what is zika virus
zika virus
News media plays a large role in the information the public receives during an infectious disease outbreak, and may influence public knowledge and perceptions of risk. This study analyzed and described the content of U.S. news media coverage of Zika virus and Zika response during 2016. A random selection of 800 Zika‐related news stories from 25 print and television news sources was analyzed. The study examined 24 different messages that appeared in news media articles and characterized them using theories of risk perception as messages with characteristics that could increase perception of risk (risk‐elevating messages; n = 14), messages that could decrease perception of risk (risk‐minimizing messages; n = 8), or messages about travel or testing guidance (n = 2). Overall, 96% of news stories in the study sample contained at least one or more risk‐elevating message(s) and 61% contained risk‐minimizing message(s). The frequency of many messages changed after local transmission was confirmed in Florida, and differed between sources in locations with or without local transmission in 2016. Forty percent of news stories included messages about negative potential outcomes of Zika virus infection without mentioning ways to reduce risk. Findings from this study may help inform current federal, state, and local Zika responses by offering a detailed analysis of how news media are covering the outbreak and response activities as well as identifying specific messages appearing more or less frequently than intended. Findings identifying the types of messages that require greater emphasis may also assist public health communicators in responding more effectively to future outbreaks.
1. INTRODUCTION
News media are a critical conduit of communication between public health officials and the public during public health emergencies. Therefore, understanding what risk‐related messages news media are communicating during a public health emergency, like the 2016 Zika virus1 outbreak, is important since it may affect what people understand about the virus and ways to protect themselves from infection and its consequences.
Communicating about the risk of Zika virus is challenging because the unusual nature of the virus and its disproportionate effects on a specific subpopulation present unique issues. Symptoms of Zika virus infection include fever, rash, headache, joint pain, conjunctivitis (red eyes), and muscle pain, but most people will not have symptoms or will only have mild symptoms.2014 As a result, they may not realize they are infected and can still transmit the virus.2016; Zika virus is spread primarily through the bite of an infected mosquito, but it can also spread through sex with an infected partner. If a pregnant woman is infected, she can pass the virus to her fetus.2016 Although Zika virus infection is rarely fatal, infection can have serious health outcomes, including Guillain–Barré syndrome (GBS) in a small proportion of those infected.2016 Most concerning of all is that infection during pregnancy can result in a range of neurological and other birth defects in a fetus or infant.2015 Approximately 10% of pregnant women with laboratory‐confirmed Zika virus infection have a fetus or infant with Zika‐virus‐related birth defects.2016
In the U.S. states, as of September 13, 2017, most cases of Zika virus infection have been associated with travel to areas with risk of Zika virus transmission. Locally acquired cases have occurred in Florida (n = 218, as of September 13, 2017), Texas (n = 6), and in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands (n = 36,862).2014., 2014.
The explosive growth of the Zika virus outbreak in Brazil and other areas of South America, Central America, and the Caribbean, and its spread to the United States, spurred news media coverage of the outbreak, particularly during 2016.2016 Research has shown that the news media may influence audience knowledge about and perceptions of some issues.2006, 2007, 2001 For instance, agenda setting theory shows that the news media can drive what topics or issues are salient or important in the public mindset.1972 Framing theory shows that the news media can also present issues in a number of different ways or through different perspectives, which can shape how an issue is conceptualized and influence public perception in varying ways. Message frames can influence understanding of an issue, and the more frequently the public is exposed to a message frame, the more likely a certain message frame is to sway opinion.2007 As a result, the news media may contribute to public understanding of Zika virus transmission and infection and influence how the public may prioritize response activities.
