondents (72%) had personal or             dents), diabetes (61%), HIV/STDs
(n5472) in general audience newspa-
                                             family history of cancer.                     (56%), cancer (39%), and heart disease
pers (P,.001).
                                                                                           (31%). When stratified by respondent
Journalistic Variables                       Use of Black and General                      age in decades (ie, ,30, 30–39, …,
    Cancer stories in Black newspapers
                                             Audience Newspapers                           $70 years), HIV/STDs was the most
were significantly larger than those in          Table 2 describes survey respon-          commonly identified health problem
general audience newspapers and more         dents’ use and perceptions of Black           affecting African Americans by those
likely to have a local angle. There were     and general audience newspapers as well       ,60 years, whereas high blood pressure
no differences by newspaper type in          as their health concerns. On average,         is the top problem for those §60 years.
story location or presence of a visual.      respondents reported reading the local        Respondents who have had a personal/
Table 1 summarizes cancer coverage by        Black newspaper 2.7 times per month           family history of cancer identified the
type of newspaper.                           (out of 4–5 weekly issues per month),         same health problems in the same order
                                             and the local daily general audience          and roughly the same proportions:
Public Health Variables                      newspaper 14.5 times per month (out of        high blood pressure (66% of respon-
    Cancer stories in Black newspapers       30–31 daily issues per month). Fre-           dents), diabetes (60%), HIV/STDs
were more likely than those in general       quency of reading Black newspapers did        (53%), cancer (43%), and heart disease
audience newspapers to include infor-        not vary significantly by sex, age,           (29%).
mation on racial disparities, personal       education, or income. In contrast,                When asked an open-ended question
mobilization and community mobiliza-         frequency of reading general audience         for the health issue that had concerned the
tion. They were also more likely to          newspapers increased with higher levels       respondent the most in the last
address prevention in general, secondary     of education (P5.001) and income              12 months, cancer was named most
prevention (ie, screening and early          (P5.01), and was positively correlated        frequently (32%), followed by diabetes
detection) specifically, and to refer        with age (P5.001).                            (15%), high blood pressure (10%), HIV/
readers to topic-related resources. Breast                                                 STDs (9%), and heart disease (8%). For
and prostate cancers were the leading        Perceptions of Black and General              all age categories, cancer was the health
cancer sites covered in both types of        Audience Newspaper Coverage                   issue that concerned respondents most,
newspapers, although prostate cancer             At least 84% of respondents strongly      followed by HIV/STDs for those
accounted for a larger proportion of all     agreed or agreed that the local Black         ,50 years, and diabetes for those
cancer stories in Black newspapers.          newspaper: 1) has a lot of influence in       $50 years. Respondents who have had a
                                             the Black community; 2) shows how             personal/family history of cancer named
Reader Survey                                national news affects the local commu-        the same health issues in the same order
                                             nity; 3) does a good job reporting on         and roughly the same proportions: cancer
Respondent Characteristics                   local issues; and 4) is fair and balanced     (36%), diabetes (14%), high blood
   Respondents were mostly women             in its reporting. Many respondents also       pressure (9%), HIV/STDs (9%), and
(76%), completed high school (86%),          strongly agreed or agreed that the local      heart disease (7%).

