Issue 10: Newspaper coverage of childhood nutrition policies
Wednesday, August 01, 2001News coverage can have a strong influence on how the public and policy makers interpret and respond to social issues. To advocate effectively for policies that will improve childhood nutrition, advocates must be able to articulate a clear message that resonates with specific audiences. They have to make their case well, and make it publicly. This means they must understand the current public conversation regarding nutrition policy and how it is being framed in the news. Similarly, if journalists are going to tell the story of childhood nutrition as it is debated by different stakeholders, they should know what parts of that discussion are being emphasized and which, if any, are being neglected. For these reasons, we wanted to know how the news was covering childhood nutrition policy. To find out, we analyzed a representative sample of newspaper coverage of policy debates around childhood nutrition to determine the dominant subjects, spokespeople, and arguments being used on the issue. The purpose of the content analysis research is to give advocates a thorough grounding in the way their issue is being portrayed in the news and thus, by extension, being presented to policy makers and the public.What we did
To select our sample, we searched the online Nexis database for news coverage as well as editorials, letters and opinion pieces printed in the Fresno Bee, Los Angeles Times, Sacramento Bee, San Diego Union Tribune, and San Francisco Chronicle from July 1998 through August 2000. We chose these papers in order to understand how the relevant issues were portrayed across California, in major newspapers that are read by statewide policy makers and opinion leaders. We focused specifically on these newspapers because they are some of the news sources most critical in shaping state-level policymakers' understanding of key public issues, and because they are also influential in setting the agenda for television news coverage. To capture any pieces having to do with policies related to childhood nutrition, school lunches/breakfasts, obesity prevention, etc., we devised a three-part key word search. We searched for pieces that contained one of the terms "child (including children, child's, etc.) or teen or adolescent or youth" and one of the terms "nutrition or diet or fast food or school lunch or school breakfast or snack or obese (including obesity, etc.) or overweight or pouring contract" and one of the terms "policy or rule or law or legislation (including legislate, etc.) or contract." There were more than 2000 pieces that contained that combination of key words in the five newspapers over the two years. Narrowing the search to include pieces where the search terms occurred within 30 words of each other limited the sample to 171 pieces, which were also more likely to be substantive discussions of the issues. We then eliminated duplicate stories (such as the same editorial printed in both the city and Orange County editions of the Los Angeles Times; we counted such instances as a single piece) and those that did not deal substantively with child nutrition. To qualify as substantive, at least one-third of the piece had to discuss nutrition issues, to ensure that the article was not simply a passing reference to the topic. After eliminating duplicates and nonsubstantive pieces, we were left with 88 pieces that were then coded in depth. We coded the sample to determine primary subjects, initial frames or arguments, byline, date, placement, individuals and organizations quoted, policies mentioned, and other factors. We coded for both problem definition and solutions mentioned; that is, to what do sources quoted in the newspaper attribute the problem of childhood obesity or other nutrition problems, and what solutions or policies do they suggest to remedy the problem? We worked with Project LEAN, a project of the California Department of Health Services and the Public Health Institute, in this phase to discover the issues and spokespeople they are most interested in tracking in the news. (Project LEAN's mission is to increase healthy eating and physical activity to reduce the prevalence of chronic disease such as heart disease, cancer, stroke, osteoporosis, and diabetes.) Next we developed a coding instrument for the quantitative count of key variables and collection of basic information. We then entered decisions about research variables into a computer database in order to automate the analysis.What we found
Source: The Fresno Bee had the most pieces on the subject, with 26% of the total. This was followed closely by the Sacramento Bee (23%), San Diego Union Tribune (22%), and the Los Angeles Times (18%). The San Francisco Chronicle had the fewest substantive pieces on childhood nutrition during the sample period, with 11% of the sample. Wire stories vs. local stories: We found that fully one quarter of the pieces in our sample were from wire services, such as Associated Press or Reuters, or were first published in another newspaper, such as the Boston Globe and the Dallas Daily Herald. Many of these were "food features" such as articles on helping children pack healthy lunches from home; however, many others were national-level news stories reporting on new research on obesity trends or the federal government's new dietary recommendations. In general, smaller papers are more likely to use wire stories, and indeed the Fresno Bee, the paper with the lowest circulation numbers in our study, had the highest proportion of such articles in our sample. This would suggest that smaller local newspapers, which we did not survey in this study, might be even more likely to rely on wire services for material, rather than being able to dedicate local news staff to nutrition policy issues. Advocates may have extra work to do to interest local reporters in food policy issues. One quarter of the stories in our sample did have a specific local angle. These included stories on soda pouring contracts in schools (in which a specific soda company such as Pepsi is given exclusive rights to a school district's soda vending franchise, in exchange for extra payments or support of other school programs such as