The messages and frames used to communicate about risks can influence how people understand and perceive risk, influence decisions on how to protect themselves and their families from risks, and decide what risk reduction or mitigation policies to support.1987, 2003, 1993, 1988, 1987 Risk perception theory shows that the social experience of risk is molded by more than a simple calculation of absolute risk. Instead, risk perception is a subjective judgment of risk influenced by cultural, social, and individual responses to a risk.1987, 1988 Additionally, communicating some aspects of a risk over others may influence how severe a risk is perceived to be. As noted by Slovic, a risk that is not observable, unknown to those exposed, unknown to science, new, with delayed effects, uncontrollable, dreaded, catastrophic, fatal, not easily reduced, increasing, or involuntary may be perceived as more severe than a risk that does not have these characteristics.1987
As noted by Kasperson et al., the information systems through which people receive messages about risk and the characteristics of public response shape perception of risk through “social amplification of risk,” and can be influenced by several attributes, such as information volume. In particular, information volume can intensify messages and increase perception of the seriousness of these messages.1988, 1984, Furthermore, signals about risk are processed by “amplification stations,” which include the news media, and can lead to the increase or decrease in intensity––as well as selective filtration––of these signals.1988, 2005 Research has shown that the news media serves as a key mediator of risk information by highlighting or downplaying certain messages and influencing the volume of certain messages about an event received by the public.2002, 2017 Other effects, such as deleting or adding information in the presentation of messages, altering the order of how messages are presented to the public, and placing the message in particular contexts can also be influenced by the media. Amplification stations and information volume are particularly important when considering the frequency of messages about Zika virus/response provided by the news media. Accordingly, news media coverage of Zika virus/response may influence public attitudes and perceptions about risks related to Zika virus/response. Investigation of the frequency of risk‐related messages provided by the news media may help to expand SARF scholarship by characterizing the risk signals produced by the news media as a risk amplification station.
Both communication practitioners and researchers agree that an important element of effective risk and crisis communication is that messages must contain information on how people can protect themselves, avoid harm, and reduce negative consequences of a crisis.2014, 2012, 2015 Although these protective action messages are often provided by public health officials to the media, news stories frequently fail to include these action messages.2014 Research also shows that adding instructional communication to risk and crisis media messages makes them more effective than media messages without this information and has a positive effect on self‐efficacy and behavioral intention of receivers of those messages.2015, 2014
The purpose of this study was to analyze and describe the content of U.S. news media coverage of Zika virus/response during 2016. Broadly, this research aims to characterize information about Zika received by the public. Specifically, it was designed to answer the research question: What messages does the news media provide about Zika risks and responses? Four areas of inquiry were used to describe the messages provided by the news media about Zika virus/response. These included the comparison of risk‐increasing and risk‐minimizing messages, specific message frequency, comparison in message frequency by source location, and comparison in message frequency before and after detection of locally transmitted cases. This content analysis used theories on risk perception to further characterize differing messages about Zika virus/response. Results may help inform Zika response efforts by offering a detailed description of the ways in which the news media is covering the outbreak and response activities as well as the specific messages that are most prominent. Findings may also assist public health communicators to communicate more effectively through the media about future outbreaks, as more is understood about which public health messages are more often conveyed to the public by the news media.
2. METHODS
To evaluate news media coverage of Zika virus/response and implications for risk perception by the public, we analyzed news stories focused on Zika virus/response from selected English‐language U.S. news sources that were published from January 1, 2016, through December 31, 2016. This period was chosen to capture both international spread and importation of the disease into the United States, as well as seasonal differences related to mosquito‐borne virus transmission.
2.1. Source Selection
We analyzed news coverage of Zika virus/response in 25 news sources (20 print and five television),2 which included: articles from the Atlanta Journal Constitution, Chicago Sun Times, Chicago Tribune, Denver Post, Fort Worth Star Telegram, Houston Chronicle, Los Angeles Times, Mercury News (San Jose), Miami Herald, New York Daily News, New York Times, Orlando Sentinel, Philadelphia Inquirer, Plain Dealer (Cleveland), San Antonio Express, Star Tribune: Newspaper of the Twin Cities (Minneapolis), Tampa Bay Times, USA Today, Virgin Islands Daily News, and Washington Post and transcripts from the following television news programs: ABC News World News Tonight, CBS Evening News, CNN Situation Room, Fox News Special Report, and NBC Nightly News. News source selection was based on the following nonmutually exclusive criteria: (1) geographic variation with at least three news sources from each of the four U.S. census regions (Northeast, Midwest, South, and West); (2) representation of news sources into areas at high risk for Zika virus transmission (e.g., states or territories that experienced locally transmitted cases of Zika virus in 20163); and (3) variation in news source type (print and television).