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                                                                                                   HIV/AIDS, a leading cause of death for
Table 1. Characteristics of cancer stories in Black and general population
newspapers                                                                                         African Americans in their 20s and 30s,
                                                                                                   was rated lower as a personal health
                                        Black newspapers       General population                  concern than as a problem affecting
                                         (n=598 stories)    newspapers (n=472 stories)     P
                                                                                                   Blacks. However, this would not explain
Journalistic variables                                                                             why diabetes and high blood pressure
  Average size in square inches               28.6                      24.4             ,.001
  Percent with local angle                    36.3                      25.5              .001     were rated lower as personal health
  Percent with a visual                       43.1                      43.0              .965     concerns than as population threats. A
  Percent above fold                          74.9                      74.1              .772     follow-up analysis that controlled for
Public health variables
                                                                                                   frequency of reading Black and general
  Percent with disparity information          29.8                      10.4             ,.001
  Percent with personal mobilization          42.4                      15.0             ,.001     audience newspapers, age, education,
  Percent with community mobilization         16.4                       4.9             ,.001     and personal or family history of cancer
  Percent with any prevention focus           79.7                      69.7             ,.001     did not change these results. Though
  Percent with primary prevention             30.0                      25.4              .096
                                                                                                   not asked in the current study, future
     focus
  Percent with secondary prevention           36.3                      20.3             ,.001     research may explore how personal or
     focus                                                                                         family history of these specific health
  Percent with referral to resources          42.5                      23.3             ,.001     issues (other than cancer) could help
Percent with primary cancer site                                                         ,.001
  Breast                                      31.3                      22.5
                                                                                                   explain these discrepancies.
  Prostate                                    19.2                       9.1                            Third, the study found that frequen-
  Colon and rectum                             7.5                       6.4                       cy of reading general audience newspa-
  Leukemia                                     3.5                       1.7                       pers varied by education, income, and
  Lung and bronchus                            1.7                       7.6
  Uterus                                       1.5                       1.1                       age, but was constant for readers of
  Ovary                                        1.0                       2.5                       Black newspapers. To the extent that
                                                                                                   socioeconomic status is an indicator of
                                                                                                   disparity, general audience newspapers
DISCUSSION                                       media sources. Black and general                  are read less by the most disadvantaged
                                                 audience newspapers both appear to                African Americans. This finding high-
    Exploring underutilized channels for         serve important functions in Black                lights and supports one unique feature
cancer communication is necessary to             communities. The unique aspects of                of Black newspapers – that their use is
help eliminate cancer disparities. Re-           Black newspapers – including covering             more universal and not limited to
search using these channels can help             issues and events specific for their local        members of the population with higher
inform future health communications              African American readership – might               levels of education or income. As a
and have implications for cancer-relat-          lend themselves to covering cancer or             result, use of the Black newspaper as a
ed policies. This national-level study of        other health topics in a similar, com-            channel for cancer communication
health and cancer coverage in Black              munity-focused way.                               should reach a broader cross section of
newspapers expands the limited exist-                Second, respondents to the reader             African Americans than would general
ing literature with three main findings.         survey thought that health issues other           audience newspapers.
First, Black newspapers publish pro-             than cancer were more serious for                      Although cancer coverage in Black
portionately more stories about cancer           Blacks, yet cancer was the most impor-            newspapers is more likely to have a local
than general audience newspapers, and            tant health issue for them personally.            angle, disparity information, personal
this coverage contains more desirable            This discrepancy is interesting given             mobilization, any prevention focus, and
attributes for public health advocates,          that cancer is the second leading cause           referral to resources than general audi-
such as being locally relevant and               of death among Blacks in the United               ence newspapers, these attributes are
containing mobilization information,             States 1 – and that incidence and                 still found in less than half of all cancer
referrals to resources, and prevention           mortality rates for a wide range of               stories. Both Black and general audience
information. Findings from both the              cancers are higher among African                  newspapers still have room to improve
content analysis and reader survey also          Americans than any other racial or                on their current quality of cancer
support claims that Black newspapers             ethnic group.1,39 Given that certain              coverage.
are community-focused. Black news-               diseases are more likely to affect younger
papers are also a trusted source of              or older adults, the age of the survey            Limitations
cancer information, trusted more than            sample (mean550 years) might explain                Three limitations of the study
general audience newspapers or other             part of these findings. For example,              must be recognized. First, although the

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Table 2. Respondents’ newspaper use, perceptions of coverage and health concerns (N=783)

Newspaper use
Average times/month (SD) has read the local (weekly) Black newspaper                                                               2.7 (3.2)
Average times/month (SD) has read the local (daily) general population newspaper                                                  14.5(12.2)
Perceptions of Black newspapers
The local Black newspaper has a lot of influence in the Black community.*                                                         85.7%
The local Black newspaper shows how national news affects my community.*                                                          84.0%
The local Black newspaper does a good job reporting local issues.*                                                                90.4%
The local Black newspaper does a good job reporting on issues relevant to Black community.*                                       92.9%
Comparing Black and general population newspapers
The local Black newspaper is fair and balanced in its reporting.*                                                                 84.3%
The general population newspaper is fair and balanced in its reporting.*                                                          53.4%
In the Black newspaper I can read about issues and events not covered in the general population newspaper.*                       91.8%
How much would you trust the information about cancer from:3
   A doctor or other health care professional                                                                                     71.4%
   Black newspapers                                                                                                               51.2%
   The Internet                                                                                                                   46.7%
   Television                                                                                                                     37.5%
   Magazines                                                                                                                      36.0%
   General population newspapers                                                                                                  33.1%
   Family or friends                                                                                                              24.4%
   The radio                                                                                                                      21.7%
Health concerns
Top health problems affecting Blacks4
  High blood pressure                                                                                                             65.1%
  Diabetes                                                                                                                        61.2%
  HIV/STDs                                                                                                                        55.6%
  Cancer                                                                                                                          39.0%
  Heart disease                                                                                                                   31.2%
  Violence                                                                                                                        25.0%
  Stroke                                                                                                                          21.6%
Health issue of most concern to you in last 12 months (n5731)
 Cancer                                                                                                                           31.7%
 Diabetes                                                                                                                         14.6%
 High blood pressure                                                                                                               9.6%
 AIDS/HIV/STDs                                                                                                                     9.3%
 Heart disease, heart attacks                                                                                                      8.3%
 Other topics                                                                                                                     26.4%
 * Percent ‘‘strongly agree’’ or ‘‘agree.’’
 3 Percent stating ‘‘a lot.’’
 4 Because respondents could mention any three health problems, percentages do not total 100%.

