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Smoking prevalence in the lesbian, gay, and bisexual (LGB) community is higher than in the mainstream population. The reason is undetermined; however, normalization of tobacco use in the media has been shown to affect smoking rates. To explore whether this might be a factor in the LGB community, we examined noncommercial imagery and text relating to tobacco and smoking in LGB magazines and newspapers. Tobacco-related images were frequent and overwhelmingly positive or neutral about tobacco use. Images frequently associated smoking with celebrities. Text items unrelated to tobacco were often illustrated with smoking imagery. Text items about tobacco were likely to be critical of tobacco use; however, there were three times as many images as text items. The number of image items was not accounted for by the number of text items: nearly three quarters of all tobacco-related images (73.8%) were unassociated with relevant text. Tobacco imagery is pervasive in LGB publications. The predominant message about tobacco use in the LGB press is positive or neutral; tobacco is often glamorized. Noncommercial print images of smoking may normalize it, as movie product placement does. Media advocacy approaches could counter normalization of smoking in LGB-specific media.
Tobacco use is the leading preventable cause of death in the United States (Department of Health and Human Services, 2000). Smoking prevalence in the United States has declined substantially since its high point in 1965 (Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, & Centers for Disease Control and Prevention, 1999) when 42.4% of adults smoked, to 22.8% in 2001 (Woollery, Trosclair, Husten, Caraballo, & Kahende, 2003). Tobacco still causes the premature deaths, however, of approximately 440,000 people in the United States annually (Prevalence of current cigarette smoking among adults and changes in prevalence of current and some day smoking—United States, 1996–2001–2003).
Smoking prevalence among LGB people is higher than it is among their heterosexual counterparts (Greenwood et al., 2005; Ryan, Wortley, Easton, Pederson, & Greenwood, 2001; Stall, Greenwood, Acree, Paul, & Coates, 1999; Tang et al., 2004). A study of men who have sex with men in four urban areas found that 31.4% were smokers, compared with 24.7% of men in general (Greenwood et al., 2005). A population-based telephone survey in California found that smoking prevalence among gay men was 33.2%, compared with 21.3% among heterosexual men (Tang et al., 2004). The California sample also found that lesbians’ smoking rate (25.3%) was 70% higher than that of heterosexual women (14.9%). Data on bisexual (and trans-gender) people are anecdotal but suggest similar patterns. Why LGB people smoke at higher rates is undetermined; hypotheses include the stresses of homophobia and marginalization, and a culture historically centered around bars, where smoking has been a norm (Plumb, 1998; Stall et al., 1999). However, little research has been done to determine why smoking prevalence is so high in this community.
The tobacco industry has identified the LGB community as a valuable market (Offen, Smith, & Malone, 2003; Smith & Malone, 2003; Yamey, 2003). Several companies have advertised in the LGB press, sponsored community events (Drabble, 2001), and contributed money to LGB organizations (Offen, 2001). Such advertising and promotion is known to affect prevalence (Saffer & Chaloupka, 2000). But other factors also may be relevant.
One contributing factor may be the perception that smoking is normal in the LGB community. Normalization of smoking in the media has been identified as contributing to the mainstream tobacco disease epidemic (Brown & Witherspoon, 2002; Dalton et al., 2003; Malone, Boyd, & Bero, 2000; Sargent et al., 2002; Wakefield, Flay, Nichter, & Giovino, 2003; Watson, Clarkson, Donovan, & Giles–Corti, 2003). Numerous studies have examined tobacco content in the popular press, including articles (Albright, Altman, Slater, & Maccoby, 1988; Altman, Slater, Albright, & Maccoby, 1987; Dewhirst & Pollay, 2001; Kelly, Slater, Karan, & Hunn, 2000) and articles (Balbach & Glantz, 1995; DeJong, 1996; Durrant, Wake-field, McLeod, Clegg-Smith, & Chapman, 2003; Kennedy & Bero, 1999; Lima & Siegel, 1999; Magzamen, Charlesworth, & Glantz, 2001; Menashe & Siegel, 1998; Wenger, Malone, & Bero, 2001; Wenger, Malone, George, & Bero, 2001). Concern about such content is two-fold. Articles and editorials may be framed so as to minimize the harms of tobacco use, glamorize smoking, or to emphasize political arguments (e.g., about clean indoor air laws) favorable to industry positions. Advertising may also glamorize smoking and minimize its dangers in the effort to persuade readers to try specific brands. A third category of tobacco-related material—images of smoking in the movies—has also come under considerable scrutiny (Dalton et al., 2003; Gibson & Maurer, 2000; McCool, Cameron, & Petrie, 2001; Sargent et al., 2002). Tobacco use in movies normalizes it, thus contributing to the tendency to start or sustain smoking. Rates of smoking in movies have not declined as they have in the U.S. population (Kacirk & Glantz, 2001). Among youth, viewing movies containing smoking has been linked to starting to smoke (Dalton et al., 2003).
