LIBRARY Michigan State University PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINE-S return on or before date due. MTE DUE MTE DUE DATE DUE "FEB'Z'O 1399 . 8.1995593?“ 1/“ WWW“ CIGARETTE ADVERTISING AND CANCER CONTENT IN AFRICAN-AMERICAN AND CAUCASIAN MAGAZINES BY Nicole Marie Hebert A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS IN COMMUNICATIONS School of Journalism 1997 ABSTRACT CIGARETTE ADVERTISING AND CANCER CONTENT IN AFRICAN-AMERICAN AND CAUCASIAN MAGAZINES BY Nicole Marie Hebert The purpose of the study is to examine the effect of cigarette advertising in magazines geared toward African- Americans and Caucasians, on cancer coverage in the publications. Prior research indicated that the amount of tobacco advertising is negatively related to the amount of coverage of cancer and other diseases related to smoking. Despite the fact that millions die from lung cancer each year, tobacco companies continue to advertise their product through print media. By using content analysis, this study examined four publications, one each geared toward the African-American female, the African—American male, the Caucasian female, and the Caucasian male. Each publication stated that health was among the topics important to its readers. This study found evidence to support these previous studies although the overall correlations between advertising and editorial content were quite low. This occurred because although health-related information was important within the prospective magazines, very little information appeared on the subject of cancer and smoking in any of the magazines. Copyright by NICOLE MARIE HEBERT 1997 To mommy and daddy for providing me with strength, love, desire and the knowledge that any goal I set is attainable. iv ACKNOWLEDGMENTS This project would not be possible without the knowledge, leadership, and patience provided by two very key people. First and foremost I would like to thank my advisor on this project, Professor Stephen Lacy, for his time, understanding and guidance throughout the completion of this thesis. Most importantly, I would like to thank him for his insight where all aspects of this paper are concerned. I would also like to thank Teresa Mastin for her help and guidance based on her previous study detailing the coverage of cancer in Ebsenceumagazine when compared to advertisements for tobacco. Her wisdom where this subject is concerned proved to be priceless. Her assistance and input on this project was greatly appreciated. TABLE OF CONTENTS LIST OF TABLES ............................................. vii CHAPTER 1 INTRODUCTION .................................................. 1 CHAPTER 2 LITERATURE REVIEW ............................................. 13 Hypotheses ............................................... 21 CHAPTER 3 METHOD ........... . ............................................ 26 Coding Procedure ........................ . ................ 28 CHAPTER 4 RESULTS ...................................................... 32 CHAPTER 5 CONCLUSION AND DISCUSSION ..................................... 46 CHAPTER 6 FUTURE RESEARCH ............................................... 49 APPENDICES A. Reliability of Variables ............................ 51 B. Coding Instructions ................................. 52 C. Variable Definitions and Levels ..................... 53 D. Coding Sheet ........................................ S7 BIBLIOGRAPHY .................................................. 59 vi Table Table Table Table Table LIST OF TABLES Average Paragraphs Per Issue Which Discuss Cancer but Do Not Relate it to Smoking ..... . .......... .........35 Average Number of Cigarette Advertisements for Each Magazine According to Year .......................... 37 Pearson Correlations Between Total Advertising Pages and the Content Measures by Magazine................39 Average Paragraphs Per Issue Which Discuss Smoking in Neither a Positive Nor a Negative Light.............42 Average Paragraphs Per Issue Which Discuss Cancer and Relate it to Smoking..... ........... . ..... ..........45 vii CHAPTER 1 INTRODUCTION Lung cancer is one of the most preventable diseases in America. The elimination of cigarettes and other tobacco products would drastically reduce the number of deaths from this type of cancer. Despite this fact, cigarettes continue to be one of the most heavily advertised products in the United States. The tobacco industry spent $340 million alone on advertising in 1993. (Advertising Fact Book, 1995). One of every four deaths in the U.S. is from cancer. Lung cancer caused by smoking can be prevented because the decision to use cigarettes and other tobacco products is left up to the individual. The American Cancer Society estimates that there were 177,000 new cases of lung cancer diagnosed in 1996 due to tobacco use. Of these cases, almost 99,000 were males and 78,000 were women. It is also estimated by the ACS that 160,000 lives were lost during 1996 due to lung cancer (Cancer Facts & Figures 1996). Cancer is the second leading cause of death in the United 1 2 States, accounting for 23 percent of overall mortality. It is exceeded only by cardiovascular deaths. However, with the downward changes in heart disease and strokes, it is expected that by the let century, cancer will be the leading cause of mortality (Hardy 1991). Presently, in the area of all cancers, lung cancer is the leading cause of cancer mortality for men in the United States and exceeds breast cancer as the primary cause of cancer mortality in women as well (Hardy 1991). For more than 40 years breast cancer was the leading cause of cancer death in women. Since 1987 however, deaths from lung cancer in women have surpassed those from breast cancer (Mortality Trends, 1993). While the number of cardiovascular deaths is on the decline, smoking-related cancer deaths continue to rise (Hardy 1991). The number of deaths from lung cancer has risen drastically. In 1962, approximately 35,000 males and 6,000 females died from lung cancer. In 1992, these numbers escalated to 91,405 males, and 55,000 women (Cancer Facts & Figures 1996). On a day—to-day basis, every two minutes, it is estimated that five teen-agers will begin smoking. At least one of the teens will die a premature death because of it (Blair 1979). Cigarette smoking is by far the most important risk factor in the development of lung cancer. Approximately three million people die worldwide each year as a result of smoking (Cancer 3 Facts & Figures 1996). According to the former Surgeon General, almost one out of six deaths in the United States can be traced back to cigarette smoking (Koop 1989). Smoking is related to approximately 87 percent of lung cancers. It is also linked to cancers of the mouth, pharynx, larynx, esophagus, pancreas, uterine cervix, kidney and bladder (Cancer Facts & Figures 1996). Currently, 46.3 million adults in the United States are smokers (Bartecchi 1993). Lung cancer is the number one cause of cancer death in the United States for Caucasians, African- Americans, Native Americans, Asian & Pacific Islanders and Hispanics (Cancer Facts & Figures 1996). Of the total U.S. male population, 28 percent are smokers. Males who smoke are 22 more times likely to die from lung cancer than those who do not smoke. Twenty-three percent of the female population are current smokers, and are 12 times more likely to develop the disease. Thirty-three percent of African-American males smoke, while 27 percent of Caucasian males take part in the habit. Twenty-one percent of African-American women smoke and 23 percent of Caucasian women smoke (Simmons 1993). There is a significant difference of cancer outcome (incidence, survival and mortality) for African-Americans when compared with Caucasians. Incidence rates for black males (112/100,000) far exceed those of all other groups including 4 white males (76/100,000), black women (24.3/100,000), and white women (21.8/100,000) (Hardy 1991). As the numbers above indicate, mortality rates for black women and black men transcend those of whites. The esophageal cancer rate is four times as high among black males as it is among whites, and blacks die from this cancer at a rate of 240 percent higher than whites. The lung cancer incidence is 60 percent higher for black males than for white males, and the death rate for blacks is 40 