2.2. Search Strategy
News media stories were collected through a search of included news sources via LexisNexis, ProQuest, and NewsBank online archives using the search term “Zika.” If searches of the same source in different online archives resulted in different numbers of total articles, the results from the search that generated the higher number of resulting articles were used. Searches yielded 4,708 total stories. A list of all stories in random order was generated and each story was then reviewed for inclusion or exclusion until a total analytical sample of 800 stories was obtained. Stories were included if they were news stories or opinion pieces (editorial or opinion‐editorial) about Zika virus/response and excluded if they were print stories shorter than 100 words, corrections, letters to the editor, solely business focused (e.g., articles covering stock values of cruise companies), duplicates, indexes, introductions/lead ins, calendar/event reports, and items that mentioned Zika virus only in passing (e.g., articles covering political events and listing the Zika virus outbreak as one of many issues of the time but not providing information about Zika). The first author reviewed the entire article when applying exclusion criteria. In total, 1,482 of the randomized stories were reviewed for these criteria to achieve the desired sample size of 800 (44% exclusion rate).
2.3. Content Analysis and Measures
Before coding the analytical sample of 800 news stories, an informal news media scan was conducted to identify common messages related to Zika virus/response, with a focus on messages about Zika‐virus‐related guidance and messages that could increase or decrease an individual's perception of risk severity in relation to Zika virus/response. The latter types of messages were mapped onto factors drawn from risk perception literature that have been demonstrated to either elevate or minimize audiences’ perception of a risk's severity. The initial set of messages was assembled based on messages used in previous disease responses,2017 pertinent characteristics of the Zika virus, and ongoing issues in Zika response that were known to the research team or were observed in the initial scan. It was then reviewed by those who had expertise and pre‐existing knowledge of Zika‐virus/response‐related news media messages in circulation, and additional messages were added. The instrument was then piloted on a separate sample of 80 randomly selected Zika‐virus/response‐related news stories from the study period that were not included in the analysis but were drawn from the set of news sources used in the analysis. The coding instrument was then refined on the basis of results from pilot testing.
Two members of the research team then independently coded a random sample of 25% (n = 200) of the news stories in the study sample to assess interrater reliability for each dichotomous variable (yes/no item). Most items (n = 23) had kappa values above 0.69 and therefore met conventional standards for adequate reliability.1977 One item had kappa values slightly below this threshold but was rare (i.e., found in only a small number of articles)2005 and met adequate reliability standards using Krippendorff's alpha.2004 It was therefore included in the analysis. Eight items were dropped from the analysis because of poor agreement (Appendix A given in the Supporting Information). Excluded items often required more interpretation by coders or were rare, making them difficult to code consistently. The final set of messages used for data analysis included 14 messages with characteristics likely to increase perception of risk (risk‐elevating messages) related to Zika virus/response, eight likely to decrease perception of risk (risk‐minimizing messages) related to Zika virus/response, and two guidance messages (Table I). (See Appendix B given in the Supporting Information for list of example messages.)
| Print and TV News Stories (n = 800)a % of News Stories with Message | |
|---|---|
| Risk‐Elevating Messageb | |
| Science does not fully understand the risks of infection with Zika virus | 17 |
| Challenges in testing/diagnosis | 4 |
| No or limited countermeasures | 23 |
| Asymptomatic people could spread Zika virus | 4 |
| Zika virus and travel | 43 |
| Zika virus may spread to the United States or is present (U.S. states only) | 51 |
| Infection could cause GBS or adult neurologic disease | 16 |
| Infection during pregnancy causes birth defects | 67 |
| Zika virus could be in the blood supply | 7 |
| You can get Zika virus infection from sex | 31 |
| You can get Zika virus infection from a mosquito | 74 |
| Prevention tactics are controversial or may cause problems if conducted | 7 |
| Mosquito control efforts are not effective | 4 |
| Travel to areas with/potential for Zika virus transmission is not safe | 30 |
| Risk‐Minimizing Message | |
| Transmission in the United States will not be widespread | 4 |
| Serious adverse events occur in a limited number of those infected | 23 |
| Efforts are underway to protect the blood supply | 4 |
| Infection can be prevented by applying mosquito repellent | 21 |
| Infection can be prevented by wearing appropriate clothing (e.g., long sleeves and pants) | 11 |
| Infection can be prevented by using safe sex practicesc | 15 |
| Mentions individual mosquito control efforts (dumping water and AC screens) | 15 |
| Mentions public health/government mosquito control efforts (GMO mosquitoes, Wolbachia mosquitoes, traps, aerial spraying, and awareness/outreach campaigns) | 31 |
| Guidance Message | |
| Message about CDC travel warning regarding Zika virus/transmission | 19 |
| Mentions guidelines for testing | 6 |
- aSources included in all news stories are ABC News World News Tonight,Atlanta Journal Constitution, CBS Evening News,Chicago Sun Times, Chicago Tribune, CNN Situation Room,Denver Post, Fort Worth Star Telegram, Fox Special Report,Houston Chronicle, Los Angeles Times, Mercury News (San Jose), Miami Herald, NBC Nightly News,New York Daily News, New York Times, Orlando Sentinel, Philadelphia Inquirer, Plain Dealer (Cleveland), San Antonio Express, Star Tribune: Newspaper of the Twin Cities (Minneapolis), Tampa Bay Times, USA Today, Virgin Islands Daily News, and Washington Post.