While there has been intense research interest in the contribution of media portrayals of tobacco, however, noncommercial imagery in print media has been largely ignored as a potential avenue for “selling” smoking. Previous studies also have focused predominantly on mainstream publications (Chapman, Jones, Bauman, & Palin, 1995), while smoking has become concentrated among certain subgroups who may obtain information through alternative media, including LGB people (Gross, 2001; Streitmatter, 1993, 1995).
Normalization has been defined as making tobacco use look acceptable (Smoke Screeners, 2003). Normalization occurs when smoking is integrated uncritically into an image. Such integration is known in marketing as product placement, the display or use of a product in what is assumed to be a noncommercial setting, such as a movie or television program. Product placement often is referred to as brand placement, since the point of such display is generally the promotion of a specific brand (Karrh, 1998). In most cases, this is because the placement is a matter of replacing a generic item (shoe, pizza) that a character is using with a branded version (Nike, Pizza Hut), and making sure the brand or logo is prominently displayed or mentioned or both. Companies routinely pay for placement of their products (Balasubramanian, 1994; Darlin, 1995), and sometimes brands are “simply ‘included’ in programming”—that is, featured in order to add verisimilitude. This distinction is generally irrelevant to the viewer, since it involves the intention of the creator and is “often invisible to a program’s audience” (Karrh, 1998).
Placement has several advantages as a promotional strategy. Research shows that placement may be equally or more effective than direct advertising, as measured by audience recall, recognition, or intention to purchase a product or brand (Babin & Carder, 1996; Gupta & Lord, 1998; Law & Braun, 2000; Shapiro, MacInnis, & Heckler, 1997). This may be because viewers tend to disengage from or discount advertising, whereas placement is seamlessly integrated with programming, plot, and characters with which the viewer is involved (Hawkins & Hoch, 1992; Janiszewski, 1993; Lord & Putrevu, 1993; Russell, 2002; Shapiro, 1999; Shapiro et al., 1997). Placement can take advantage of implied celebrity endorsement, particularly since any depiction in mass media gives an aura of celebrity to the subject. Such endorsement may be particularly powerful in the case of smoking, both because brands primarily are sold through image (Balbach, Gasior, & Barbeau, 2003; Donovan, Jancey, & Jones, 2002; Sutton & Robinson, 2004; Wakefield, Morley, Horan, & Cummings, 2002), and because no celebrity endorsements have been used in U.S. cigarette advertising since 1965. Placement also allows products to be placed in contexts that support or emphasize their symbolic qualities by associating them with other goods or with a “lifestyle” (Dewhirst & Hunter, 2002; McCracken, 1988; Wenger, Malone, George et al., 2001). These qualities can operate for specific brands, but also for types of products or activities in general, such as cigarettes and smoking.
Most tobacco-related content analyses of static images have focused on cigarette advertisements in magazines (Altman et al., 1987; King, Reid, Moon, & Ringold, 1991; Ringold & Calfee, 1989; Warner, 1985b) or on billboards (Schooler, Basil, & Altman, 1996). Most analyses of noncommercial imagery have focused on movies (Dalton et al., 2003; Gibson & Maurer, 2000; McCool et al., 2001; Sargent et al., 2002; Sargent, Dalton, Heatherton, & Beach, 2003; Wakefield et al., 2003). Print media also contain noncommercial imagery, however, including photographs and other illustrations accompanying articles, editorially-selected fashion and event photos, and cover art. If we regard smoking imagery as product placement, as previous work on movies and television has suggested it is, it is important to examine all examples of such images to understand the media environment. Indeed, if the power of product placement lies in viewers’ perception that they are not viewing a commercial message, it may be especially important to understand how smoking is depicted noncommercially. Therefore, to explore this question as it relates to the LGB community, we examined tobacco and smoking images in the LGB press.
