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1.  Health disparities and advertising content of women's magazines: a cross-sectional study 
BMC Public Health  2005;5:85.
Background
Disparities in health status among ethnic groups favor the Caucasian population in the United States on almost all major indicators. Disparities in exposure to health-related mass media messages may be among the environmental factors contributing to the racial and ethnic imbalance in health outcomes. This study evaluated whether variations exist in health-related advertisements and health promotion cues among lay magazines catering to Hispanic, African American and Caucasian women.
Methods
Relative and absolute assessments of all health-related advertising in 12 women's magazines over a three-month period were compared. The four highest circulating, general interest magazines oriented to Black women and to Hispanic women were compared to the four highest-circulating magazines aimed at a mainstream, predominantly White readership. Data were collected and analyzed in 2002 and 2003.
Results
Compared to readers of mainstream magazines, readers of African American and Hispanic magazines were exposed to proportionally fewer health-promoting advertisements and more health-diminishing advertisements. Photographs of African American role models were more often used to advertise products with negative health impact than positive health impact, while the reverse was true of Caucasian role models in the mainstream magazines.
Conclusion
To the extent that individual levels of health education and awareness can be influenced by advertising, variations in the quantity and content of health-related information among magazines read by different ethnic groups may contribute to racial disparities in health behaviors and health status.
doi:10.1186/1471-2458-5-85
PMCID: PMC1208907  PMID: 16109157
2.  Communicating information about “what not to do” to consumers 
Background
Americans devote more resources to health care than any other developed country, and yet they have worse health outcomes and less access. This creates a perfect set of opportunities for Consumer Reports, a nonprofit consumer advocacy and multimedia organization known for its focus on individual consumers in markets where significant amounts of misinformation is in play. Consumer Reports uses comparisons/ratings based on the best available data to “level” the market playing field. While our early efforts to inform consumers of overuse and underuse in health care were successful, we sensed there were opportunities to have greater impact. Over a 5-year period, with the help of many partners, Consumer Reports learned more about how to communicate “what not to do” to consumers, ultimately enhancing the effectiveness of this difficult message.
Analysis
Consumer Reports began an in-depth examination of the overuse of health services in 2010 with an exploratory review of the cognitive psychology literature. Lessons learned from this review were used in the presentation of subsequent ratings of heart disease and cancer screening tests. Surveys showed surprising gaps in the prevention/screening knowledge of healthy, low-risk Consumer Reports subscribers aged 40 to 60 years. Of these subscribers, 44% reported engaging in heart screening tests that received the lowest ratings from the U.S. Preventive Services Task Force and from Consumer Reports. At the same time professional societies and the ABIM (American Board of Internal Medicine) Foundation created Choosing Wisely®, a campaign focused on identifying lists of health tests and treatments not to do. Consumer Reports joined the Choosing Wisely campaign as the consumer “translator” and organizer of a network of consumer organizations with access to tens of millions of consumers. Over the past year, Consumer Reports has conducted multiple qualitative evaluations of content related to overuse of health services. Ratings of cancer screening tests were released in 2013 in an article readers reported as one of the most heavily read articles in the magazine’s recent history.
Conclusions
Telling consumers that more is not better is not a popular or easy message to deliver. The message is most likely to be “sticky” but is best received if it comes from trusted sources (e.g., physicians), focuses on safety when justified, is communicated in plain language, and uses both mass media and individual consumer approaches. Changing the culture of health care in an era of health reform is an essential part of the transformation needed if we are to allocate finite resources fairly in hopefully fair markets while assuring that better quality products and services at lower prices dominate.
doi:10.1186/1472-6947-13-S3-S2
PMCID: PMC4029324  PMID: 24565077
3.  Variations in food and drink advertising in UK monthly women's magazines according to season, magazine type and socio-economic profile of readers: a descriptive study of publications over 12 months 
BMC Public Health  2011;11:368.
Background
Overweight and obesity are recognised nationally and internationally as key public health challenges. Food and drink advertising is one of the array of factors that influence both diet and physical activity choices and, hence, body weight and obesity. Little previous work has focused on food and drink advertising in magazines. We studied food and drink advertising in a wide range of popular UK monthly women's magazines published over a full year. We explored differences in the prevalence of food and drink advertising and the type of food and drinks advertised according to season, magazine type and socio-economic profile of readers.
Methods
All advertisements in all issues of 18 popular UK monthly women's magazines published over 12 months were identified. For each food or drink advertisement, branded food and drinks were noted and categorised into one of seven food groups. All analyses were at the level of the individual advertisement.
Results
A total of 35 053 advertisements were identified; 1380 (3.9%) of these were for food or drink. The most common food group represented was 'food and drinks high in fat and/or sugar' (28.0% of food advertisements), the least common group was 'fruits & vegetables' (2.0% of food advertisements). Advertisements for alcohol accounted for 10.1% of all food advertisements. Food and drink advertisements were most common in summer, general interest magazines, and those with the most affluent readerships. There were some differences in the type of food and drink advertised across season, magazine type and socio-economic profile of readers.