percent higher. This being partly due to heavier smoking by blacks (Djata). Despite these numerous statistics linking cigarette smoking to ultimate death, tobacco companies continue to spend millions every year to advertise their product in consumer magazines across the United States. Tobacco companies spent approximately $340 million advertising cigarettes in 1993 and $210 million of that was spent on consumer magazines alone (Advertising Fact Book, 1995). These magazines in turn receive a large portion of advertising revenue from these tobacco ads. The tobacco industry has been quite successful at promoting it's product as well as keeping it's customers. According to a British government study, at least 85 percent of teens who smoked more than one cigarette, became regular users. Former drug addicts and alcoholics who have been surveyed, consider it harder to give up tobacco than booze. In addition to this, both 5 drug and alcohol addicts can tolerate drug-free periods, whereas only two percent of all cigarette users are intermittent smokers (Blair 1979). The targeting of women in tobacco advertising-in particular, the heavy concentration of cigarette advertisements in women's magazines and tobacco companies' sponsorship of women's sports, fashion, artistic, and political activities, have been well documented. There is a significant inverse relationship across women's magazines between their proportion of cigarette advertising revenues and their editorial coverage of smoking and health (”Women and Smoking" 1993). The inverse relationship being that as the revenue from cigarette advertising increases, editorial content on the subject of cancer decreases. Americans receive a large amount of information from consumer magazines. The topics range from fashion to world news and everything in between. Health information is one of the topics many consumer magazines claim to keep their readers abreast of. Readers in return rely on magazines to keep them informed on subjects dealing with health. There is reason to believe however that consumer magazines tend to limit information dealing with the issue of cancer, lung cancer in particular, in order to avoid offending the tobacco companies which advertise in their publications. This could all soon change. The continuing saga being played out in the headlines between cigarette companies and their opponents has finally provided information that could change how and where tobacco products are advertised. Toward whom the ads are geared, the content and where they are placed have long been among the many controversial issues surrounding tobacco companies. Because of the considerable amount of money that these companies pay media outlets in order to promote their product, one can only ponder as to whether or not these publications remain true to their readers. Society is left with the question: Do publishers stray away from articles which would inform their readers of the dangers surrounding tobacco in order to indulge their tobacco advertisers? The following study explores this question and other issues surrounding tobacco advertising in magazines. The study concerns the relationship between the amount of tobacco advertisements in African-American and Caucasian-oriented publications and the number of articles dealing with the subject of cancer in general within these magazines. The study will compare the number of advertisements with the related number of articles dealing with the subject of cancer. The number of articles dealing with all types of cancer will be mentioned but 7 those which relate cancer and smoking are the main focus. The amount of cancer—related deaths are most prevalent among African—Americans and Caucasians. Deaths from lung cancer among other ethnic groups are significantly lower in comparison. Therefore, the focus of the study leaned more towards African- Americans and Caucasians. In order to look at how often the magazines provided cancer information to both races, four magazines were chosen based on their targeted group within the population as well as their dedication to bringing readers important health issues. In order to focus on both genders as well, the category for choosing a magazine had to also be specified for the particular gender of the particular race. ESsence, for example, was chosen so that cancer coverage in an African-American woman periodical could be specifically examined. A study such as this is relevant for a number of reasons. It will help determine the extent that readers are exposed to the dangers that surround cigarette smoking and tobacco use through magazines. The amount of advertising for one group may be linked to the coverage of cancer within that specific publication. The fact that lung cancer is responsible for taking as many as 160,000 lives in 1996, leads one to question the role, if one exists, of consumer magazines and their coverage of lung cancer. 8 If there is indeed a link, it has not shown that exposure of these ads to consumers is connected to developing lung cancer. Tobacco is not the only product that uses consumer magazines for much of its advertising. The fashion/beauty industry, the automotive industry and the liquor industry make up a large portion of consumer magazine advertising pages. For tobacco companies, however, print media, specifically magazines, is the only option. When tobacco advertising was banned from television in 1971, it was print media that the industry pursued. Liquor ads which have only recently begun to advertise their product on television, also rely heavily on print media. In 1948, in order to regulate themselves, manufacturers of hard liquor products formed The Distilled Spirits Council of the United States (DISCUS). The voluntary group ruled that they would restrict hard liquor advertising from appearing on television (Fueroghne 1995). This self regulatory ban lasted until it was lifted by DISCUS in the Fall of 1996. Seagrams company was the first to begin advertising their product on television. President Clinton and Congress are opposed to the lifting of the ban and would like to see liquor ads remain from being placed on television. Although ads for the auto and fashion industries, have long had the extra advantage of television, they too spend millions advertising in consumer magazines. Studies have shown that 9 advertising in consumer magazines has an enormous effect on the editorial content. The assumption has been made that magazines design their articles around the products being advertised in their publications. Gloria Steinem's article, focuses on the the media wide influence advertisers have on what the reader reads. She states that along with consumer magazines, newsmagazines use ”soft" cover stories to sell ads, confuse readers with "advertorials," and occasionally self—censor themselves on issues known to be a problem with big advertisers (Steinem 1990). Beer companies have for the most part always had the distinction of having television on their list of advertisers. The beer and liquor industries have much in common with the tobacco companies in that the question still remains as to whether or not the advertising of these products causes them to be abused by consumers. A study which appeared in the summer of 1982 in JOurnalism Quarterly; took a look at the role alcohol advertising plays on editorial content within magazines. The study found that the number of alcohol ads within each magazine played a role in whether the editorial content would be negative or positive. The magazines with only a few liquor ads tended to provide negative editorial content surrounding alcohol. Those magazines with a large amount of alcohol ads tended to provide editorial 10 content with a positive view of the use of alcoholic beverages (Pierce & Tankard 1982). With the automobile industry's realization that women are responsible for about half of all new-car purchases and influence some 80 percent of all car-and truck-buying decisions,. women's magazines have been added to the list of many automobile manufacturers. In 1993, the entire automotive industry accounted for $946.7 million in magazine advertising revenue, including all equipment and accessories. In order for some women's magazines to be included in this revenue, they formulated and invented columns and special sections dedicated to discussing automotive