Placement in magazines and newspapers has been used by the tobacco industry in the past. Placement of editorials, op-eds, and news articles has been used in the African American press to “generate balanced/favorable coverage” of tobacco-related issues (Smith, 1987). RJ Reynolds distributed cigarettes to fashion photographers for use in photo shoots of models and celebrities (Cowan & Rogers, 1980). Thus, to call any tobacco-related content “noncommercial” is somewhat problematic. We have used this nomenclature because the material examined was presented as noncommercial and we have no specific evidence otherwise.
This study breaks new ground in two ways. First, it examines for the first time the tobacco text and imagery in the LGB press. Second, this is the first study of any press to examine the entire universe of noncommercial tobacco-related material, including text and imagery.
Major LGB print media have two primary forms: national magazines and community newspapers. Our data sources consisted of the 5 largest-circulation national magazines (3 for gay men, 2 for lesbians); 3 smaller-circulation magazines (1 directed at African American gay men and lesbians, 1 for bisexuals, and 1 for HIV-positive people); and 13 community newspapers (Table 1). (Although transgender people make up part of the audience for these periodicals, we were unable to find any periodicals directed primarily at them. In addition, there are no data on smoking prevalence among transgender people. We therefore have restricted our discussion to LGBs.) We selected the magazines on the basis of their circulation, with the addition of the smaller periodicals to gain demographic breadth. We selected the newspapers on the basis of geographic diversity, although we were limited to those of which local libraries had the most complete collections. We examined all available issues (N = 4724) published between January 1990 and December 2000. Two research assistants collected two types of items: images and text having tobacco content. Imagery included all nonadvertising images of tobacco or smoking, including article illustrations, fashion spreads, and covers. Text items included articles, editorials, columns, letters, and so on, that referred to tobacco or smoking in the headline, subhead, or pullquote (a pullquote is a line from an article that is enlarged or boxed or both for emphasis), or that were illustrated by tobacco or smoking imagery.
Image and text items were coded with separate instruments, based on instruments used in previous analyses of mainstream publications (Kennedy & Bero, 1999; Wenger, Malone, & Bero, 2001). Both instruments included item “demographics” (e.g., size, location, type of item) and item content (e.g., image of smoking, type of tobacco shown or discussed, association with celebrities). Items were classified as having a negative image of smoking if they contained reference to cessation or to any social (e.g., bad breath) or health-related harms of smoking or otherwise portrayed smoking as undesirable. For purposes of analysis, items with positive and neutral images of tobacco were grouped together, since both portrayed tobacco use uncritically.
Two coders were used. Intercoder reliability was established through an overlapping sample of 20% of each type of item. All reported data achieved an adjusted Kappa score of between .7 and 1; 63% of reported variables achieved adjusted Kappas of .90 or greater. (Kappas were adjusted to account for the homogeneity of the material [Lantz & Nebenzahl, 1996]). Image variables that did not achieve a Kappa over .70 included the perceived race and sexual orientation of the person depicted. These were not used in the analysis and are not reported. All text variables achieved a Kappa of at least .70. Average intercoder reliability over all items was .90. No additional significance testing was done because the items collected were a census of items in the periodicals selected.
Our selection method utilized headlines, subheads, pullquotes, and illustrations, as a full text search of all articles in all publications was impractical. We made the assumption that an item with significant tobacco content would be likely to reflect it in one of these. This method, however, may have missed some references to smoking contained in general articles about health, for example. This study does not represent the entire gay press; we were unable to acquire sufficient print runs of several gay newspapers, such as the Philadelphia Gay News and the Southern Voice (with editions in Atlanta, GA, and Houston, TX). California is overrepresented in the sample, with 3 newspapers from San Francisco, 1 from Los Angeles, and 1 from Sacramento. California was one of the leaders in tobacco control during this period, with statewide tobacco control media campaigns in the 1990s and implementation of the first statewide smoke-free workplace law including restaurants and bars. California is also home to the first LGBT tobacco control organization, the Coalition of Lavender-Americans on Smoking and Health, founded in 1991, and the first statewide LGBT tobacco control campaign, the California Lavender Smokefree Project, founded in 1994. This might bias the sample toward an overestimation of references to tobacco, and an overestimation of negative references. The study is descriptive and no inferences can be drawn about the relative prevalence of tobacco content in the LGB press compared with general circulation magazines and newspapers. In addition, LGBs are not universally or exclusively exposed to the LGB press; therefore, other types of media are likely also influencing the LGB community.