- bSee Appendices A and B in the Supporting Information for detailed descriptions of content of coded messages.
- cSafe sex practices included: a male wearing a condom to prevent acquiring or transmitting Zika virus infection, abstaining from sex to prevent individual transmission/acquisition of Zika virus infection, abstaining from sex by a pregnant woman to prevent acquisition and vertical transmission of Zika virus infection, and the use of other contraceptives (e.g., birth control) by a woman of child‐bearing age who is at risk for Zika infection (i.e., to prevent vertical transmission in a potential pregnancy).
2.4. Data Analysis
To evaluate the content of news stories about Zika virus/response, we calculated the proportion of news stories (the unit of analysis) in the study sample that mentioned each Zika‐virus/response‐related message. Chi‐squared tests were then conducted to test differences in the proportion of news stories that mentioned each Zika‐related message from news sources based in areas at high risk for Zika virus transmission compared to national news sources or those based in areas at lower risk. Chi‐squared tests were also conducted to test differences in message frequency before and after local transmission was first confirmed in the United States on July 29, 2016.
3. RESULTS
3.1. Comparison of Risk‐Increasing and Risk‐Minimizing Messages
Of the 800 Zika‐related news stories included in the analysis, 713 (89%) were print news and 87 (11%) were television news. Risk‐elevating messages were found in 96% of news stories, while risk‐minimizing messages were found in 61% of news stories. Both types of messages were found in 61% of news stories, while only 4% had neither type of message (Table I).
3.2. Specific Message Frequency
Three specific risk‐elevating messages were found in more than 50% of news articles. These messages included those about the potential for mosquito‐borne transmission (74%), that infection during pregnancy could cause birth defects (67%), and the spread of Zika virus to or presence of Zika virus in the U.S. states (51%). The three most frequent risk‐minimizing messages included those about public health or government efforts to control mosquito populations (31%), serious adverse events occurring in a limited number of those infected (23%), and the ability to prevent Zika virus infection by applying insect repellent (21%) (Table I).
Messages about potential negative health effects of Zika virus infection were skewed toward birth defects: 51% mentioned birth defects without mention of adult neurologic disease (including GBS); 15% of articles mentioned both birth defects and adult neurological disease; and less than 1% mentioned only adult neurological disease. Messages about different modes of transmission were similarly skewed, with only 27% of news stories about Zika virus/response containing messages about both mosquito‐borne and sexual transmission. Forty‐seven percent of news stories contained only messages about mosquitoes transmitting the disease, while 4% contained only messages about sexual transmission. The most commonly mentioned personal action to reduce transmission risk was applying insect repellent (21%), while practicing safe sex4 (15%) and wearing appropriate clothing (i.e., long sleeves and pants; 11%) were mentioned less frequently. Messages about individual efforts to reduce mosquito populations around homes (e.g., eliminating standing water) were found in 15% of stories. Interestingly, only 27% of articles mentioned both potential negative health effects and individual ways to prevent Zika virus infection or reduce mosquito populations. More often (40%), stories included messages about negative potential outcomes of Zika virus infection without mentioning ways to reduce risk.