Conclusions
Food and drink advertisements represented only a small proportion of advertisements in UK women's monthly magazines. Food and drink advertisements in these magazines feature a high proportion of 'less healthy' foods. There were a number of differences across season, magazine type and according to the socio-economic profile of readers in the prevalence of food and drink advertisements. Fewer differences were seen in the type of food and drinks advertised.
doi:10.1186/1471-2458-11-368
PMCID: PMC3121635  PMID: 21605388
4.  Health disparity in black women: lack of pharmaceutical advertising in black vs. white-oriented magazines. 
CONTEXT: Racial disparities in health care between black women and white women may be attributed in part to socioeconomic status and lack of insurance, but also may be due to lack of the dissemination of health information in black communities via black popular magazines. OBJECTIVE: Comparison of the number and type of pharmaceutical advertisements between black-oriented magazines and white-oriented magazines. DESIGN: Descriptive study. SETTING: Morehouse School of Medicine. MAIN OUTCOME MEASURES: Recording of the type and number of over-the-counter and prescription drug advertisements. RESULTS: Five black-oriented magazines (Black Woman, Black Elegance, Essence, Ebony, and Upscale) and 5 white-oriented magazines (Family Circle, Working Mother, Good Housekeeping, Ladies' Home Journal, Women's Day) were evaluated for 3 months from June-August, 2000. White-oriented magazines had four to eight times more pharmaceutical ads than black-oriented magazines. Types of medications advertised in the white-oriented magazines and not the black-oriented magazines were, for example, cholinesterase inhibitors, calcium supplements, COX II-inhibitors, intranasal steroids, anorexiants, proton pump inhibitors, and smoking deterrent agents. Conversely, medications advertised in the black-oriented magazines and not the white-oriented magazines were antiviral agents and oral contraceptives. Pharmaceutical companies gave several reasons for the disparity, including the explanation that their particular company was advertising about HIV in the black community. CONCLUSIONS: A barrier to equitable health care for black women may be a low prioritization for health prevention and health management. This low prioritization or disinterest may be a reflection of the black magazine that she is reading due to the lack of pharmaceutical advertisements in black-oriented magazines. The result of this disinterest of black females may be seen in the increased morbidity and mortality for selected diseases.
PMCID: PMC2594034  PMID: 11491276
5.  PUB2/420: Supporting a "Virtual Medical Worlds Community" with the "Virtual Magazine Publisher" Software System 
Journal of Medical Internet Research  1999;1(Suppl 1):e105.
Introduction
Creating an Internet based community requires a supporting software and hardware infrastructure that enables community members and community organisers to easily enter and update information, apart from other aspects such as discussion organisation and virtual meeting places. Here we describe a software system, "Virtual Magazine Publisher" (VMP) for managing magazines, newsletters, journals, member profile pages and project description pages. Its application for "Virtual Medical Worlds Community", a group of organisations involved in telemedicine and underlying advanced technologies is described.
Methods
The VMP software (http://www.hoise.com/vmp) was designed, with the following criteria in mind:
It must be suited for almost any magazine and newsletter
Authors and editors should be able to access it from anywhere-Authors should be guided with entry of their contribution
Editors should be given enough tools to manage their publication in much the same way they are used to
The content should be separated from the lay-out-Information should be entered once: no need for hand conversions.
When analysing magazines we found that most have a simple structure, apart from glossy magazines and a number of scientific journals, being subdivided in sections, and each section is subdivided in articles or items. The lay-out of the articles in the section follow the same rules. Each issue has the same look and feel. Information from an article is used in the contents of the magazine. The structure is captured in an SGML definition (DTD) with two types of elements:
for the general structure: title, subtitle, several lead parts, main text, and reference section
for meta information: author, editors, issues, attached files
The issues can be constructed automatically from the information contained in each article using templates. Multimedia files that belong to an articles can identified by an "attach" element. The publishing software can help the editor with an overview of everything that belongs to an article or an issue.
Results
The system is used for a number of magazines and communities. The most elaborate is the "Virtual Medical Worlds Community", a group of organisations involved in telemedicine and underlying advanced technologies (http://www.hoise.com/vmw/vmwc). The main parts of this community are:
A news magazine called Virtual Medical Worlds Magazine: an extended table of contents is send by e-mail. The full magazine is available on the Web.
ITIS letters: a journal for publishing fast refereed results from telemedicine research.
Member profiles with activities, projects, products etc.
Calendar.
Discussion
The current system is implemented using an article description based on an HTML-extension. The system is written mainly in PERL, Javascript, and a Java application. The fast take-up of XML allows to revert this situation: a new design will use XML to implement the article structure.
doi:10.2196/jmir.1.suppl1.e105
PMCID: PMC1761804
Publishing; Telemedicine; Software
6.  Scripts of Sexual Desire and Danger in US and Dutch Teen Girl Magazines: A Cross-National Content Analysis 
Sex Roles  2011;64(7-8):463-474.
The aim of this comparative quantitative content analysis was to investigate how US and Dutch teen girl magazines cover sexual desire (i.e., sexual wanting, and pleasure) and sexual danger (i.e., sexual risk, and negative physical/health consequences of sex). Relying on the sexual scripts framework and Hofstede’s cultural dimension of masculinity/femininity, we examined (a) how the coverage varied for boys and girls, (b) how it differed between the United States and the Netherlands, and (c) how gender differences varied by country. The sample comprised 627 sex-related feature stories from all 2006–2008 issues of three US (i.e., Seventeen, CosmoGirl! United States edition, and Teen) and three Dutch teen girl magazines (i.e., Fancy, CosmoGirl! Netherlands edition, and Girlz!). Overall, sexual wanting occurred more frequently in the US magazines than in the Dutch magazines. In the US coverage, boys’ sexual wanting received more attention than girls’ sexual wanting, whereas in the Dutch coverage sexual wanting was depicted equally often for boys and girls. The depiction of sexual pleasure did not vary by gender in either country, but was generally more visible in the Dutch magazines than in the US magazines. Sexual risks and the negative consequences of sex were associated with girls more than with boys, and were primarily depicted in the US magazines rather than in the Dutch magazines.
doi:10.1007/s11199-011-9941-4
PMCID: PMC3062029  PMID: 21475649
Adolescents; Media; Cultural differences; Cross-national research; Sexuality
7.  Print media coverage of research on passive smoking 
Tobacco Control  1999;8(3):254-260.