Because these periodicals are not indexed and do not have on-line searchable text, we examined each page in hard copy or on microfilm. This may be a source of error if searches missed tobacco-related items. Had we searched an electronic database for text items only, however, we would not have discovered the prevalence of tobacco imagery in the LGB press. Even an index of images would likely not have found most of the images that appeared, since their primary subject was not smoking or tobacco.
Most image items (N = 1182) were either article illustrations (63%) or picture items (30%; see Figure 3). (A picture item consists only of a picture or a picture with a caption; for example, a publicity photo for a play on the calendar page of a newspaper.) The number of image items increased between 1990 and 2000. Whether that trend has continued is unknown. Almost all images (96.6%) showed people smoking. (Other items included pictures of ashtrays or other products or paraphernalia, or pictures of tobacco executives or community members otherwise referring to tobacco.) Notably, 59% of the article illustrations accompanied articles that made no mention of tobacco (see Figures 1 and and22 for examples). Only 2% (N = 25) of the images showing smoking had a clear antitobacco message (Figure 4) and only 1.4% (N = 16) made reference to the health consequences of smoking. Almost two thirds (63%) of all images associated celebrities with tobacco or smoking.
We retrieved 828 text items. Of these, 463 (55.9%) made no mention of tobacco, despite being accompanied by a tobacco image. Text data are reported only for the remainder (N = 365). The types of items found are shown in Figure 3. The number of text items peaked in 1990 (N = 49) and 1991 (N = 47) because of articles about a boycott led by AIDS groups of Marlboro cigarettes (Offen et al., 2003). Annual counts of text items did not reveal any trends.
Smoking was discussed in 63.6% of these text items (232/365). (The remainder discussed other aspects of tobacco such as economic or political issues.) Of text items that specifically discussed smoking, 66.8% (155/232) conveyed a negative image of the practice (Figure 4). Health was mentioned in more than a third (41.1%, 150/365) of all text items about tobacco; 63% (94/150) of these mentions were specific to LGB health. However, specific disease risks were rarely mentioned in relation to LGB health. Over 11 years, 21 publications, 4,724 issues, and 365 articles, LGB smoking was linked to cancer only 16 times, and to heart disease only 5 times. AIDS (N = 46) and addiction (N = 42) were the most frequently mentioned conditions.
The total tobacco-related items per issue ratio (including text and images) was .327, indicating that tobacco was shown or discussed on average in nearly 1 in every 3 issues examined. Among text items that specifically discussed smoking, antitobacco items predominated (66.8%, N = 155) (Figure 4). The vast majority of image items, however, did not convey a negative impression of tobacco; overall, a neutral or favorable depiction of tobacco use was conveyed. Only 13% of all items conveyed an antitobacco message. The number of image items was not accounted for by the number of text items: nearly three quarters of all images (73.8%) were unassociated with relevant textual material.
The vast majority of noncommercial references to tobacco in the LGB press were in the form of images. These images only rarely presented a negative view of smoking, and frequently associated celebrities with smoking. Images of tobacco use were frequently used to illustrate articles that did not mention tobacco or smoking. Text items were more often negative about smoking, but tobacco was not presented as a significant issue for the LGB community in particular, despite high smoking rates in the community. In addition, the generally negative message about smoking provided in articles and editorials was contradicted and overwhelmed by the predominance of positive smoking imagery. There were more than three times as many images as text items. Tobacco use is thus normalized through images of celebrities and other community members smoking, which appear routinely in most LGB publications. These findings suggest that tobacco use is taken for granted in the LGB community, and that the LGB press may be an important factor in its promulgation.