issues for their readers. In order to solidify relationships with certain car companies, publishers have also limited columns to dealing with only one specific manufacturer and focusing on their particular product (Hochwald 1994). The fashion/beauty industry, has long had editorial content which specifically surrounded whatever product was being advertised. From clothing spreads which feature a particular advertisers designs, to beauty columns that suggest certain products (which they are advertising) will work best. In 1995, the toiletries and cosmetics category ranked second in advertising, behind the automotive industry. The amount of advertising dollars available through beauty and fashion ads 11 have recently been realized by other niche magazines. Because of this, magazines such as Choking Light, have revamped their magazine in order to provide a section dedicated to the vanity aspect of fitness and health. Along with this new section will come the advertising dollars from the cosmetic industry and the fashion industry (Hochwald 1996). Although it is not written in stone, the assumption still remains that consumer magazines self-regulate themselves on many tOpics, especially those which may prove offensive to their prospective advertisers. As mentioned above, editorial content can be influenced in a variety of ways by advertisers. The study on alcohol and editorial content shows that depending on how many ads exist for a certain product, can determine whether or not the editorial content will be positive or negative. Advertisers who inform publishers of what topics can and cannot be dealt with if their ad appears in the magazine, have a tremendous influence on editorial content. These advertisers have drawn a fine line between what one would consider to be self-regulation on the part of the publisher. For example, food advertisers often request that recipes and articles be placed within the magazine, with mention of their particular product. The same rings true for clothing advertisers who expect to have photo spreads centering around their designers and beauty ads which ask that their make-up, hair products, fragrance, etc., be 12 given positive editorials as well as photo credit (Steinem 1990). Steinem's article goes on to state that the control advertisers have over content has now become institutionalized. Advertisers now have policies which state what must accompany a certain product. She gives the example of Proctor & Gamble and its policy that its products not be placed in an issue if articles exist on gun control, abortion, the occult, cults or the disparagement of religion. Precautions were asked to be taken as well with any issue of a magazine which dealt with sex or drugs even for the purpose of education. The De Beers Diamond Company restricts magazines from placing its ads next to articles and editorials dealing with "hard news or anti/love— romance' subjects. Bristol-Myers requests that their ads be placed next to "a full page of compatible editorial (Steinem 1990)." CHAPTER 2 LITERATURE REVIEW Numerous articles exist on the subject of causes of cancer, kinds of cancer, ways to prevent cancer as well as any other category which cancer could possibly fall under. For the most part however, these articles will most likely only be found in academic and medical journals. Lung cancer in particular is one such category, where the emphasis of the cause is placed primarily on the use of tobacco products. Surprisingly enough, only a few articles have taken a look at the amount of tobacco advertising appearing in printed media. Even fewer articles focus on tobacco advertising in relation to coverage about the product within the consumer magazine industry. The subject of cigarette advertising, however, has in no way disappeared from public view. The fact that tobacco companies haven't been allowed to advertise on television since 1971, hasn't slowed down the role they have played in mass media. The controversy over tobacco 13 14 advertising on billboards and their proximity to such establishments as schools, parks, churches, etc., has simply been the latest issue in this ongoing debate. In August of 1995, the Food & Drug Administration proposed banning outdoor ads within 1,000 feet of a school or playground, restricting tobacco companies to black and white, text only advertising in magazines with more than 15 percent of readership by those under the age of 18; eliminate giveaways of merchandise with tobacco symbols, and limit tobacco symbols in many sports sponsorships to black and white text only. In addition the FDA asked that tobacco companies be required to fund a $150 million dollar anti-smoking program (Teinowitz 1996). The Supreme Court ruled again on the subject in April of 1997. The court turned down a request to hear a challenge concerning two Baltimore city ordinances which prohibit billboard advertising of cigarettes and alcoholic beverages in areas where children gather. The high court let the ruling of the lower court stand, stating that such a ban does not violate the free speech rights of tobacco firms, breweries and distilleries (www.cnn.com April 28, 1997). The tobacco industry feels it is the responsibility of the Federal Trade Commission, not the FDA to regulate tobacco. The tobacco companies also feel that if these rules were to be adhered to, the ad industry would lose between 2,734 and 8,183 15 jobs and revenues of between $722.3 million and $2.167 billion. In April of 1997, a federal court declared that the U.S. Food and Drug Administration had the authority to regulate tobacco but that it could not mandate content where advertising is concerned. Therefore the FDA would have the authority to impose access restrictions and labeling products for cigarettes, but they can not restrict the advertising and promotion of tobacco (www.cnn.com April 25, 1997). This also includes the ability to ban free samples, billboard ads near schools and playgrounds, limit vending machine sales, ban sponsorship of sports events and the use of cigarette brands on hats, T-shirts and other products. While studies dealing with tobacco advertising in magazines, are very few, some do exist. These few only look at women's magazines. Cigarette advertising in magazines geared toward males has been all but ignored. In doing the research for this particular study, an article dealing with this topic could not be found. One of the few studies to take a look at tobacco advertising in women's magazines, appeared in Jaurnalism Quarterly in the Summer of 1989. Kessler's article examined the amount of information provided concerning the dangers of cigarette smoking in comparison to information provided on the subject of lung cancer. The article studied six magazines from 16 the years 1983 through 1987. The magazines chosen were based on circulation and whether or not the magazine described itself as dealing with health issues. The findings of the research indicated that health was indeed an important aspect of each chosen magazine. This being the case, not one of the six magazines published any full- length, feature, column, review or editorial on any aspect of the health hazards connected to smoking. In addition, tobacco ads made up for a significant amount of revenue on behalf of five of the magazines (Kessler 1989). Findings of this nature seem to ring true in publications overseas as well. A study published in January of 1991 took a look at this same topic where British women's magazines were concerned. The article not only focused on coverage of smoking hazards in relation to tobacco advertising, but also looked at the policy and decision making process involved in whether or not cigarette advertising will be accepted into a specific publication. Of the 80 magazines that were examined between July and September of 1989, nearly all had some type of policy on refusal of advertising. Most commonly, advertisements were refused if they were regarded as possibly being offensive to readers, if they were sexist, or if they advertised alcohol or "slimming" products. Six magazines refused advertisements for “dangerous or questionable products,“ although two of these 17 magazines also accepted cigarette advertising (Amos 1991). Those publications which had strict policies against accepting tobacco advertisements primarily dealt with health and fitness