OBJECTIVE—To assess the extent and content of newspaper and magazine coverage of research on passive smoking.
DESIGN—Content analysis of newspaper and magazine articles.
SUBJECTS—Articles reporting on passive smoking research published in newspapers (n = 180) or magazines (n = 92) between January 1981 and December 1994.
MAIN OUTCOME MEASURES—Numbers of articles, conclusions of articles, sources quoted, numbers and characteristics of research studies cited, presence of tobacco advertising.
RESULTS—The number of newspaper and magazine articles reporting on passive smoking research increased from four in 1981 to 57 in 1992 and 32 in 1994. Sixty-two per cent (168/272) of articles concluded that the research on passive smoking is controversial. Tobacco industry representatives were quoted significantly more often in newspaper articles (52%, 94/180) than magazine articles (12%, 11/92) (p<0.0001). Of 121 different research studies cited in the lay press articles, only 15 were from tobacco-industry sponsored projects or publications. In magazines, acceptance of tobacco industry advertising was associated with the conclusion that research on passive smoking is controversial (p<0.0001).
CONCLUSIONS—Although research on the harmful effects of passive smoking accumulated between 1981 and 1994, lay press coverage of the research maintained that the science was controversial. Few research studies were cited to support the industry's claim that passive smoking is not harmful to health. However, tobacco industry representatives who were critical of the research methods used to study the health effects of passive smoking were frequently quoted.


Keywords: environmental tobacco smoke; media; passive smoking
PMCID: PMC1763941  PMID: 10599568
8.  Representations of Celebrities’ Weight and Shape during Pregnancy and Postpartum: A Content Analysis of Three Entertainment Magazine Websites 
Body image  2011;9(1):172-175.
Entertainment magazine websites provide a continuous stream of celebrity news accessed by over 13 million unique viewers each month. Celebrities’ experiences of pregnancy and new motherhood appear to be popular topics within these media outlets; however, little research has investigated the content of this coverage. In this study, investigators coded articles (N = 387) published between August 1, 2007 and August 1, 2008 on three popular entertainment magazine websites. Relatively few articles about celebrities’ pregnancies discussed weight (13%) or shape (30%), and an even smaller proportion (6.2%) included any discussion of postpartum body dissatisfaction. This suggests a gap between portrayal of celebrities’ pregnancies and postpartum experiences and those of non-celebrity women. This disparity is concerning as it might lead to unrealistic expectations about pregnancy and postpartum for both pregnant readers and a more general audience. This study provides important initial information about the messages these media provide regarding pregnancy-related appearance.
doi:10.1016/j.bodyim.2011.07.003
PMCID: PMC3246040  PMID: 21873126
entertainment magazines; celebrity; objectification; pregnancy; postpartum; thin ideal
9.  Prostate and Colon Cancer Screening Messages in Popular Magazines 
OBJECTIVES
To 1) compare the number of articles published about prostate, colon, and breast cancer in popular magazines during the past 2 decades, and 2) evaluate the content of in-depth prostate and colon cancer screening articles identified from 1996 to 2001.
DESIGN
We used a searchable database to identify the number of prostate, colon, and breast cancer articles published in three magazines with the highest circulation from six categories. In addition, we performed a systematic review on the in-depth (≥2 pages) articles on prostate and colon cancer screening that appeared from 1996 through 2001.
RESULTS
Although the number of magazine articles on prostate and colon cancer published in the 1990s increased compared to the 1980s, the number of articles is approximately one third of breast cancer articles. There were 36 in-depth articles from 1996 to 2001 in which prostate or colon cancer screening were mentioned. Over 90% of the articles recommended screening. However, of those articles, only 76% (25/33; 95% confidence interval [CI], 58% to 89%) cited screening guidelines. The benefits of screening were mentioned in 89% (32/36; 95% CI, 74% to 97%) but the harms were only found in 58% (21/36; 95% CI, 41% to 75%). Only 28% (10/36; 95% CI, 14% to 45%) of the articles provided all the necessary information needed for the reader to make an informed decision.
CONCLUSIONS
In-depth articles about prostate and colon cancer in popular magazines do not appear as frequently as articles about breast cancer. The available articles on prostate and colon cancer screening often do not provide the information necessary for the reader to make an informed decision about screening.
doi:10.1111/j.1525-1497.2004.30504.x
PMCID: PMC1492504  PMID: 15242469
colon cancer; prostate cancer; screening tests
10.  Portrayal of caesarean section in Brazilian women’s magazines: 20 year review 
Objective To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women’s magazines.
Design Review of articles published during 1988-2008 in top selling women’s magazines.
Setting Brazil, one of the countries with the highest caesarean section rates in the world.
Data sources Women’s magazines with the largest distribution during the study period, identified through the official national media indexing organisations.