Noncommercial imagery containing smoking constitutes product placement, sometimes for a brand, and nearly always for smoking itself. Whereas in most instances of product placement the relevant item can be considered natural or inherent to the action or subject (wearing shoes, eating a pizza), smoking rarely is integral to an image, and as smoking rates decline, it is no longer a “natural” or “routine” activity (if it ever was). Thus, any positive or neutral depiction of smoking, advertising or editorial, paid or unpaid, becomes a reminder, a normalizer, and a subtle advertisement for smoking. Cigarette ads themselves may function in this way, serving as ads for smoking generically, as well as for a brand (Smith & Malone, 2004; While, Kelly, Huang, & Charlton, 1996). Indeed, as cigarette advertising has shifted away from informational advertising (providing details about the content or flavor of the product) and toward “lifestyle” advertising (focusing on the image of the user; Albright et al., 1988; Altman et al., 1987; Wenger, Malone, George et al., 2001), unpaid, incidental images of smoking may not differ very much from ads (see Figures 1 and and22).
This imagery may be particularly salient in the context of the LGB press. Until recently, there were few, if any, positive images of gay people in mass media, and the gay press developed in part to provide them (Streitmatter, 1993). But as the LGB press has moved away from its activist roots and toward a more assimilated commercialism (Fejes, 2003; Fine, 2001; Goldstein, 1997; Hanania, 1995; Harris, 1995), it has wavered between picturing an idealized, upscale gay life full of celebrities (Streitmatter, 1995), and mirroring a “real” and more ordinary gay life (Sender, 2001). In either mode, readers may well respond strongly to the people depicted. The tobacco industry frequently attempts to make cigarette advertising “aspirational,” believing that the ad will be effective if the viewer wants to emulate the image (Pollay, 2000; Wenger, Malone, George et al., 2001). These noncommercial images may operate the same way, whether LGBs desire to emulate the rich and famous, or learn how to fit into their community.
Advocates have urged LGB periodicals to refuse tobacco advertising (Drabble, 2001; Offen, Smith, & Malone, 2004). Advocates for LGB health should consider that it may be equally important to urge them to adopt the policy of rejecting noncommercial tobacco imagery as some magazines in the United Kingdom have done (Amos, Jacobson, & White, 1991), or otherwise to consider media advocacy approaches to address the portrayal of tobacco use in the LGB press (Dorfman, 2003; Wallack & Dorfman, 1996). Writers, photographers, and particularly editors of LGB publications should be approached. At minimum, they should be made aware of the amount of tobacco imagery in their periodicals (which is probably not deliberate, and therefore may have gone unnoticed), and its potential consequences. If possible, they should be persuaded to ameliorate the situation through editorial selection of images that do not feature smoking where it is not relevant.
There is no evidence that the pictures we have found in the LGB media are the result of paid product placement; brands are seldom visible. Therefore, editors who took steps to reduce or eliminate gratuitous images of tobacco use would likely not be risking loss of revenue. Advocates should be careful to articulate their concerns, however, in a way that obviates the issue of censorship. For instance, editors make choices about which images to use based on many different factors, including whether the image might be offensive to the community. Taking into account the health of the community when making those choices would have a similar effect on the editorial process. Persuading editors to make such efforts could contribute to the denormalizing of tobacco use in the LGB community.
Previous studies of other periodicals have focused on advertising (Smith, Offen, & Malone, 2004; Amos et al., 1991; Dewhirst & Pollay, 2001; King, Siegel, Celebucki, & Connolly, 1998; Minkler, Wallack, & Madden, 1987; Warner, 1985a, 1985b; Warner, Goldenhar, & McLaughlin, 1992; Weis, 1986) and on specific tobacco-related subjects (Durrant et al., 2003; Kennedy & Bero, 1999; Lima & Siegel, 1999; Magzamen et al., 2001; Malone, Wenger, & Bero, 2000, 2002; Menashe & Siegel, 1998; Wenger, Malone, & Bero, 2001), with little mention of noncommercial imagery (Chapman et al., 1995). This study suggests that, at least in the LGB press, such imagery may be important to consider. Community-based periodicals are an important communications medium for LGBs (Streitmatter, 1995), and the frequency of such imagery conveys normalization messages about smoking in this community. Because such noncommercial images have been found to have the potential to convey a more powerful prosmoking message than cigarette advertisements (MacFadyen, 2002), tobacco control advocates in other communities may want to examine noncommercial imagery in relevant periodicals for similar patterns.
Thanks to Guadalupe Salazar and Katherine Thomson for data collection and coding, the staff of the San Francisco Public Library for data collection assistance, and Steven Paul, Ph.D., and Jenni M. Buckley, M.S., for statistical consultation. This study was supported by NCI grant number CA90789.
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