as their main focus, children's magazines and parenting magazines (Amos 1991). Coverage of cancer-related articles was much the same as it had been for Kessler. Coverage of smoking-related issues was minimal compared to the amount of advertising accepted by these magazines. Magazines that refused tobacco advertising were more likely to publish information on the topic of those issues which were related to smoking (Amos 1991). In 1989, former U.S. Surgeon General, Dr. C. Everett Koop issued a report suggesting that magazines which accept cigarette advertising, pay less attention to informing their readers of the dangers surrounding the use of tobacco products. The Surgeon General stated that several publications which carry cigarette advertising, refuse to run articles on the health aspect of smoking (KoOp 1989). Relying on charges made by health professionals, an article from New'Ehgland Journal of'Medicine, stated that magazines which depend on revenue from cigarette advertising are less likely to publish articles on the dangers of smoking for fear of offending cigarette manufacturers. NEJM felt that magazines could in fact be harming their readers by leading them to 18 underestimate the risks involved in smoking, in relation to other health risks that are covered more often within the magazines (Warner 1992). The study collected data from 99 U.S. magazines between the years of 1959 through 1986. The primary focus was annual data from cigarette advertising revenue, coverage of health risk factors and demographic data pertaining to race and gender where readership was concerned. By analyzing the probability that the magazines would publish articles on the risks of smoking in relation to whether or not they carried ads for cigarettes, and in relation to the proportion of their advertising revenue derived from cigarette advertisements, the study came to the conclusion that there is strong statistical evidence to show that magazines in the United States have limited coverage of articles dealing with the hazards of smoking in relation to the amount of cigarette advertising that exists. The study stated that the case could possibly be made that publishers and editors of the various magazines where information on smoking was relatively low, may not feel that smoking is a serious health hazard. Therefore, the need to focus on the dangers of smoking simply wasn't a priority. The article went on to say that this was most likely not the case, based on the fact that if editors and publishers were ill- advised on the topic of smoking, they would indeed fall short in 19 other areas of health as well (Warner 1992). A study which examined cigarette advertising in niche publications found that tobacco companies do indeed target their product to specific segments of the population. Following the broadcast ban on cigarette ads, tobacco advertisers actively pursued consumers through magazines geared toward women and African-American readers, more so than any other segment of the magazine market (Basil 1991). The study stated that beginning in 1970, the number of cigarette ads in Black-and youth oriented magazines had risen dramatically and steadily. Beginning with the early 19808, the number of cigarette ads in these same magazines have remained constant, despite the fact that there has been a large drop in the number of cigarette ads in general (Basil 1991). Although fewer cigarette ads may exist in recent years of some publications, these ads may account for an even greater amount of revenue. Agencies achieve this by purchasing larger ad spaces and/or purchasing the most prominent ad space, like the back cover or the inside front cover (Djata). The article which most closely relates to the area of study which I focused on, appeared in the waard JOurnal of communications in 1996. Mastin looked at the relationship existing between cigarette advertising and editorial content in ESsence.magazine. EBsence is a publication targeted at women 20 African—American readers. Mastin focused on the editorial content and amount of tobacco advertisements in selected years of the magazine (Mastin 1996). The study found that the magazine's coverage of smoking health hazards, paled in comparison to the amount of tobacco advertising. As Mastin went on to explain, this in itself is quite significant since African-American women who smoke, die more often from diseases associated with tobacco, than any other member of the female population (Mastin 1996). The overwhelming amount of tobacco advertisements in relation to editorial content and the dangers surrounding smoking, suggests that the magazine's acceptance of tobacco ads plays a role in the decision making process behind whether or not the subject will be covered. Mastin stated that the magazine's need for advertising dollars may outweigh it's responsibility to the African-American woman, which is it's obligation to inform its readers of information that is important to their health and well-being. The study found that the editorial content of this specific magazine geared toward this specific audience, concerning the health issue of smoking and cancer, is influenced by tobacco advertising. The influence of advertising on editorial content within magazines is somewhat of an unwritten fact. For the most part, one could actually say that the content of the magazine is 21 geared toward the advertiser, not the reader. EsSence.magazine clearly states that one of their main objectives is providing their readers with pertinent information regarding health. Mastin‘s study shows that this was not the case in dealing with the issue of diseases which are caused by smoking and tobacco products (Mastin 1996). The African-American women who turn to ESSence for health- related information would find this information extremely important, if they do indeed turn to ESsence for health-related issues. Mastin went on to state that a magazine which prints less than one paragraph a month on the the topic of hazards surrounding the use of tobacco products, is not living up to the standards which they themselves have set (Mastin 1996). These studies were the basis for my attempt to look at tobacco advertising in relation to smoking related coverage in consumer magazines geared toward Caucasians and African- Americans as well as both genders. Hypotheses Based on these studies, the hypotheses for this study are as follows: H1. Articles in the publication geared toward Caucasian women will supply more information on the issue of cancer than 22 the African-American woman magazine. Studies indicate that Caucasian women have a better survival rate when it comes to cancer, as well as knowing what precautions to take when cancer is dicovered. According to a study from the Journal of the National Mbdica1 Association, socioeconomic status and class have been shown to be significant predictors of poor outcome, and blacks are disproportionately represented among the poor and disadvantaged (Hardy 1991). Caucasian women who are diagnosed with cancer have a higher survival rate than African-American women based on the above mentioned information. H2. As the number of tobacco advertisements increase, the number of articles dealing with cancer will decrease. Tobacco companies spend a great deal of money on advertising within these respective magazines. Therefore publishers are at times put in the predicament of not wanting to offend the companies by placing articles in their magazines which tell of the dangers of cigarette smoking. H3. Those publications that do contain articles on cancer will have very few articles about lung cancer. In order to fill the desire for articles on the subject of cancer in general, publications will focus on other types of cancers straying away from the concentrated area of lung cancer. Publishers will do this in order to fulfill their responsibility 23 of supplying cancer related articles, but at the same time being sure to stay on the positive side of their cigarette advertisers. Other research questions which will be examined include the following: R1. Do articles dealing with cancer appear more frequently in the magazine geared toward Caucasian males in comparison to the periodical geared toward Caucasian women? Based on the fact that white males have the lowest incidence of cancer-related diseases, media outlets such as magazines, may