study reports on a national sample of                  local Black newspaper on a more               cases, because these characteristics are
Black newspapers, it was not intended                  sporadic basis and may have inflated          more likely to be ‘‘absent’’ from articles
to be a nationally representative sample.              estimates of reading frequency, though        in Black and/or general audience news-
Findings may not be generalizable to                   it is not clear whether or how it might       papers and thus more difficult to assess
other weekly Black newspapers, or to                   affect observed differences between use       reliability for their identification, the
daily or monthly Black newspapers in                   and perceptions of Black vs general           calculated kappa yields a more conser-
the United States.                                     audience newspapers. However, if the          vative estimate of reliability. For exam-
    Second, respondents in the reader                  purpose of media intervention is to           ple, reliability for personal mobilization
survey were those who had read the                     target those who regularly read Black         in terms of percent agreement is
local Black newspaper in our study at                  newspapers, these results are particularly    relatively higher (87%) than kappa
least once in the past month. This                     relevant.                                     (.72); a similar difference for commu-
selection bias may have resulted in a                       Third, a few of the content analysis     nity mobilization is also found (75% vs
sample of Black newspaper readers who                  variables had relatively low (ie, ,0.75)      .56), For these reasons, results from
are different than others who read the                 inter-coder reliability. In some of these     these variables with lower reliability

                                                      Ethnicity & Disease, Volume 18, Autumn 2008                                          493
BLACK NEWSPAPERS FOR CANCER EDUCATION - Caburnay et al

should be viewed with caution until                           source. The Howard Journal of Communica-            25. Swain K, Walsh-Childers K, Chance J.
replicated in other studies of cancer                         tions. 1999;10(3):147–167.                              Minorities in health stories: How newspapers
                                                        8.    Oliver P, Maney G. Political processes and              promote stereotypes, role models, and aware-
coverage in Black weekly newspapers.                          local newspaper coverage of protest events:             ness of social challenges. Paper presented at:
                                                              From selection bias to triadic interactions.            Association for Education in Journalism and
Application of findings                                       Am J Sociology. 2000;106(2):463–503.                    Mass Communication; August 10–13, 1996;
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reason to think that the Black press                           and present. Nieman Reports. 2003;57(3):13–            tising in African-American women’s popular
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cancer communication.                                         NNPA media services. Available at http://www.       29. Hoffman-Goetz L, Freidman D. Dispar-
                                                              nnpa.org/news/article/article.asp?sID524. Ac-           ities in the coverage of cancer informa-
                                                              cessed January 28, 2008.                                tion in ethnic minority and mainstream
ACKNOWLEDGMENTS                                        15.    Hatcher J. Passion for the ‘minor leagues’:             mass print media. Ethn Dis. 2005;15(2):
This study was supported by the National                      Nurturing devotion in an increasingly corpo-            332–340.
Cancer Institute’s Centers of Excellence in                   rate community press. Columbia Journalism           30. Stryker J, Emmons K, Viswanath K. Uncov-
Cancer Communication Research program                         Review. May/June 2003.                                  ering differences across the cancer control
(CA-P50-95815).                                        16.    Davis N. Ring around the metros. Presstime.             continuum: A comparison of ethnic and
                                                              September 1999.                                         mainstream cancer newspaper stories. Preven-
   The authors thank Stephanie McClure,
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Anthony Hurst, and I-Huei Cheng for
                                                              US newspapers. Reuters. June 12, 2006.              31. Wallack L, Dorfman L, Jernigan D, Themba
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    analysis. Journalism Quarterly. 1993;70(1):     41. Jemal A, Siegel R, Ward E, Murray T, Xu J,       Data analysis and interpretation: Caburnay,
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    study interview instrument. Bethesda, MD,       AUTHOR CONTRIBUTIONS                                 Acquisition of funding: Kreuter, Cameron
    2003.                                           Design concept of study: Caburnay, Kreuter,          Administrative, technical, or material assis-
40. U.S. Preventive Services Task Force. Guide to       Cameron, Luke, Cohen, McDaniels,                     tance: Caburnay, Kreuter, Cameron,
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    VA: International Medical Publishing, Inc.;     Acquisition of data: Cameron, McDaniels,             Supervision: Caburnay, Kreuter, Cameron,
    2002.                                               Wohlberg, Atkins                                     Luke, Cohen

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