3.3. Comparison in Message Frequency by Source Location
Significant differences in message frequency were found when comparing news sources in areas at high risk for Zika virus transmission to national news sources or those in areas at low risk for Zika virus transmission (Table II). In general, many risk‐minimizing messages appeared significantly more frequently in news sources located in areas where local infections occurred in 2016. For instance, several different messages about prevention of transmission of Zika virus and mosquito control were significantly more frequent in these sources. Conversely, a number of risk‐elevating messages were more frequently found in national news sources and those from areas at low risk for Zika virus transmission. In particular, these sources mentioned negative health effects (both GBS [11% for sources in areas at high risk for Zika virus transmission vs. 20% for sources in areas at low risk for Zika virus transmission; p < 0.001] and birth defects [56% vs. 74%; p < 0.001]) significantly more often. However, messages about Zika virus and travelers, as well as spread to the United States, were found significantly more often in news sources from areas at high risk for Zika virus transmission (51% vs. 38%; p < 0.001 and 64% vs. 42%; p < 0.001).
| % of News Stories with Message | |||
|---|---|---|---|
| News Sources in Areas with Local Transmission in 2016 (Areas at High Risk for Zika Virus Transmission; n = 332)a | Nationally Produced News Sources or Those in Areas Without Local Transmission in 2016 (Areas at Low Risk for Zika Virus Transmission; n = 468)b | Source Location with Higher Message Frequency | |
| Risk‐Elevating Message | |||
| Science does not fully understand the risks of infection with Zika virus | 11 | 22 | Areas at low risk ***c |
| Challenges in testing/diagnosis | 5 | 4 | – |
| No or limited countermeasures | 20 | 26 | – |
| Asymptomatic people can spread Zika virus | 4 | 4 | – |
| Zika virus and travel | 51 | 38 | Areas at high risk *** |
| Zika virus may spread to the United States or is present (U.S. states only) | 64 | 42 | Areas at high risk *** |
| Infection could cause GBS or adult neurologic disease | 11 | 20 | Areas at low risk *** |
| Infection during pregnancy causes birth defects | 56 | 74 | Areas at low risk *** |
| Zika virus could be in the blood supply | 9 | 6 | – |
| You can get Zika virus infection from sex | 30 | 31 | – |
| You can get Zika virus infection from a mosquito | 72 | 76 | – |
| Prevention tactics are controversial or may cause problems if conducted | 9 | 6 | – |
| Mosquito control efforts are not effective | 4 | 4 | – |
| Travel to areas with/potential for Zika virus transmission is not safe | 24 | 34 | Areas at low risk ** |
| Risk‐Minimizing Message | |||
| Transmission in the United States will not be widespread | 1.51 | 6 | Areas at low risk ** |
| Serious adverse events occur in a limited number of those infected | 20 | 26 | – |
| Efforts are underway to protect the blood supply | 4 | 4 | – |
| Infection can be prevented by applying mosquito repellent | 28 | 15 | Areas at high risk *** |
| Infection can be prevented by wearing appropriate clothing (e.g., long sleeves and pants) | 16 | 7 | Areas at high risk *** |
| Infection can be prevented by using safe sex practices | 14 | 16 | – |
| Mentions individual mosquito control efforts (dumping water and AC screens) | 20 | 11 | Areas at high risk *** |
| Mentions public health/government mosquito control efforts (GMO mosquitoes, Wolbachia mosquitoes, traps, aerial spraying, and awareness/outreach campaigns) | 43 | 22 | Areas at high risk *** |
| Guidance Message | |||
| Message about CDC travel warning regarding Zika virus/transmission | 18 | 19 | – |
| Mentions guidelines for testing | 7 | 5 | – |
- aSources included in news sources in states or territories with local transmission in 2016 are Fort Worth Star Telegram, Houston Chronicle, Miami Herald, Orlando Sentinel, San Antonio Express, Tampa Bay Times, and Virgin Islands Daily News.
- bNationally produced news sources or those in locales without local transmission in 2016 are ABC News World News Tonight, Atlanta Journal Constitution, CBS Evening News,Chicago Sun Times, Chicago Tribune, CNN Situation Room,Denver Post, Fox Special Report,Los Angeles Times, Mercury News (San Jose), NBC Nightly News,New York Daily News, New York Times, Philadelphia Inquirer, Plain Dealer (Cleveland), Star Tribune: Newspaper of the Twin Cities (Minneapolis), USA Today, and Washington Post.
- cChi‐squared test. *p < 0.05, **p < 0.01, ***p < 0.001.