provide them with more information where cancer is concerned. R2. Do articles in the African-American periodical geared toward males have more cancer-related articles than the magazine geared toward African-American females? Being that black males have an extremely high rate of cancer, the African-American publication will take note in realizing that this is an important issue where black men are concerned and therefore require as much information as possible. R3. Do articles dealing with cancer appear more frequently in the magazine geared toward Caucasian males in comparison to the periodical geared toward African-American males? Based on the fact that white males have the lowest incidence of cancer-related diseases, media outlets such as 24 magazines, may provide them with more information where cancer is concerned. R4. Do articles dealing with cancer appear more frequently in the publication geared toward Caucasian women in comparison to the periodical geared toward African-American women? Previous research indicates that Caucasian women have a lower rate of cancer incidence than that of their African- American counterparts. Caucasian-oriented publications geared towards women may provide their readers with more cancer coverage, enabling them to seek more information on a disease which may be afflicting them. In each magazines description of the topics that are available to its readers, health is stated among all four as being a priority. It is under these guidelines that it is assumed, each magazine is providing its readers with information on all aspects of health. Research questions one through four are based on the assumption that "all aspects of health," would include coverage on the topic of cancer. Linking the number of advertisements for tobacco to the number of articles that focus on cancer in the preceding magazines is important for two main reasons as far as both races are concerned. As far as African-Americans are concerned, since the magazines Ebony Man and ESsence define themselves as being geared specifically for African-Americans, their readers may 25 feel that this is the best source of information for learning about issues affecting them. Readers of the magazines may assume that based on the mission statements of both publications, information pertinent to them can be found within the magazines pages. Therefore they may not feel the need to go to another source for this information. Secondly, it is important because as we noted before, blacks have higher rates of cancer. Knowing that this is one of the highest risk factors for blacks, the magazines should gear its information toward publishing articles which focus on the reasons behind this as well as what can be done. It is unlikely that a study such as this would convince magazines to change the role that they play in providing the public with tobacco advertisements. The study, however, may reach those readers who subscribe to or are avid readers of the featured publications. This in itself will provide the readers with the needed information that will keep them abreast of what is going on. The importance of this study stems from the importance of pinpointing cigarette ads within African-American periodicals. CHAPTER 3 METHOD The method used for this study is content analysis. Beginning with the months of January for all four publications, I examined a 20 year period of all the magazines for cigarette advertisements and articles about cancer. The study included an African-American male magazine, an African-American woman magazine, a Caucasian woman—oriented magazine and a Caucasian male-oriented magazine. The chosen magazines were picked based on summaries in the 1996 writers Market (Garvey 1996). Essence represented African-American women readers based on the summary which reads: "We look for articles that inspire and inform black women.‘I ”Every article should move the Essence woman emotionally and intellectually." The topics cover a wide range of issues including general interest, health and fitness, historical, how-to, humor, self- help, relationships, work, personality interview, personal experience, political issues, business and finances and personal 26 27 opinion (Garvey 1996). Under the title of women's consumer magazines, the publication which most closely resembles ESSence but is Caucasian-oriented is that of Redbook. The magazine states that its subjects of interest are social issues, parenting, sex, marriage, news profiles, true crime, dramatic narratives, money, psychology and health (Garvey 1996). Although Redbook doesn't specify that it is a publication geared geared toward Caucasian women, of its circulation of 3.2 million in 1995, only 265,000 were African-American (Simmons 1993). The African-American male publication will be Ebony Man. This magazine states that it is geared toward the needs of black men. Whereas the other magazines will begin with the year 1976, Ebony Man did not begin until 1985 and will therefore begin at this point. The magazine could not be substituted based on the fact that no other magazine geared toward African- American males existed until 1990. Gentleman's Quarterly, otherwise known as GQ, will be the chosen magazine for Caucasian males. The CO summary states that the primary focus of the magazine is on politics, personality profiles, lifestyles, trends, grooming, nutrition, health and fitness, sports, travel, money, investments and business matters (Garvey 1996). Intercoder reliability figures were found by using Pearson's product moment correlation. To establish intercoder 28 reliability, three coders assisted in the coding. Before beginning the actual reliability, the coders coded three magazines each, of a publication that was not a part of the study. This was done in order to insure that the coding instructions were understandable. For the reliability of the study, the coders examined 18 of the same issues from each of the prospective magazines. The average intercoder reliability for all variables was 97.4%, using Pearson product moment coefficient of correlation (Dietrich, 1992). The range was 90% to 100% for all variables. See appendix A. Variables included in the study were: v1. The four magazines will be identified by a number 1-4. For example, EBsence was coded as 1 while Redbook was coded as 2 and so on. v2. The month and year was coded beginning with the identification number of the magazine, then the month of the magazine, followed by the year. Therefore, the December issue of Essence 1981 will read 011281. v3. Explicit cigarette advertisement-full page/half page/quarter page v4. PSA advertisement-full page/half page/quarter page v5. Number of health paragraphs that link cigarette smoking-related diseases with cigarette smoking v6. Number of health paragraphs that discuss cigarette smoking-related diseases, but fail to link the diseases with cigarette smoking v7. Number of non-health related paragraphs that discuss smoking in neither a positive or negative context. CodingiProcedure The magazines selected for this study are Ebsence, Redbook, 29 Ebony Han, and Gentleman's Quarterly; A content analysis of these sources was done to determine which gender as well as race receives more information on cancer-related subjects in comparison to the amount of tobacco advertisements within these publications throughout a 20-year period. Using content analysis, articles were studied based on information on all types of cancers, with the emphasis being placed on lung cancer. A total of 240 issues of each of the four magazines were selected. Research began with the year 1976 for each publication with the exception of Ebony'Man which began with 1986. All 12 issues were studied every five years for each periodical. Therefore a total of 60 issues for each publication were studied. Because Ebony'Man did not begin until 1985, the years 1986, 1988, 1992, 1994, and 1996 were examined. No other magazine could be substituted because all other publications focusing on African-American men, did not begin until 1990. A total of 231 issues of the four chosen magazines were examined because certain issues of each magazine could not be located. A total of 56 ESsence magazines were examined. Those issues which could not be found were November of 1976, August and September of 1991, and April of 1996. Fifty-eight issues of Redbook