Selection criteria Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section.
Main outcome measures Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section.
Results 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section.
Conclusions Most of the articles published in Brazilian women’s magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to underestimate the maternal/perinatal risks associated with this route of delivery.
doi:10.1136/bmj.d276
PMCID: PMC3026601  PMID: 21266421
11.  Features of sales promotion in cigarette magazine advertisements, 1980-1993: an analysis of youth exposure in the United States 
Tobacco Control  1999;8(1):29-36.
OBJECTIVE—To examine the presence of features of sales promotion in cigarette advertising in United States magazines, and to describe trends in youth (ages 12-17) exposure to such advertising (termed "promotional advertising").
DESIGN—Analysis of 1980-1993 annual data on: (a) total pages and expenditures for "promotional advertising" (advertising that contains features of sales promotion) in 36 popular magazines (all magazines for which data were available), by cigarette brand; and (b) readership characteristics for each magazine. We defined promotional advertising as advertisements that go beyond the simple advertising of the product and its features to include one or more features of sales promotion, such as coupons, "retail value added" promotions, contests, sweepstakes, catalogues, specialty item distribution, and sponsorship of public entertainment or sporting events.
MAIN OUTCOME MEASURES—Total pages of, and expenditures for promotional advertising in magazines; and gross impressions (number of readers multiplied by the number of pages of promotional advertising) among youth and total readership.
RESULTS—During the period 1980-1993, tobacco companies spent $90.2 million on promotional advertising in the 36 magazines. The proportion of promotional advertising appearing in "youth" magazines (defined as magazines with a greater than average proportion of youth readers) increased from 7% in 1980 to nearly 100% in 1987. Although youth readers represented only 19% of magazine readers, the proportion of youth gross impressions to total gross impressions of tobacco promotional advertising exceeded this value throughout the entire period 1985-1993, peaking at 33% in 1987. The five "youth" cigarette brands (defined as brands smoked by at least 2.5% of smokers aged 10-15 years in 1993) accounted for 59% of promotional advertising in all magazines, but for 83% of promotional advertising in youth magazines during the study period.
CONCLUSIONS—In their magazine advertising, cigarette companies are preferentially exposing young people to advertisements that contain sales promotional features. 


Keywords: advertising; magazines; adolescents
PMCID: PMC1763919  PMID: 10465813
12.  What do popular Spanish women's magazines say about caesarean section? A 21-year survey 
Bjog  2014;121(5):548-555.
Objectives
Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines.
Design
Systematic review.
Setting
Women's magazines printed from 1989 to 2009 with the largest national distribution.
Sample
Articles with any information on CS.
Methods
Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study.
Main outcome measures
Accuracy, comprehensiveness and sources of information.
Results
Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles.
Conclusions
The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery.
doi:10.1111/1471-0528.12513
PMCID: PMC4162994  PMID: 24467797
Caesarean section; medicine in literature; periodicals as topic; pregnancy; Spain
13.  Disclosing conflicts of interest in German publications concerning health services research 
Background
The influence of the pharmaceutical industry and other stakeholders on medical science has been increasingly criticised. When dealing with conflicts of interest in scientific publications it is important to ensure the best possible transparency. The objective of this work is to examine the disclosure practice of financial and non-financial conflicts of interest in German language publications concerning health services research for the first time.
Methods
We performed a systematic literature search in the PubMed data base using the MeSH term "health services research". The review was conducted on July 10, 2006, setting the limits "dates: published in the last 2 years" and "languages: German" (only articles with abstracts). 124 articles in 31 magazines were found. In the magazines the instructions for authors were examined as to whether a statement on conflicts of interest is expected – and if, in which form. Regarding the articles in the journals which require a statement, we examined whether the statement is explicitly published. The results are descriptively represented.
Results
13 magazines (42%) do not require any statement on conflicts of interest, whereas 18 journals (58%) expect a statement. Two of these 18 magazines refer explicitly to the uniform requirements of the International Committee of the Medical Journal Editors (ICMJE); the remaining 16 magazines give differently accentuated instructions on how to disclose conflicts of interest, whereby the focus is primarily on financial issues. A statement on conflicts of interest is explicitly published in 11 of the 71 articles (15%) which are found in the magazines that require a statement with the submission of a manuscript. Related to the total number of included articles, this means that the reader explicitly receives information on potential conflicts of interest in 9% of the cases (11 of 124 articles). Statements of others that are involved in the publication process (reviewers, editors) are not available in any of the articles examined.
Conclusion
A better sensitization for possible conflicts of interest in German publications concerning health services research is necessary. We suggest tightening the criteria for disclosure in the instructions for authors in the scientific journals. Among other things the equivalent consideration of financial and non-financial conflicts of interest as well as the obligatory publication of the statements should be part of good practice.
doi:10.1186/1472-6963-7-78
PMCID: PMC1905913  PMID: 17543111
14.  An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study 
Objective To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms.
Design Cohort study.
Setting Waiting room of a general practice in Auckland, New Zealand.
Participants 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women’s Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images.
Interventions The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly.
Main outcome measures Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines.
Results 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P<0.001). All 15 of the most gossipy magazines and all 19 of the non-gossipy magazines had disappeared by 31 days. The study was terminated at this point.