3.4. Comparison in Message Frequency Before and After Detection of Locally Transmitted Cases
Message frequency also changed significantly before and after local cases were first diagnosed in a U.S. state on July 29, 2016 (Table III). In most cases, risk‐elevating messages were more common before local transmission in the United States was confirmed. Messages about negative health effects (both GBS [20% before vs. 11% after; p < 0.001] and birth defects [76% before vs. 55% after; p < 0.001]) were significantly lower in the later time period as were messages about the ability of Zika virus to be transmitted sexually (37% before vs. 22% after; p < 0.001) and prevention of sexual transmission of Zika virus (19% before vs. 10% after; p < 0.001). The frequencies of messages about government efforts to control mosquito populations (23% before vs. 42% after; p < 0.001) and controversy surrounding Zika virus infection prevention and Zika response efforts (4% before vs. 11% after; p < 0.001) were significantly higher after the first local case was diagnosed in a U.S. state.
| % of News Stories with Message | |||
|---|---|---|---|
| Before First Case of Local Transmission (July 29, 2016; n = 448) | After First Case of Local Transmission (July 29, 2016; n = 352) | Source Type with Higher Message Frequency | |
| Risk‐Elevating Message | |||
| Science does not fully understand the risks of infection with Zika virus | 23 | 11 | Before***a |
| Challenges in testing/diagnosis | 4 | 5 | – |
| No or limited countermeasures | 26 | 19 | Before* |
| Asymptomatic people could spread Zika virus | 5 | 3 | – |
| Zika virus and travel | 47 | 38 | Before** |
| Zika virus may spread to the United States or is present (U.S. states only) | 35 | 71 | After*** |
| Infection could cause GBS or adult neurologic disease | 20 | 11 | Before*** |
| Infection during pregnancy causes birth defects | 76 | 55 | Before*** |
| Zika virus could be in the blood supply | 8 | 6 | – |
| You can get Zika virus infection from sex | 37 | 22 | Before*** |
| You can get Zika virus infection from a mosquito | 76 | 71 | – |
| Prevention tactics are controversial or may cause problems if conducted | 4 | 11 | After*** |
| Mosquito control efforts are not effective | 3 | 4 | – |
| Travel to areas with/potential for Zika virus transmission is not safe | 31 | 28 | – |
| Risk‐Minimizing Message | |||
| Transmission in the United States will not be widespread | 4 | 3 | – |
| Serious adverse events occur in a limited number of those infected | 28 | 18 | Before*** |
| Efforts are underway to protect the blood supply | 4 | 4 | – |
| Infection can be prevented by applying mosquito repellent | 19 | 23 | – |
| Infection can be prevented by wearing appropriate clothing (e.g., long sleeves and pants) | 10 | 13 | – |
| Infection can be prevented by using safe sex practices | 19 | 10 | Before*** |
| Mentions individual mosquito control efforts (dumping water and AC screens) | 14 | 16 | – |
| Mentions public health/government mosquito control efforts (GMO mosquitoes, Wolbachia mosquitoes, traps, aerial spraying, and awareness/outreach campaigns) | 23 | 42 | After*** |
| Guidance Message | |||
| Message about CDC travel warning regarding Zika virus/transmission | 16 | 22 | After* |
| Mentions guidelines for testing | 4 | 8 | After* |
- aChi‐squared test. *p < 0.05, **p < 0.01, ***p < 0.001.
4. DISCUSSION
These findings provide researchers and public health communicators with critical information on what Zika‐related messages audiences may be exposed to and point to some areas in which messaging and relationships with reporters and editors from an array of news media outlets can be strengthened. These findings also help to characterize the news media as a station for social amplification of risk.
4.1. High Frequency of Risk‐Elevating Messages
The fact that news stories about Zika virus/response more frequently mentioned risk‐elevating messages––e.g., mosquito‐borne transmission, potentially catastrophic birth defects, and potential spread in the United States––may have increased public concerns.2007, 1988 In some cases, increasing public awareness of risks may be a desired outcome; in others, public concerns may be too extreme. This and other research support the idea that messages in the news media about infectious disease outbreaks are often skewed toward increasing public perception of risk.2017 The high frequency of risk‐elevating messages may suggest that, in the context of an infectious disease outbreak, the news media may be more likely to serve as a station for social amplification of risk, rather than attenuation of risk.
