1. Media-Directed Intervention Increases Likelihood of Cancer Stories in Black Newspapers
Sarah Betsworth
Douglas A. Luke, PhD, Glen T. Cameron, PhD,
Charlene A. Caburnay, PhD, MPH, Matthew W. Kreuter, PhD, MPH
Center for Excellence in Cultural Cancer Communication
Saint Louis University School of Public Health

2. Purpose
To examine the effectiveness of a customized media intervention on the amount and quality of cancer coverage in 24 Black weekly newspapers
The purpose of this study is to determine whether a cancer information news service that provides customized cancer stories can enhance the quantity and quality of cancer coverage in Black newspapers.

3. Problem
African Americans experience cancer at higher rates than other groups
Increasing reach, relevance of cancer information may help reduce disparities
As a group African Americans have the highest mortality rate for all cancers and
most major cancers
Many African Americans do not perceive cancer to be a high priority health problem, which combined with misconceptions, fears, and incomplete knowledge, could be barriers to screening or prevention
By increasing the reach and relevance of cancer information we may be able to help reduce cancer disparities.

4. Black newspapers Owned and managed by Blacks
Intended for Black consumers
Serve, speak, and fight for the Black minority
deFelice, 1969,
Wolseley, 1972
First, I will define some of the main terms relating to Black and general population newspapers.
A Black newspaper is one that is owned and managed by Blacks, intended for Black consumers, and serve, speak, and fight for the Black minority. Here is an example of a Black newspaper in St. Louis, the St. Louis American.

5. Black newspapers Provide unique perspective for African Americans
Serve a large proportion of US Black population
Black newspapers, circulation of 6-15 million
Read by African Americans
69% of respondents read Black newspaper in previous 2 weeks
Black newspapers were originally established to provide a mechanism for public dialogue within Black communities, to serve as a counterpoint to negative representations of or controversies involving Blacks, and as an outlet for stories of unique interest or concern to Black communities.
Although Black newspapers cannot match the reach of general population newspapers, they do serve a large proportion of the U.S. Black population. There are between 188 and 237 Black newspapers across the U.S., with a combined circulation ranging from 6 to 15 million.
To further illustrate reach of the Black newspaper, a 1993 survey of African American households found that 69% of respondents (N=2,094) reported reading a Black newspaper in the previous two weeks.
Cox & Nkomo, 1992; Davidson & Cotter, 1997; Gregory, 1998; Nkomo, 1992; Sylvester, 1993

6. General population newspapers
Intended for general population
No overt targeting to a given racial or ethnic group
Jones-Webb, et al., 1997
In contrast, A general population newspaper is one that is intended for the general population at large without specific targeting to a given racial or ethnic group. In St. Louis, the general population counterpart to the American is the Post-Dispatch.

7. General population newspapers
Perceived by African Americans as:
Inattentive to Black issues
Unbalanced in portrayal of Blacks
Lacking in coverage of Blacks and cancer
However, African Americans have been found to have negative perceptions of general population newspapers, including that they are inattentive to Black issues, unbalanced in their portrayal of Blacks, and lack coverage of Blacks and cancer specifically.
Brodie et al.,1999; Harris, 1981; Mastin, 2000; McAneny, 1994

8. Research questions
Does a customized media intervention affect the amount of health and cancer coverage in Black newspapers?
Does this customized media intervention influence the content of cancer stories in Black newspapers?
This presentation seeks to answer two research questions -- whether a cancer information media intervention can enhance the amount and content of cancer coverage in Black newspapers.

9. Translation and dissemination
Translate cancer science for local, racial,
and cultural relevance
Basic cancer science
Disseminate to Black newspapers
The focus of the intervention is translating basic cancer science, from sources such as the National Cancer Institute, the American Cancer Society, and scientific journals into localized, race specific, and culturally relevant news releases that are disseminated to Black newspapers.

10. Intervention Ozioma! - A cancer news service
Cancer-related news releases customized for African American communities
Sent bi-weekly to Black newspapers in intervention group
Our media intervention involves developing cancer news releases customized to African Americans in each specific community, and providing them to intervention newspapers on a bi-weekly basis.
To deliver this intervention, we created a cancer information news service and named it “Ozioma.” Ozioma, is a Igbo/Nigerian word meaning “good news”.