Conclusions General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed.
doi:10.1136/bmj.g7262
PMCID: PMC4263958  PMID: 25500116
15.  Descriptive Analysis of Articles and Advertisements Pertaining to Skin Cancer Prevention in 2 Popular US Parenting Magazines, 2000–2010 
Magazines focused on parenting are popular in the United States, and parents may use them to guide decisions about the health of their children. We analyzed issues of 2 popular parenting magazines published in the past 11 years during the months of peak ultraviolet radiation exposure for content related to sun protection and for advertisements for skin products that did and did not contain sun protection factor. Only 24 of 2,594 articles addressed the topic of sun protection for skin cancer prevention. Although advertising is pervasive in these magazines, the extent to which such advertising focuses on products with sun protection factor was low. These findings suggest that parenting magazines can do more to assist parents in making informed decisions about preventing skin cancer risk among youth.
doi:10.5888/pcd10.120200
PMCID: PMC3617992  PMID: 23557639
16.  Use of the Internet as a Resource for Consumer Health Information: Results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II) 
Background
The Internet offers consumers unparalleled opportunities to acquire health information. The emergence of the Internet, rather than more-traditional sources, for obtaining health information is worthy of ongoing surveillance, including identification of the factors associated with using the Internet for this purpose.
Objectives
To measure the prevalence of Internet use as a mechanism for obtaining health information in the United States; to compare such Internet use with newspapers or magazines, radio, and television; and to identify sociodemographic factors associated with using the Internet for acquiring health information.
Methods
Data were acquired from the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II), a national telephone survey using random-digit dialing within the United States during 2000. The target population consisted of adult, noninstitutionalized, household members. As part of the survey, data were collected on: facility with the Internet, sources of health information, and sociodemographic characteristics. Multivariate analysis was used to identify factors associated with acquiring health information on the Internet.
Results
A total of 499 (64% response rate) respondents participated in the survey. With the exception of an overrepresentation of women (66%), respondents were generally similar to national referents. Fifty percent of respondents either strongly agreed or agreed that they felt comfortable using the Internet as a health information resource. The prevalence rates of using the health information sources were: newspapers or magazines, 69%; radio, 30%; television, 56%; and the Internet, 32%. After adjusting for potential confounders, older respondents were more likely than younger respondents to use newspapers or magazines and television to acquire health information, but less likely to use the Internet. Higher education was associated with greater use of newspapers or magazines and the Internet as health information sources. Internet use was lower in rural than urban or suburban areas.
Conclusions
The Internet has already surpassed radio as a source of health information but still lags substantially behind print media and television. Significant barriers to acquiring health information on the Internet remain among persons 60 years of age or older, those with 12 or fewer years of education, and those residing in rural areas. Stronger efforts are needed to ensure access to and facility with the Internet among all segments of the population. This includes user-friendly access for older persons with visual or other functional impairments, providing low-literacy Web sites, and expanding Internet infrastructure to reach all areas of the United States.
doi:10.2196/jmir.3.4.e31
PMCID: PMC1761915  PMID: 11772546
Internet, health care surveys, socioeconomic factors, age factors, family practice
17.  Tobacco Industry Lifestyle Magazines Targeted to Young Adults 
Purpose
This is the first study describing the tobacco industry’s objectives developing and publishing lifestyle magazines, linking them to tobacco marketing strategies, and how these magazines may encourage smoking.
Methods
Analysis of previously secret tobacco industry documents and content analysis of 31 lifestyle magazines to understand the motives behind producing these magazines and the role they played in tobacco marketing strategies.
Results
Philip Morris (PM) debuted Unlimited in 1996 to nearly 2 million readers and RJ Reynolds (RJR) debuted CML in 1999 targeting young adults with their interests. Both magazines were developed as the tobacco companies faced increased advertising restrictions Unlimited contained few images of smoking, but frequently featured elements of the Marlboro brand identity in both advertising and article content. CML featured more smoking imagery and fewer Camel brand identity elements.
Conclusions
Lifestyle promotions that lack images of smoking may still promote tobacco use through brand imagery. The tobacco industry still uses the “under the radar” strategies used in development of lifestyle magazines in branded websites. Prohibiting lifestyle advertising including print and electronic media that associate tobacco with recreation, action, pleasures, and risky behaviors or that reinforces tobacco brand identity may be an effective strategy to curb young adult smoking.
doi:10.1016/j.jadohealth.2009.02.008
PMCID: PMC2849991  PMID: 19699423
Tobacco; Marketing; Lifestyle Advertising; Content Analysis; Young Adults
18.  Infant feeding and the media: the relationship between Parents' Magazine content and breastfeeding, 1972–2000 
Mass media content likely influences the decision of women to breastfeed their newborn children. Relatively few studies have empirically assessed such a hypothesis to date, however. Most work has tended to focus either on specific interventions or on broad general commentary about the role of media. In this study, we examined infant feeding advertisements in 87 issues of Parents' Magazine, a popular parenting magazine, from the years 1971 through 1999. We then used content analysis results to predict subsequent changes in levels of breastfeeding among U.S. women. When the frequency of hand feeding advertisements increased, the percentage change in breastfeeding rates reported the next year generally tended to decrease. These results underscore the need to acknowledge the potential role of popular media content in understanding breastfeeding patterns and public health trends.
doi:10.1186/1746-4358-1-10
PMCID: PMC1489921  PMID: 16722542
19.  Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used 
Background
Complementary and Alternative Medicine (CAM) is increasingly popular with cancer patients and yet information provision or discussion about CAM by health professionals remains low. Previous research suggests that patients may fear clinicians' 'disapproval' if they raise the subject of CAM, and turn to other sources to acquire information about CAM. However, little empirical research has been conducted into how cancer patients acquire, and, more importantly evaluate CAM information before deciding which CAM therapies to try.