magazine were examined. Those issues which could not be found include January and December of 1996. A total of 57 issues of Ebony'MBn were examined. The November and December 30 issues of 1988, and the December issue of 1996 could not be located. Gentleman's Quarterly'was the only magazine where all of the issues could be found. Tobacco advertisements which measure a quarter page or more were counted. A tobacco advertisement is one that is defined as calling primary attention to the specific cigarette in order to provide enough interest on behalf of the consumer to purchase the said product. A cigarette advertisement also included a public service announcement on behalf of a tobacco company or the magazine calling attention to the dangers involved in any tobacco-related activity. Editorial content was closely examined. For all text the unit of measurement was a paragraph, which is defined as a unit- of-text beginning with an indentation that signals a new thought on the same subject or that introduces a new topic. A full article was defined as any subject being covered by the magazine, using five paragraphs or more. The editorial content was based on categories used by Kessler(l989) and Mastin(1996). Sections of the magazines such as letters to or from the editor, book excerpts, book reviews, and horoscopes were not studied. The categories are: 1. total number of health-related paragraphs that link cigarette-smoking-related diseases with cigarette smoking; 2. total number of health—related paragraphs that discus cigarette-smoking-related diseases, but fail to link the diseases with cigarette smoking; 3. number of paragraphs that discuss the benefits of cigarette smoking; and 4. number of paragraphs tbs: mention cigarette smoking in neither a negative nor a positive context. Diseases in this study which are considered to be caused by or seriously enhanced by cigarette smoking are cardiovascular disease (heart disease), malignant neoplasms (cancer), lung disease, cerebrovascular disease (stroke), diabetes, and hypertension (high blood pressure). The total number of advertising pages within the magazines which dealt with tobacco were calculated by adding all cigarette ads for tobacco products, with public service announcements warning of the dangers of tobacco. PSA's were included in order to see if the magazines advertised the dangers of tobacco, in addition to advertising which promotes the product. Using Pearson's product moment correlation, three specific categories were examined. These were the number of paragraphs which discussed cancer and related the disease to smoking, the number of paragraphs which discussed cancer but did not relate it to smoking, and the number of paragraphs that discussed smoking but did not place it in a positive nor a negative light. Pearson's product moment correlation was used to find the correlation's between the variables. A test for statistical significance was not used because the sample was not randomly selected. Therefore, sampling was not an issue (Kerlinger 1986). CHAPTER 4 RESULTS The study provided information which shows that consumer magazines do an extremely poor job of providing their readers with pertinent information related to that of lung cancer. These findings are significant in that lung cancer continues to claim the lives of thousands yearly. Lung cancer contracted from smoking in particular will roughly take the lives of 180,000 this year alone. Except for that of lung cancer, the magazines seemed to have a very good grasp on health issues surrounding Americans everyday. The magazines covered an array of articles appealing to and informing their readers of the causes and precautions to take where many health topics were concerned. With the exception of lung cancer, various types of cancers were at some time among the health topics discussed by the magazines. Overall however, cancer in general was not a health topic covered on a regular basis by the magazines. 32 33 Of the 231 issues, within the four magazines covered over a twenty year period, not one full length article on lung cancer ran. Other cancers, were however, on a few occasions discussed. Breast cancer, skin cancer, testicular cancer, bowel cancer, cervical cancer, ovarian cancer, colon cancer, and prostate cancer, were all covered at some point within at least one of the four magazines. Those articles which simply took on the topic of ”cancer“ usually took the form of ways to prevent cancer. This included foods that may prevent the disease, exercises which may prevent it, having annual pap smears and mammograms done, and toxins in the environment to avoid. Giving up smoking was not given as a means to prevent cancer. Hypothesis one states that articles in the publication geared toward Caucasian women will supply more information on the issue of cancer than the African-American woman magazine. The study's results support Hypothesis one. Redbook showed that the periodical carried an average of eleven paragraphs concerning cancer in each issue. Essence, on the other hand, averaged only three paragraphs dealing with the topic of cancer in each issue. Despite its higher averages, Redbook did not begin covering cancer until 1981. In 1976, the first year of the study, there was no cancer coverage at all. Results indicate that an average of thirteen paragraphs an issue appeared during 1981 in the 34 magazine. The last year of the study, 1996, showed that this number had jumped to eighteen. In the September 1981 issue of Redbook, the magazine dedicated 154 paragraphs to a special issue on breast cancer (see Table 1). This may account for the large percentage of cancer articles for that year where Redbook is concerned. Along with there being no cancer coverage during the first year of the study, Redbook averaged fourteen cigarette advertisements an issue during that year. In 1981, this number went up to sixteen, before advertisements for tobacco began to decline. In 1996, the last year of the study, the number of cigarette ads in Redbook had dropped to three ads an issue as shown in Table 2. Coverage of cancer in the magazine geared toward African- American women, Essence, was a great deal less. Once again no coverage of cancer appeared at all in 1976. The average in 1986 only rose to seven paragraphs an issue, and this is as high as it would go. The ending year of the study, 1996, showed that only an average of three paragraphs appeared in the twelve issues from that year as shown in Table l. Hypothesis two states that as the number of tobacco advertisements increase, the amount of articles dealing with cancer will decrease. In order to demonstrate the connection among variables, Pearson's product moment correlation was used. 35 Table 1. Average Paragraphs Per Issue Which Discuss Cancer but Do Not Relate it to Smoking YEAR 1976 1981 1986 1991 1996 Avg. ESSENCE .00 .17 6.92 5.40 3.36 3.2 REDBOOK .00 12.92 12.50 11.42 17.60 10.89 60 .83 2.92 2.33 5.08 2.08 2.65 *EM .58 .20 .00 1.75 3.00 1.11 *Years for Ebony Man differ. 36 Data shows there was a negative correlation between these two variables. The negative sign indicates that as the total number of ads decreased, the amount of paragraphs on the topic of cancer increased, although these numbers in themselves were quite small (see Table 3). The increase of cancer coverage with the decrease of tobacco advertisements was evident in all of the magazines, but was probably most evident where Redbook was concerned. In 1976, Redbook averaged fourteen cigarette advertisements an issue compared with no cancer coverage. By 1996, the magazine averaged one tobacco ad an issue and eighteen paragraphs on the subject of cancer as shown in Table 2. Hypothesis three states that those publications which do contain cancer coverage, will have very little on lung cancer. The study's results support hypothesis three. Each magazine during some time of the study ran an article on some type of cancer. Lung cancer was not one of these. Where the hypothesis maintained that very few articles on lung cancer would appear, there were in fact no full length articles on the subject of lung cancer. The coverage that existed on lung cancer in fact averaged no more than a paragraph in most cases. For example, for the issues of the magazine GQ, studied over the twenty-year period, smoking was linked to cancer on three