11. Ozioma! Active ingredients
Local and/or race specific cancer-related data
Information graphic or photograph
At least one core element:
Cancer is an important health issue
Cancer is not a death sentence
There are things you can do to prevent cancer
Every African American should be screened for cancer
It’s important to talk to family, friends about cancer
There are resources in your community
Each customized news release contains the following ingredients…

12. To illustrate how the active ingredients are incorporated into Ozioma news releases we can look at an example. This news release discusses colon cancer screening.

13. “…BLACKS IN NEW YORK DOING BETTER THAN NATIONAL AVERAGE”
The headline provides race- and place- specific language -- here we note that Blacks in New York are doing better than the national average when it comes to colon cancer screening.

14. lost their lives to colon cancer in 1990-1994 alone.”
“In Buffalo, 109 African
American men and women
lost their lives to colon cancer in alone.”
We continue the local angle by naming the community, and providing cancer-related data…

15. “African American men and women over age 50 in New York were more likely to complete the test than were African Americans in the U.S. as a whole.”
…specific to the local Black community.

16. “…health experts stress that there are many ways colon
cancer can be prevented.”
This quote and the others that follow…

17. “Even if colon cancer occurs, the survival rate is much higher if the cancer is found early through screening.”
…incorporate some of the core messages…

18. “More information about colon cancer, screening, and prevention can be found…”
… listed earlier.

19. So to summarize, first we took a story idea, like this NCI press release…

20. Transformed it into one of our press releases customized to each local African American community…

21. And monitored each of the intervention newspapers for any pickups of the Ozioma release. Here we have the resulting news story published in the Buffalo newspaper.

22. Sampling frames of Black and general population newspapers
Sample
24 Black newspapers
April 1, January 27, 2007
Large cities
Total population ≥ 200,000
Total African American population ≥ 100,000
Standard metropolitan areas (SMAs)
No geographic overlap with large city
Total population < 600,000
For this study, we selected a total of 24 Black newspapers from two different sampling frames: large cities and standard metropolitan areas. For both the large cities and SMAs, we also limited the sampling frames to communities with a local Black weekly newspaper and whose cancer mortality rates for Black men or women were greater than or equal to US rates.

23. Study design and variables
Community randomized intervention trial
Journalistic variables
Story Size
Location
Visual Elements
Headline Size
Local Angle
Public health variables
Cancer as health topic
Disparity Information
Personal Behavior Mobilization
Community Mobilization
Prevention Focus
Referral to Resources
Public Health Facts
The study design is a community randomized intervention trial, and the news releases were coded for both journalistic and public health variables.

24. Analysis Content analysis: Inclusion criteria Health story
Health promotion, wellness, disease prevention, well-being, lifestyle
Cancer story
Cancer key words, risk factors, cancer continuum, or policy in headline or first 2 paragraphs
Now that I’ve told you about the design of the intervention and how we develop news releases, I will discuss how the health and cancer stories were analyzed.
Each of the newspaper issues included in the sample was read cover to cover to first identify any health-related stories. These are classified as those pertaining to health promotion, wellness, disease prevention, well-being, lifestyle, and any mental, physical or spiritual aspects of health for individuals or populations.
Once a health-related story was identified, it was then determined whether or not it was also cancer-related. Cancer-related stories are those that, within the headline or first 2 paragraphs, contain cancer key words such as cancer, malignant, carcinogen or information about cancer risk factors, any stage of the cancer continuum, or cancer-related policy. Once a health- or cancer-related story was identified, it was flagged and later coded based on the variables discussed earlier.

25. Release adoption
37/444
Releases
sent to each
community
(12/05 - 9/07) 11
Newspapers
adopted
releases
102
Ozioma-
based stories
published
299,000
Potential
audience of
newspaper
readers
To date, 37 releases have been sent to 12 intervention communities over a 21-month period, and each of the releases have been adopted by at least one newspaper, leading to 102 stories or “hits” printed in the 12 intervention newspapers. The number of hits per release range from 1-6, with an average of about 3.
Ozioma-based stories published per release:
Range: 1-6
Mean = 2.9 (SD=1.3)
Median = 3.0

26. Characteristics of cancer coverage: Number of stories
Statistic p
# Total stories
6,819
F = 0.39
0.531
# Cancer stories
F = 1.84
0.175
# Non-cancer stories
F = 1.28
0.258
Proportion of cancer stories
F = 11.78
0.001
To answer the first research question, Does a customized media intervention affect the amount of cancer coverage in Black newspapers we examined in each Black newspaper issue the total number of health and cancer stories combined, the number of cancer and non-cancer stories alone, and the proportion of health stories that are cancer related….