Methods
Qualitative study, comprising semi-structured interviews with 43 male cancer patients of varying ages, cancer type and stage of illness, 34 of whom had used CAM. They were recruited from a range of NHS and non-NHS settings in Bristol, England.
Results
As a result of the lack of CAM information from health professionals, men in this study became either 'pro-active seekers' or 'passive recipients' of such information. Their main information resource was the 'lay referral' network of family, friends and acquaintances, especially females. 'Traditional' information sources, including books, magazines, leaflets and the media were popular, more so in fact than the internet. Views on the internet ranged from enthusiasm or healthy scepticism through to caution or disinterest. CAM information was generally regarded as 'empowering' as it broadened treatment and self-care options. A minority of participants were information averse fearing additional choices that might disrupt their fragile ability to cope. There was general consensus that CAM information should be available via the NHS, to give it a 'stamp of approval', which combined with guidance from informed health professionals, could help patients to make 'guided' choices. However, a small minority of these men valued the independence of CAM from the NHS and deliberately sought 'alternative' information sources and treatment options.
Men were selective in identifying particular therapies to use and sceptical about others, basing their choices on forms of 'evidence' that were personally meaningful: personal stories of individuals who had been helped by CAM; the long history and enduring popularity of some therapies; the plausibility of the mechanism of action; a belief or trust in individual therapies or their providers; scientific evidence. Scientific evidence ranked low in the men's personal decision-making about CAM, while it was recognised as important for NHS support for CAM.
Conclusion
These male cancer patients valued the support and guidance of 'trusted individuals' in making choices about CAM. Trusted health professionals could also play a significant role in helping patients to make informed choices. Any such dialogue must, however, acknowledge the different standards of evidence used by patients and clinicians to evaluate the benefits or otherwise of CAM therapies. Such open communication could help to foster an environment of mutual trust where patients are encouraged to discuss their interest in CAM, rather than perpetuate covert, undisclosed use of CAM with its attendant potential hazards.
doi:10.1186/1472-6882-7-25
PMCID: PMC2000907  PMID: 17683580
20.  The Unbearable Lightness of Health Science Reporting: A Week Examining Italian Print Media 
PLoS ONE  2010;5(3):e9829.
Background
Although being an important source of science news information to the public, print news media have often been criticized in their credibility. Health-related content of press media articles has been examined by many studies underlining that information about benefits, risks and costs are often incomplete or inadequate and financial conflicts of interest are rarely reported. However, these studies have focused their analysis on very selected science articles. The present research aimed at adopting a wider explorative approach, by analysing all types of health science information appearing on the Italian national press in one-week period. Moreover, we attempted to score the balance of the articles.
Methodology/Principal Findings
We collected 146 health science communication articles defined as articles aiming at improving the reader's knowledge on health from a scientific perspective. Articles were evaluated by 3 independent physicians with respect to different divulgation parameters: benefits, costs, risks, sources of information, disclosure of financial conflicts of interest and balance. Balance was evaluated with regard to exaggerated or non correct claims. The selected articles appeared on 41 Italian national daily newspapers and 41 weekly magazines, representing 89% of national circulation copies: 97 articles (66%) covered common medical treatments or basic scientific research and 49 (34%) were about new medical treatments, procedures, tests or products. We found that only 6/49 (12%) articles on new treatments, procedures, tests or products mentioned costs or risks to patients. Moreover, benefits were always maximized and in 16/49 cases (33%) they were presented in relative rather than absolute terms. The majority of stories (133/146, 91%) did not report any financial conflict of interest. Among these, 15 were shown to underreport them (15/146, 9.5%), as we demonstrated that conflicts of interest did actually exist. Unbalanced articles were 27/146 (18%). Specifically, the probability of unbalanced reporting was significantly increased in stories about a new treatment, procedure, test or product (22/49, 45%), compared to stories covering common treatments or basic scientific research (5/97, 5%) (risk ratio, 8.72).
Conclusions/Significance
Consistent with prior research on health science communication in other countries, we report undisclosed costs and risks, emphasized benefits, unrevealed financial conflicts of interest and exaggerated claims in Italian print media. In addition, we show that the risk for a story about a new medical approach to be unbalanced is almost 9 times higher with respect to stories about any other kind of health science-related topics. These findings raise again the fundamental issue whether popular media is detrimental rather than useful to public health.
doi:10.1371/journal.pone.0009829
PMCID: PMC2844412  PMID: 20352089
21.  Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register 
PLoS Medicine  2011;8(5):e1001033.
Charles Wolfe and colleagues collected data from the South London Stroke Register on 3,373 first strokes registered between 1995 and 2006 and showed that between 20% and 30% of survivors have poor outcomes up to 10 years after stroke.
Background
Although stroke is acknowledged as a long-term condition, population estimates of outcomes longer term are lacking. Such estimates would be useful for planning health services and developing research that might ultimately improve outcomes. This burden of disease study provides population-based estimates of outcomes with a focus on disability, cognition, and psychological outcomes up to 10 y after initial stroke event in a multi-ethnic European population.