occasions. In each case, mention of the subject was only a paragraph. The 37 Table 2. Average Number of Tobacco Advertisements for Each Magazine According to Year *Years for Ebony Man differ. YEAR 1976 1981 1986 1991 1996 Avg. ESSENCE 5.41 4.60 6.13 5.00 3.07 4.84 REDBOOK 14.00 16.00 8.67 3.21 1.40 8.66 GD .83 .50 3.54 4.33 5.50 2.94 *EM .58 1.80 1.08 1.58 1.09 1.23 38 same held true for Essence where smoking was linked to cancer on four occasions, all of which were a paragraph long with the exception of an issue from September of 1986. This mention of the subject was two paragraphs in length. The magazines did focus on cancer with the exclusion of lung cancer but this coverage in itself was quite low. As mentioned above, Essence averaged three paragraphs an issue on cancer and Redbook averaged eleven paragraphs an issue. The averages for the male periodicals were even lower with 60 averaging two paragraphs an issue on cancer and Ebony'Msn just one (see Table 1). Where the magazines geared toward women were concerned, the topic of cancer focused on most often was that of breast cancer. Following this was ovarian cancer. Where the males were concerned, the main cancers focused on were testicular and prostate cancer. Redbook and GO magazines focused on skin cancer as well, a cancer that was not focused by the publications geared toward African-Americans. Research question number one asks whether or not more articles on cancer appear in the magazine geared toward Caucasian males in comparison to Caucasian women. Findings from the study show that Caucasian females received more cancer information from their prospective magazine when compared to Caucasian males (see Table 1). As the numbers indicate, there 39 Table 3. Pearson Correlations between Total Advertising Pages and the Content Measures by Magazine Content Measures Paragraphs Paragraphs Paragraphs about cancer about smoking about cancer and smoking Magazines Essence .00 -.17 -.15 Redbook -.12 -.22 -.11 Ebony Man .08 .01 -.07 G0 .01 .22 .22 All Magazines .008 .093 -.043 40 is in fact a large gap between the two variables. This in itself was surprising since white males have the lowest incidence of cancer. Research question two asks whether or not the African- American male periodical provides more information on cancer than the African-American female publication. Because African- American males have the highest rate of cancer it was expected that this group would have the most information. Since publishers are expected to be aware of the health issues which are most important to their readers, Ebony.Msn was expected to carry several articles on the dangers of smoking because of this. In contrast, Ebony Man provided readers with the least amount of cancer information. Ebony'Man averaged only one paragraph an issue on the subject of cancer, where Essence provided on average, of three paragraphs on the subject. Research question three asked whether or not Caucasian males or African-American males received more cancer information. Because white males have the lowest incidence of cancer, the Caucasian periodical was expected to carry the most cancer information. The results supported this in that GO carried more cancer articles than Ebony'Man, although these numbers in themselves were quite low based on the small amount of cancer coverage existing in all of the magazines (see Table 1). 41 Finally, research question four asked if Caucasian women received more cancer coverage from their prospective magazine in comparison to the publication geared toward African—American women._ Because Caucasian women have a lower incidence of cancer outcome, Redbook was expected to provide readers with more cancer-related information than that of Essence. The results of the study support this in that readers of Redbook were provided with more information on lung cancer as well as cancer in general when compared with coverage in Essence as shown in Table 1. Although the magazines very rarely discussed the link between tobacco and cancer, the topic of smoking was covered in the publications in a variety of ways. Articles on the relationship between smoking and whiter teeth, smoking and its effect on pregnancy, and smoking as a cause for wrinkles were covered in the magazines geared toward women on a few occasions (see Table 3). In comparison, the male publications covered the issues of smoking and wrinkles, smoking and its effect on whiter teeth as well as smoking and impotence. Several articles however appeared on cigar smoking in the male publications which portrayed the past time in neither a positive nor a negative light. These included articles on various types of cigars, cigars and leisure, cigars and fashion, as well as where to 42 Table 4. Average Paragraphs Per Issue Which Discuss Smoking in Neither a Positive Nor a Negative Light YEAR 1976 1981 1986 1991 1996 Avg. ESSENCE .00 2.33 .00 .00 .00 .57 REDBOOK .00 .25 .00 .75 .30 .26 GO .33 .17 1.92 1.27 4.50 1.64 *EM .25 .00 .00 .08 .00 .07 *Years for Ebony Man differ. 43 purchase the best cigars (see Table 4). Race, along with gender played a large role in editorial content where cancer coverage was concerned. Women received the most cancer coverage in the pages of Essence and Redbook. They also received more information on the topic of lung cancer as r ~ ‘ new?! well, although the amount for both genders was quite similar as shown in Table 5. Redbook, the magazine geared toward Caucasian females showed a substantial difference where coverage of cancer was a concerned. Redbook dedicated on the average, eleven paragraphs to the subject of cancer. African-American women readers of Essence were provided with far less information, averaging three paragraphs an issue on the subject. The amount for Caucasian male readers of GO were even lower with an average of two paragraphs an issue on the subject (see Table 1). Where the subject of lung cancer in particular was concerned, African-American male readers of Ebony'Msn fared the best although the average number for all of the magazines was significantly low. Caucasian male readers of GO'received the least amount of information on diseases which are related to tobacco. Where women were concerned, the magazine geared toward Caucasian women provided more information on the subject of lung cancer than that of Essence. However, the differences in these averages, once again, were quite low (see Table 5). 44 African-American women received more information on the topic of cancer in general, compared to African-American male readers of Ebony Man. The outcome was quite different where coverage of lung cancer was concerned. African-American male readers were provided with more information on diseases related to smoking than that of African-American women readers of Essence as shown in Table 5. Caucasian readers of Redbook and GO, received the most cancer coverage where all types of cancers were concerned. African-American readers of Essence and Ebony Han however received more information on the topic of tobacco-related diseases, when compared to Caucasians. 45 Table 5. Average Paragraphs Per Issue Which Discuss Cancer and Relate it to Smoking YEAR 1976 1981 1986 1991 1996 Avg. ESSENCE .00 .00 .25 .60 .00 .17 REDBOOK .00 .00 .58 .00 .40 .20 G0 .00 .00 .00 08 .17 05 *EM .67 .00 .00 .00 .18 .30 *Years for Ebony Man differ. CHAPTER 5 CONCLUSION AND DISCUSSION The results of the study show that cancer as a general topic is not being covered by the consumer magazines used in this study, let alone the topic of lung cancer. The amount of articles are extremely low, so that very little information on cancer and smoking exists within the magazines. Because of the low coverage, the expected negative relationship between the number of cigarette ads and the number of cancer—related articles was low. With declining cigarette advertising and little cancer coverage, this data didn't have enough variance to establish a significant level of correlation. As previous literature on this subject suggests, self- regulation on the part of the publisher may be a large factor where cancer coverage is concerned. The publishers may want to distance themselves from the topic of cancer all together in order to avoid possibly offending their tobacco advertisers. Publishers most likely do not know whether or not the 46 47 tobacco advertisers will keep their