4.2. Emphasis of Some Messages Over Others
Results also show that some messages may be largely omitted or muted in news coverage––for example, the message that people who are infected but who have no or mild symptoms can still spread the disease (4%)––which may lead the public to be misinformed about sources of risks related to Zika virus and Zika response. Additionally, frequency imbalances were found when considering messages about different modes of transmission and different outcomes. For example, transmission messages about mosquitoes were mentioned twice as often as sexual transmission messages (74% vs. 31%), and messages about negative outcomes of potential birth defects were more frequent than GBS (67% vs. 16%). The higher frequency of news coverage may be appropriate as both sexual transmission and GBS are less common, and pregnant women and their partners are prime targets of Zika‐related messaging. But these imbalances may also skew larger public understanding of other modes of transmission and negative outcomes of Zika virus infection and result in reduced vigilance in populations not currently pregnant, considering pregnancy, or in a sexual relationship with a woman of child‐bearing age.
4.3. Negative Outcomes Versus Protective Actions
Our findings also indicate that information about preventing Zika virus transmission and reducing risk from mosquitoes appeared less frequently in news coverage of Zika virus/response than messages about potential negative outcomes related to the Zika virus infection, a finding consistent with previous research showing standard media stories are less likely to contain protective action messages.2014 Public health officials routinely include recommended protective actions in their messaging. Without media providing this critical information, increased concern cannot be translated into increased adoption of protective behaviors without additional information seeking by members of the public. Therefore, our findings suggest that relationships between public health officials and the news media need to be strengthened in ways that encourage reporters and editors to include protective actions in their stories on the threat.
4.4. News Source Location
The implications of geographic variability in risk‐related messages across news stories support previous research on news media coverage of Ebola2017 and provide additional information for public health practitioners and news providers, although the implications for practice are less obvious. News stories originating in areas at high risk for Zika virus transmission were more likely to mention protection steps, whether those steps were individual actions or government efforts. These patterns could be positive as people living in areas at greater risk may be more likely to receive the protective information they need. At the same time, people outside of areas at high risk for Zika virus transmission may have less exposure to messages about protective actions. Although messages in airports and ports could supplement this lack of exposure via news media, it may be important for travelers and to prevent spread to other areas in the United States. Our findings indicate that public health communicators need to work with the news media to more effectively ensure messages about protective actions are emphasized even in areas without immediate risk of disease spread.
4.5. Change in Messages Over Time
The differing frequencies of risk‐elevating and risk‐minimizing messages in news stories before and after local transmission was detected in the continental United States show a disparity in the timing of risk‐elevating messages. The shift in messages may have changed as a result of local transmission, but it may also be related to increasing scientific understanding about Zika virus transmission and implementation of mosquito control activities over the course of the year. Messages about sexual transmission and prevention of sexual transmission of Zika virus declined after local mosquito transmission was announced. This may be the result of decreased attention to cases of sexual transmission later in the outbreak, or the fact that once local transmission is established, sexual transmission is not reported as a transmission route. In addition, messages about negative outcomes similarly declined in this period. This reduction in the frequency of important messages about Zika virus infection risks and prevention actions may have reduced public exposure to these informational messages, potentially leading to decreased knowledge and risk perception on the part of the public.
5. LIMITATIONS
These results should be considered in the context of a number of limitations. The news story sample included print and television news sources but not all sources through which many Americans may receive at least some news (radio, social media, local television, and blogs). Additionally, one coding item did not meet conventional reliability standards but had very high raw percent agreement and therefore remained in the coding instrument. Also, some messages may have not been accounted for in the coding instrument or were eliminated due to poor agreement and the final set of messages included a greater number of risk‐elevating messages than risk‐minimizing messages. Although the instrument development process should have accounted for any messages that may have not initially been included, the imbalance of the number of each type of message may have influenced results about the overall frequency of each type of message. Finally, analyses of competing news stories, number of people exposed to these Zika‐related messages, and influence of messages were beyond the scope of this study.
6. CONCLUSIONS
- Develop plans to work more collaboratively with reporters and editors
- Explore ways to make messages more appealing and comprehensible
- Anticipate messages requiring greater emphasis
These actions and the results of this study may help public health communicators refine and shape Zika‐virus/response‐related messaging to be more effective in the context of what messages the news media has been using and also improve responses to future outbreaks.
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