Methods and Findings
Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability (Barthel Index <15), inactivity (Frenchay Activities Index <15), cognitive impairment (Abbreviated Mental Test < 8 or Mini-Mental State Exam <24), anxiety and depression (Hospital Anxiety and Depression Scale >10), and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12) health survey. Estimates were stratified by age, gender, and ethnicity, and age-adjusted using the standard European population. Plots of outcome estimates over time were constructed to examine temporal trends and sociodemographic differences. Between 1995 and 2006, 3,373 first-ever strokes were registered: 20%–30% of survivors had a poor outcome over 10 y of follow-up. The highest rate of disability was observed 7 d after stroke and remained at around 110 per 1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors, respectively); thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 mo to 10 y after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black survivors reported better outcomes in the SF-12 physical domain. No other major differences were observed by gender or ethnicity. Increased age was associated with higher rates of disability, inactivity, and cognitive impairment.
Conclusions
Between 20% and 30% of stroke survivors have a poor range of outcomes up to 10 y after stroke. Such epidemiological data demonstrate the sociodemographic groups that are most affected longer term and should be used to develop longer term management strategies that reduce the significant poor outcomes of this group, for whom effective interventions are currently elusive.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Every year, 15 million people have a stroke. About 5 million of these people die within a few days, and another 5 million are left disabled. Stroke occurs when the brain's blood supply is suddenly interrupted by a blood clot blocking a blood vessel in the brain (ischemic stroke, the commonest type of stroke) or by a blood vessel in the brain bursting (hemorrhagic stroke). Deprived of the oxygen normally carried to them by the blood, the brain cells near the blockage die. The symptoms of stroke depend on which part of the brain is damaged but include sudden weakness or paralysis along one side of the body, vision loss in one or both eyes, and confusion or trouble speaking or understanding speech. Anyone experiencing these symptoms should seek immediate medical attention because prompt treatment can limit the damage to the brain. Risk factors for stroke include age (three-quarters of strokes occur in people over 65 years old), high blood pressure, and heart disease.
Why Was This Study Done?
Post-stroke rehabilitation can help individuals overcome the physical disabilities caused by stroke, and drugs and behavioral counseling can reduce the risk of a second stroke. However, people can also have problems with cognition (thinking, awareness, attention, learning, judgment, and memory) after a stroke, and they can become depressed or anxious. These “outcomes” can persist for many years, but although stroke is acknowledged as a long-term condition, most existing data on stroke outcomes are limited to a year after the stroke and often focus on disability alone. Longer term, more extensive information is needed to help plan services and to help develop research to improve outcomes. In this burden of disease analysis, the researchers use follow-up data collected by the prospective South London Stroke Register (SLSR) to provide long-term population-based estimates of disability, cognition, and psychological outcomes after a first stroke. The SLSR has recorded and followed all patients of all ages in an inner area of South London after their first-ever stroke since 1995.
What Did the Researchers Do and Find?
Between 1995 and 2006, the SLSR recorded 3,373 first-ever strokes. Patients were examined within 48 hours of referral to SLSR, their stroke diagnosis was verified, and their sociodemographic characteristics (including age, gender, and ethnic origin) were recorded. Study nurses and fieldworkers then assessed the patients at three months and annually after the stroke for disability (using the Barthel Index, which measures the ability to, for example, eat unaided), inactivity (using the Frenchay Activities Index, which measures participation in social activities), and cognitive impairment (using the Abbreviated Mental Test or the Mini-Mental State Exam). Anxiety and depression and the patients' perceptions of their mental and physical capabilities were also assessed. Using preset cut-offs for each outcome, 20%–30% of stroke survivors had a poor outcome over ten years of follow-up. So, for example, 110 individuals per 1,000 population were judged disabled from three months to ten years, rates of inactivity remained constant from year one to year eight, at 280 affected individuals per 1,000 survivors, and rates of anxiety and depression fluctuated over time but affected about a third of the population. Notably, levels of inactivity were higher among men than women at all time points and were higher in white than in black stroke survivors. Finally, increased age was associated with higher rates of disability, inactivity, and cognitive impairment.
What Do These Findings Mean?
Although the accuracy of these findings may be affected by the loss of some patients to follow-up, these population-based estimates of outcome measures for survivors of a first-ever stroke for up to ten years after the event provide concrete evidence that stroke is a lifelong condition with ongoing poor outcomes. They also identify the sociodemographic groups of patients that are most affected in the longer term. Importantly, most of the measured outcomes remain relatively constant (and worse than outcomes in an age-matched non-stroke-affected population) after 3–12 months, a result that needs to be considered when planning services for stroke survivors. In other words, these findings highlight the need for health and social services to provide long-term, ongoing assessment and rehabilitation for patients for many years after a stroke.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001033.
The US National Institute of Neurological Disorders and Stroke provides information about all aspects of stroke (in English and Spanish); the US National Institute of Health SeniorHealth Web site has additional information about stroke
The Internet Stroke Center provides detailed information about stroke for patients, families, and health professionals (in English and Spanish)
The UK National Health Service Choices Web site also provides information about stroke for patients and their families
MedlinePlus has links to additional resources about stroke (in English and Spanish)
More information about the South London Stroke Register is available
doi:10.1371/journal.pmed.1001033
PMCID: PMC3096613  PMID: 21610863
22.  Exposure of black youths to cigarette advertising in magazines 
Tobacco Control  2000;9(1):64-70.
OBJECTIVE—To estimate the potential exposure of black adolescents to brand specific advertising in magazines.