ads from appearing in a magazine with a cancer article, but in order to play it safe, the publications simply stay away from the topic. This however cannot be measured through content analysis. The results somewhat support previous studies which state E‘ that cigarette advertising plays an important role on editorial 1 content of tobacco related diseases. These publications are in turn neglecting their responsibility of informing their readers of pertinent health information. The lack of cancer coverage in ,_ relation to smoking could possibly lead readers to believe that other health issues surpass that of lung cancer in importance. Although cigarette advertising began to decline in all of the publications during the last year of the study, this did not have an effect on the amount of cancer coverage existing in relation to lung cancer. The magazines studied, overwhelmingly lack coverage of the dangers surrounding cigarette smoking. These findings are of importance to each race, especially African—Americans where deaths from lung cancer transcend those of whites. The numbers overwhelmingly indicate that the Caucasian readers of Redbook receive the most cancer coverage in comparison to the readers of the other magazines. This supports data which indicate that Caucasian women receive the most information on cancer coverage as shown in Table 1. 48 The African—American and Caucasian male publications fail to come even remotely close to providing their readers with the amount of information on cancer provided by Redbook. It is clear that the publication, Radbook provides its readers with much more cancer coverage than that of Essence whose readers are primarily African-American women. As stated previously, cancer deaths for African-American women surpass those of Caucasian women. Knowing this, there may be a link between the amount of cancer coverage for Caucasian women in relation to their lower rate of death from the disease. This study began by stating that editorial content on cancer may be lacking because of the publications dependency on cigarette advertising. Further analysis is needed however, before it can be definitely concluded that as tobacco advertising increases, editorial content on lung cancer decreases. CHAPTER 6 FUTURE RESEARCH In the publications geared toward women, the occasional article on breast cancer did appear. Although few, the later years of the study did see an increase in coverage of breast cancer in those respective magazines. If publications used the same kind of targeting that is used for breast cancer and direct it toward coverage of lung cancer, it is quite possible that the awareness of the dangers surrounding smoking would reach those in society ignorant of the toll smoking can take on one's life. Effective preventive strategies for eliminating smoking may require a better understanding of why people smoke, societal factors, cultural factors and the satisfaction which comes from smoking. As studies indicate that socioeconomic factors play a role in why minorities smoke, efforts should be made in developing culturally-sensitive educational programs. These programs would make blacks and other minorities aware of the extent of the 49 50 problem and the treatment and the services that are available. Knowledge of what attracts a person to smoke, may prove useful in discrediting smoking advertisements and in designing prevention programs. ’ Consumer responsibility can not be ignored. They too must take some responsibility for the products they purchase and consume. Heavy advertising of a product does not equal an obligation to purchase the product. APPENDICES APPENDIX A Number Number Number Number Number Number Number relate Number of of of of of of of APPENDIX A RELIABILITY OF VARIABLES Variable full cigarette Ads half cigarette Ads quarter cigarette Ads full PSA Ads half PSA Ads quarter PSA Ads paragraphs which smoking to cancer of paragraphs which discuss cancer but do not relate it to smoking Number of paragraphs which discuss smoking in neither a positive nor a negative light 51 Reliability .98 None None None None None .99 .99 .94 were were were were were found found found found found 1 q . IF APPENDIX B APPENDIX B CODING INSTRUCTIONS FOR STUDY OF CIGARETTE ADVERTISING IN BLACK AND WHITE Nicole Hebert Coding Protocol The study I have proposed will analyze which gender as well as . r“ race receives more cancer-related information via magazine, compared with the amount of tobacco advertising that the said magazine prints. Four magazines have been chosen which are portrayed as being specifically geared toward the African- E American woman, the African—American male, the Caucasian woman, and the Caucasian male. Each magazine will be coded for the title of the magazine, the month and the year. Content coding will focus on tobacco advertising and cancer-related information. Tobacco advertising will encompass any attempt by any of the magazines to sell a tobacco product to its reader. Cancer-related information will include any article by the magazine which gives insight to any cancer by informing readers of its cause and precautions against it. The method of study will be through content analysis which will cover a time period of twenty-years for each magazine. Each 52 APPENDIX C '.r)r —— w. .m-J’ré VARIABLE Magazine Title Month and Year Tobacco Ad APPENDIX C DEFINITIONS AND LEVELS Each magazine will be coded with a single digit number: Essence will be coded as 1 while Redbook will be 2 and etc. The month and year will be coded beginning with the identification number of the magazine, then the month of the magazine followed by the year. Therefore, the December issue of Essence from 1980 will read as 01-12-80. A tobacco ad will be coded as a full page, a half page or a quarter page. This will include any attempt by a tobacco company to convince a reader to purchase the product. l=full 2=half 53 PSA Ad Health articles linking cancer and smoking 3=quarter A public service announcement concerning the use of tobacco products will be coded as a full page,a half page or a quarter page. F This will include any advertisement that discusses the dangers of using any type of tobacco product. fr" Number of health graphs that link cigarette- smoking related diseases with cigarette smoking. Diseases in this study which are considered to be caused by or seriously enhanced by cigarette smoking are cardiovascular disease (heart disease), malignant neoplasms (cancer), lung disease, lung disease, cerebrovascular disease (stroke), diabetes, and hypertension (high 54 Cancer related articles that do not link smoking and cancer. Non-biased Articles blood pressure). This would include any article which specifically connects some types of cancer to tobacco use. Number of health articles that discuss cigarette smoking related diseases, but fail to link the diseases with cigarette smoking. Diseases in this study which are considered to be caused by or seriously enhanced by cigarette smoking are cardiovascular disease (heart disease), malignant neoplasms (cancer), lung disease, lung disease, cerebrovascular disease (stroke), diabetes, and hypertension (high blood pressure). This includes any article which discusses cancer but does not give the use of tobacco products as being a cause. Number of non-health related articles that mention cigarette smoking in neither a positive nor a negative context. This 55 includes any article which mentions tobacco use and or cancer, but does not place either in a negative light or a positive light. 56 APPENDIX D APPENDIX D Coding Sheet F“ Magazine 1 2 3 4 L- Month/Year Number of Cigarette Advertisements F H Q PSA F H Q Number of articles relating smoking and cancer Number of articles which discuss cancer but do not relate \ I | | 57 them to smoking Number of articles which portray smoking in neither a positive nor negative light 58 IT. ‘5 BIBLIOGRAPHY BIBLIOGRAPHY Amos A., Jacobson B. and White P, "Cigarette advertising policy and coverage of smoking and health in British women's magazines," The Lancet 337 (1991): 93-95. Bartecchi, Carl E., Thomas D. Mackenzie and Robert W. Schrier, "The Human Costs of Tobacco Use," The New England Journal of Medicine 330, no. 13 (1993): 907. Basil, Michael 0., Caroline Schooler, David G. Altman, Michael Slater, Cheryl L. 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