The news media can provide information about health issues to a very large proportion of the population. 1, 2 Early research linked decreases in tobacco consumption and smoking prevalence to news and publicity surrounding some of the first widely publicised reports on smoking and health. 3 Notably, unpaid publicity has been credited as the main factor contributing to the 30% decline in smoking prevalence among British males between 1960 and 1980—substantial falls followed the publication of the 1962 and 1971 Royal College of Physicians’ reports. Declines in the prevalence of smoking among US males have been attributed chiefly to the influence of the mass media and especially the publicity given to the early US Surgeon General’s reports. 4
Journalists and media outlets are particularly likely to report on new developments in scientific knowledge, public policy initiatives and policy debates with strong proponents and opponents. 5-7 News stories can therefore be an accessible and low-cost public education intervention 8 as well as a useful adjunct to a paid media strategy. Health advocates aiming to raise awareness of health issues by generating news coverage (which can in turn lead to support for and actual policy changes), 9 need a good understanding of how smokers receive, hear and see tobacco news, how the news media works, 8, 9 and how to attract media attention. Opportunities for coverage of newly published research are limited when other tobacco control issues are ‘live’ and already gathering media attention. 10 Online news in particular is a wide-reaching, very low-cost avenue for disseminating news stories that have a high level of public interest. 7 It is important to understand which tobacco issues are most likely to be covered across each of the different news media channels, 10, 11 the nature of the coverage 12, 13 and the role the information disseminated by the news media has in shaping smokers’ beliefs, intentions and behaviours. 14, 15
14.6.1 Volume of news coverage
Tobacco control efforts often attract significant news media attention 8, 16-18 and aggregated news coverage sometimes outweighs even the most intensive exposure gained through paid anti-smoking campaigns. 19 Quit Victoria has estimated, for instance, that its 40 media mentions on average per week between January 2007 and December 2010 resulted in an additional 9,000 stories in the Australian media that mentioned smoking or tobacco control. 20
Studies of news coverage of tobacco control issues often examine the tone of the story. The studies typically note a predominantly positive or neutral tone (in favour of tobacco control), and that stories that feature more pro-tobacco control sources tend to be more positive, and vice versa. 13, 21-23 The volume of news coverage is also a significant factor in shaping opinions. 8 Australian adults are potentially exposed to a significant amount of tobacco-related news coverage and smoking has long been a leading health news focus in Australia. 12 While the amount of coverage may vary considerably across states/territories and across a given year, 12 one estimate put this exposure at one tobacco-related news article every week from 2001 to 2006—comparable with or higher than the level of paid advertising. 6 Particular policy issues, such as plain packaging, may generate an especially high volume of news content. 23 Despite vocal opposition to plain packaging that was frequently covered in the media, news articles from Australian outlets from the time of policy announcement to post-implementation of plain packaging were overwhelmingly neutral in tone (96%), and 55% of editorials were positive. An analysis of this news coverage attributed this predominately neutral coverage to robust efforts by public health advocates to counter tobacco industry misinformation. 23
14.6.2 Advocacy in the news
By influencing public perceptions about the importance of issues, news media can influence public health behaviour directly and indirectly. 24 Indirectly, news coverage can influence attitudes and behaviours by attracting institutional attention and prompting related environmental or policy changes. 25 This strategic use of news coverage to influence public policy (media advocacy) seeks to develop and shape news stories to build public support for public policies and ultimately influence those who have the power to change or preserve laws, enact polices and fund interventions that can influence whole populations. 26, 27 This requires active engagement in the process and a good understanding of how the media works.