27. Characteristics of cancer coverage: Number of stories
Statistic p
# Total stories
6,819
F = 0.39
0.531
# Cancer stories
F = 1.84
0.175
# Non-cancer stories
F = 1.28
0.258
Proportion of cancer stories
F = 11.78
0.001
The results found that the proportion of cancer stories were significantly higher for the intervention group compared to the control group post-intervention.
The total number of health and cancer stories combined was not different between pre- and post intervention, suggesting that the amount of total health-related coverage stayed the same, but that a larger proportion of these health stories were cancer related.

28. Characteristics of cancer coverage: Journalistic variables
Statistic p
Headline size
6,819
F = 0.22
0.641
Story size
F = 2.13
0.145
Story page location
6,813
OR = 1.09
0.469
# Graphics
F = 17.2
<0.001
Size of graphics
236
F = 0.94
0.334
Story locale
6,816
F = 14.6
Story local source
998
OR = 0.75
0.376
Localized information
850
OR = 1.48
0.180
To answer the second research question, Does a customized media intervention affect the content of cancer stories in Black newspapers, we examined the influence of the media intervention on the journalistic and public-health related characteristics of health and cancer stories…

29. Characteristics of cancer coverage: Journalistic variables
Statistic p
Headline size
6,819
F = 0.22
0.641
Story size
F = 2.13
0.145
Story page location
6,813
OR = 1.09
0.469
# Graphics
F = 17.2
<0.001
Size of graphics
236
F = 0.94
0.334
Story locale
6,816
F = 14.6
Story local source
998
OR = 0.75
0.376
Localized information
850
OR = 1.48
0.180
Of the eight journalistic characteristics examined in the health and cancer stories, the number of graphics accompanying stories, and the story locale were significantly different pre- and post intervention. There were a greater number of graphics present in health stories in the intervention group newspapers post-intervention compared to pre-intervention. In addition, a greater number of the intervention group stories’ events, issues, or features took place at the local level post intervention compared to pre-intervention.

30. Characteristics of cancer coverage: Public health variables
Statistic p
Cancer topic
6,819
OR = 1.36
0.030
Disparities information
1,002
OR = 1.27
0.400
Personal behavior mobilization
998
OR = 1.59
0.081
Community mobilization
997
OR = 0.57
0.140
Prevention focus
1,001
OR = 1.10
0.734
Referral to resources
OR = 1.44
0.716
Perspective facts
996
F = 3.23
0.073
Consequences facts
994
F = 5.92
0.015
Of the fifteen public health variables examined…

31. Characteristics of cancer coverage: Public health variables
Statistic p
Cancer topic
6,819
OR = 1.36
0.030
Disparities information
1,002
OR = 1.27
0.400
Personal behavior mobilization
998
OR = 1.59
0.081
Community mobilization
997
OR = 0.57
0.140
Prevention focus
1,001
OR = 1.10
0.734
Referral to resources
OR = 1.44
0.716
Perspective facts
996
F = 3.23
0.073
Consequences facts
994
F = 5.92
0.015
Cancer topic and consequences facts were significant at the 0.05 level. Within the intervention group, stories were 36% more likely to have cancer as the health topic post-intervention compared to pre-intervention. In addition, the intervention group stories had fewer negative public health facts, such as mortality rates or consequence of cancer treatment, post intervention.