DESIGN—A probit regression analysis was conducted of pooled 1990 and 1994 data on brand specific advertising in 36 popular US magazines to examine the relationship between the presence or absence of advertising in each magazine for each of 12 cigarette brands, and the proportion of each magazine's youth (ages 12-17 years) readers who were black.
MAIN OUTCOME MEASURES—The presence or absence of advertising in each magazine in 1990 and 1994, for each of 12 cigarette brands.
RESULTS—After controlling for total magazine readership and the percentage of young adult, Hispanic, and female readers, black youth cigarette brands (those whose market share among black youths exceeded their overall market share) were more likely than other brands to advertise in magazines with a higher percentage of black youth readers. Holding all other variables constant at their sample means, the probability of a non-black youth brand advertising in a magazine decreased over the observed range of percentage black youth readership from 0.65 (95% confidence interval (CI) 0.55 to 0.75) for magazines with 5% black youth readers to 0.33 (95% CI 0.00 to 0.69) for magazines with 91% black youth readers. In contrast, the probability of a black youth brand advertising in a magazine increased from 0.40 (95% CI 0.17 to 0.62) at 5% black youth readership to 1.00 (95% CI 0.97 to 1.00) at 91% black youth readership.
CONCLUSIONS—Black youths are more likely than white youths to be exposed to magazine advertising by cigarette brands popular among black adolescents.


Keywords: advertising; magazines; youths
doi:10.1136/tc.9.1.64
PMCID: PMC1748280  PMID: 10691759
23.  Dietary advice for muscularity, leanness and weight control in Men’s Health magazine: a content analysis 
BMC Public Health  2014;14(1):1062.
Background
The dietary content of advice in men’s lifestyle magazines has not been closely scrutinised.
Methods
We carried out an analysis of such content in all 2009 issues (n = 11) of Men’s Health (MH) focusing on muscularity, leanness and weight control.
Results
Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets.
Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines’ support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns.
Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on fat-burning, good fats and consumption of single foods, with relatively little mention of dietary restriction.
Conclusions
Despite the widespread use of scientific information to endorse dietary advice, the content, format and scientific basis of dietary content of MH leaves much to be desired. The dietary advice as provided may not be conducive to public health.
doi:10.1186/1471-2458-14-1062
PMCID: PMC4198727  PMID: 25304148
Magazines; Masculinity; Body image; Diet; Qualitative research
24.  Cigar magazines: using tobacco to sell a lifestyle 
Tobacco Control  2001;10(3):279-284.
OBJECTIVE—To assess the content of two cigar "lifestyle" magazines, Cigar Aficionado and Smoke.
DESIGN—Content analysis of cigar focused articles.
SUBJECTS—Cigar focused articles (n = 353) from Cigar Aficionado and Smoke magazines.
MAIN OUTCOME MEASURES—Primary focus; mention of health effects, environmental tobacco smoke, or scientific research; quotation and description of individuals; characteristics such as sex, age, ethnicity, smoking status, affiliation, and stance towards cigars; and overall image of cigars.
RESULTS—Cigar business-focused articles were the largest category (40%, n = 143), followed by articles about cigar events (12%, n = 42). Notable were articles featuring cigar benefits to raise money for health charities. Celebrities were featured in 34% (n = 121) of articles and 96% (n = 271) favoured cigar use. Only four (1%) articles featured health effects of cigars as a primary focus.
CONCLUSIONS—Cigar Aficionado and Smoke broke new ground in tobacco marketing by combining promotion of product, lifestyle, and industry in the same vehicle and linking the medium directly to product related events that extended its reach. The creation and marketing of new tobacco use sites challenges the increasing "isolation" of smokers, and positions cigar use as a socially welcome relief from restrictions. Public health advocates should anticipate and challenge other new tobacco marketing vehicles as communications technologies advance and public spaces for smoking shrink.


Keywords: cigars; cigar magazines; lifestyles; tobacco marketing
doi:10.1136/tc.10.3.279
PMCID: PMC1747592  PMID: 11544394
25.  U.S. Tabloid Magazine Coverage of a Celebrity Dating Abuse Incident: Rihanna and Chris Brown 
Journal of Health Communication  2012;17(6):733-744.
Dating abuse is a prevalent adolescent health problem with substantial public health consequences. As many as 1 in 10 high school students in the US reports being “hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend” in the past year. We used the Rihanna-Chris Brown dating abuse incident of 2009 as a case study to conduct what is, to our knowledge, the first assessment of media framing of dating abuse. We reviewed the 20 leading U.S. single copy sales magazines published February–April, 2009 and identified 48 relevant articles which were all printed in seven “tabloid” magazines. We conducted a content analysis of the media frames of the articles using five frame categories: (1) Abuse is objectionable; (2) Victim-blaming; (3) Abuse is sexualized/romanticized; (4) Myths about abuse perpetration; and (5) Abuse is normalized. “Abuse is objectionable” was the dominant frame of 40% of articles, “victim-blaming” in 36%. Although the vast majority of articles reviewed (83%) made at least passing reference to the idea that abuse is wrong, a minority (40%) used a dominant frame that condemned abuse. Instead, the majority of articles communicated “mixed messages” about dating abuse, and many minimized the seriousness of partner abuse perpetration. Advocacy is needed to improve future tabloid media framing of dating abuse incidents.
doi:10.1080/10810730.2011.635778
PMCID: PMC3393837  PMID: 22475328

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