A study by Wakefield and colleagues quantified the recognition of Australian tobacco control advocacy groups by the news media. They found advocacy groups were explicitly mentioned in around one in five newspaper articles on tobacco use, were increasingly likely to be mentioned as the prominence of the article increased and were sought out by journalists for comment on issues. 28 News coverage can also directly influence public health behaviours by providing information that changes knowledge, attitudes or intentions, 29 or by increasing the perceived importance of a health issue 30 such that priming effects occur. 31
Efforts of the tobacco industry and the local tobacco control context can also influence the news media. Studies from the US of the content and tone of local tobacco-related newspaper coverage have shown that towns and jurisdictions that have fewer smokefree policies 32, 33 or are closer to tobacco company headquarters 34 tend to have fewer stories about tobacco control issues and more negatively toned editorials. In one of these studies, the authors noted that areas without smokefree policies also tended to have more stories related to issues such as youth smoking rates, rather than coverage of proposed policy or other tobacco control issues. The authors suggested that this may be the result of tobacco industry efforts to divert attention away from tobacco control efforts in jurisdictions yet to pass smokefree policies. 32 An analysis of news coverage of the announcement of the Philip Morris-funded Foundation for a Smokefree World found that while more than half of the print and web-based news stories examined presented an opposing argument against the Foundation, almost 30% were neutral, and 20% were positive. Around 40% of articles were critical of the credibility of the Foundation or presented the Foundation as a tactic to undermine tobacco control efforts. 13
14.6.3 Influence of news coverage on smoking behaviour
Despite the high level of exposure of news coverage, and research exploring the ways in which mass media can influence smokers by paid anti-smoking advertising, 35, 36 research on the role of the news media in directly shaping individual-level smoking outcomes has been limited. Studies have shown correspondence between patterns of news media coverage of tobacco to cigarette purchasing patterns 37 and annual rates of cessation. 5 Some evidence suggests that the volume of newspaper coverage can be related to youth smoking-related cognitions 38, 39 and behaviours. 38, 40 Very little research has linked adults’ self-reported exposure to tobacco news content with any smoking-related beliefs. The first study to do so examined support for policies to limit smoking in movies. 41 Only a small number of studies have examined smokers’ recall of tobacco-related news. 31, 41, 42
In an Australian study, Dunlop and colleagues explored smokers’ and recent quitters’ recall of tobacco news, and associations between tobacco news recall and smoking-related cognitive and behavioural outcomes. High levels of self-reported exposure to tobacco news were associated with important smoking-related cognitions, including beliefs about harm from smoking and frequent thoughts about quitting. The relationship between news recall and these outcomes was maintained when controlling for known predictors of news exposure such as education. News recall was not, however, related to an increased probability of having made a recent quit attempt. 43 Among Aboriginal and Torres Strait Islander smokers, self-reported noticing of anti-tobacco news stories in the past six months was associated with significantly higher levels of worry about the dangers of smoking to individual health and desire to quit smoking. 44 A US study of coverage of the lung cancer deaths of high-profile individuals found that, following coverage of these deaths, attitudes toward lung cancer changed and a sustained increase in quitline calls was observed. 45
14.6.4 News media channels
With the exception of MacKenzie and colleagues’ analysis of television news portrayals of lung cancer, 14 most Australian research examining news coverage of tobacco control has focused on print media. 6, 12, 15, 16, 23, 38, 43 US research suggests that television news coverage may be more neutral and less likely to feature public health advocates than newspaper content. This content analysis of television news stories of tobacco issues from 2008-2009 found the majority of stories had a balanced tone (68%) and most others were supportive of tobacco control. 46 Approximately half of the stories examined did not quote any sources, and of those that did, government officials were most often featured. Smoking bans and stories about cessation were the most frequently covered topics. Another US study observed differences in the themes featured in news stories in newspapers compared with on television, and much more variability between individual newspapers and newswires compared to across television networks. 47
The ways in which news is disseminated has changed dramatically. In 2018, use of online news—including news websites, social media, and blogs—among Australians surpassed traditional (offline) news sources, with 82% accessing online news and 79% accessing offline news. 48 Television remained the most popular news source (66%), followed by online news websites and apps (64%), and social media (54%). Use of social media as the main source of news was 17% in 2018, second only to television (26%), but much higher among those aged 18–24 years (36%). 48
Social media provides further avenues for news stories to reach audiences through ‘earned media’ via blog posts, reader engagement (e.g. Facebook ‘likes’ and comments on articles) and sharing of content by users. 49, 50 Researchers have also begun analysing the content and tone of public comments on news sites to understand the impact and public perceptions of coverage of public health issues and public education campaigns. 49
*Acknowledgement: Thank you to Dr Sally Dunlop and Professor Melanie Wakefield for advice and assistance on a previous version of this section.
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