32. Characteristics of cancer coverage: Public health variables
Statistic p
Cancer topic
6,819
OR = 1.36
0.030
Disparities information
1,002
OR = 1.27
0.400
Personal behavior mobilization
998
OR = 1.59
0.081
Community mobilization
997
OR = 0.57
0.140
Prevention focus
1,001
OR = 1.10
0.734
Referral to resources
OR = 1.44
0.716
Perspective facts
996
F = 3.23
0.073
Consequences facts
994
F = 5.92
0.015
A couple variables approached significance, personal behavior mobilization and perspective facts.
Personal mobilization is a call to action to individuals to change their health behavior.
Perspective facts might include information on incidence rates, or other data. For example, “Maryland’s incidence rate of cervical cancer is 7.9 per 100,000 women (lower than the national average)” would be an example of a perspective fact.
Stories in the intervention group were more likely to contain personal behavior mobilization information and had a greater number of perspective facts post intervention compared to pre-intervention.

33. Ozioma increases proportion of health stories about cancer, p=0.030
This graph illustrates the increase in proportion of health stories about cancer, post-intervention. Health stories in intervention group newspapers were 36% more likely than those in the control group to be about cancer.
This is evidence for an increase or shift in newspaper coverage from just health to cancer -- an important finding because it is a core outcome measure for this project.

34. Ozioma increases proportion of health stories about cancer
As a follow-up analysis, we also examined the shift in cancer coverage from pre- to post- intervention by newspaper adoption rate (the rate at which newspapers published Ozioma news releases - denoted as hits).
The results show a dose effect whereby newspapers with the highest adoption rates (defined as running at least eight Ozioma news releases) also show the largest shift in cancer coverage from health to cancer between pre- and post-intervention.

35. Summary of findings
Intervention vs. control newspapers, post- vs. pre-intervention
Higher proportion of health stories that were about cancer
Contained more graphics, more likely to take place locally
More likely to contain personal behavior mobilization information
No significant effects for containing risk factors, disparities, localization, or prevention characteristics
To summarize our findings, we found that the Ozioma intervention had a positive effect in shifting intervention newspapers’ health news environment.
Black newspapers in the intervention group had a significantly higher number of cancer stories as a proportion of all health stories.
We also found that intervention papers were more likely to contain cancer as the health topic, personal behavior mobilization information, graphics, and stories whose event, issue, or feature took place on a local level, post-intervention.
However, we did not find any significant effect for the likelihood of stories containing risk factor, disparities, localization, or prevention characteristics.

36. Summary of findings Important features of news releases Graphics
Personal calls to action
Local community
These findings illustrate the importance of adding graphics and personal calls to action to cancer news releases, along with having the story take place in the local community.

37. Limitations
Sample of Black newspapers not selected to be nationally representative
Did not examine communities on an individual basis for subtle community-level differences
Alternative explanations for intervention effects
Three limitations of this study should be recognized. First, while the sample of 24 Black newspapers is more representative of communities with larger African American populations than were previous studies, and though the study reports on a national sample of Black newspapers from large cities and standard metropolitan areas, it was never intended to be a nationally representative sample. Therefore, findings may not be generalizable to all other weekly Black newspapers, or to daily or monthly Black newspapers in the U.S.
Second, because we have limited community-level information, we did not examine communities on an individual basis. Many subtle community-level differences may be present but not teased apart with the current set of analyses.
And third, there may be alternative explanations for the intervention effects that we have not examined

38. Next steps
Integrate within existing organizations or communication systems
Expand to more Black newspapers
Adapt for other special population media or groups
e.g., television, radio, Hispanic/Latino population
Our next steps are to look at how we can translate and disseminate these results for others to benefit from them.
Some ideas that we have are:
First, we could integrate the Ozioma news service within existing organizations or communication systems to improve upon the press releases currently being sent to news outlets across the country
And second, we could expand Ozioma to more Black newspapers across the country or adapt it for other special population media such as Black TV or radio, or to other population groups.
In an era of declining general population newspaper readership, Black newspapers remain an important source of information for African Americans. This study helped to determine if and how we can effectively access this channel for cancer communication.

39. Acknowledgements Study Team Funding Agency
Saint Louis University Center for Cultural Cancer Communication (4C), University of Missouri - Columbia
Funding Agency
National Cancer Institute’s Centers for Excellence in Cancer Communication Research Program
I’d like to thank the project team at both St. Louis University and at the University of Missouri, and would like to acknowledge the National Cancer Institute for funding this research.

40. QUESTIONS?