athletics), organic-only policies for school food service, fast food in schools, cuts in physical education (PE) programs in schools, and fraud in the child care food program. Story type: Reflecting the typical balance of news to opinion in newspapers, 66% of our sample was news or feature stories. Columns and other opinion pieces made up 13% of the sample. Editorials and letters to the editor comprised about 10% of the sample each. Story placement: Nearly one-third of the pieces appeared on the front page of their section, indicating the strong newsworthiness of food and nutrition stories. Many of these pieces were on the front page of a weekly food section, but others appeared on page one of the business section or page one of the local or metro news section. Fourteen percent of the pieces appeared on page A1 of the paper. Primary subject: Table A lists the subjects represented in the sample. The largest single topic, accounting for 14% of the sample, was advice for parents, including subjects such as what to pack in kids' lunch boxes and how to please finicky eaters. Several other subjects accounted for significant parts of the sample:- Food safety, including articles on pesticides and regulation of food processing plants that make foods served in school cafeterias; these pieces appeared in our sample because school children were cited as the "victims" of unsafe food production practices;
- milk pricing and other issues related to the regulation of the dairy industry in California and the potential for competition from other states;
- new research on obesity, including articles on the release of studies showing escalating obesity trends in the U.S.;
- school breakfast programs and other food service issues, including President Clinton's announcement of reimbursement for after-school snacks served at school-based programs.
The remaining subjects each accounted for 6% or less of the sample, but are worth mentioning due to the variety of topics covered:
- fast food in schools this category included substantive news articles in most of the newspapers as well as opinion pieces following the release of the Project LEAN report on fast food in high school cafeterias;
- new dietary/Body Mass Index recommendations this category illustrates the federal government's power to shape the news agenda by releasing new nutrition recommendations (this may be a possible news hook for state or local efforts if the date of USDA's recommendation release is known in advance);
- pouring contracts the appearance of this topic on the list is entirely due to California Project LEAN and others' efforts to stimulate citizen participation about Pepsi contracts in the Sacramento school district: letters to the editor from concerned parents and others comprised the bulk of this category;gardening and organics in schools most of these stories covered the Berkeley school district's groundbreaking decision to offer only organic foods in its school cafeterias;
- fraud in the child care food program all of these pieces were related to the discovery of criminal fraud among a few providers and sponsors of the federal program providing reimbursement for foods served to low-income children in child care;
- hunger a couple of these pieces focused on hunger in international settings but most focused on the irony of hunger in the U.S., the "most over-fed country in the world," according to one opinion piece;
- immigrants' use of government programs these pieces covered a new Clinton administration policy to encourage undocumented immigrants to use the Women, Infants, & Children (WIC) program, food stamps, and other social service programs without fear of deportation;
- media usage and inactivitywas covered because the American Association of Pediatrics announced a new effort to prevent obesity in children by having pediatricians counsel families about reducing children's time spent watching TV, using the computer and playing video games; and
- other topicsincluded cuts in funding for school PE programs and discrimination against the obese.
Who speaks?
It is critical to pay attention to who is quoted in news stories on nutrition issues, as this helps indicate who reporters turn to as sources and who therefore has the power to dominate the debate. In our sample, we coded each story for what type of person was quoted in each story; the results are in Table B.
Of interest here is the fact that advocates for various food policies are the most commonly quoted sources, indicating that advocates are doing a good job of getting their voices into the news. Other professionals from the field are also well represented. (Many advocates in the news were also nutritionists, researchers, or other public health professionals, but we coded them first for their advocacy position. This means that the 23% of speakers that were nutritionists and dieticians appeared in an educational role, not an advocacy role.)
Students, children or youth were quoted in 13% of the sample. Many of these were in stories on school-based issues such as fast food, school breakfast or the lack of PE classes. However, it seems that reporters chose random students to interview in these pieces, as an advocacy perspective is lacking. For instance, one 4th grader in a piece on organic salad bars in schools says "If we had this food in our school, I'd eat vegetables every day. And that would be good." However, most other students quoted are taking a more stereotypically youthful position toward nutrition, such as describing how they prefer fast food to healthier options.
The relatively low number of politicians quoted on the issue indicates that this is not a high priority issue for these leaders; advocates could perhaps do more to stimulate politicians' interest in and ownership over childhood nutrition.
There were very few antagonists quoted in news coverage. With the exception of a couple of opinion pieces reflecting a libertarian, keep-government-out-of-our-food-choices perspective, most news coverage quoted public health professionals and others concerned with improving children's health and nutrition. We didn't find a strong negative frame or a dominant voice opposing public health that must be countered.
Key frames
As part of our analysis, we looked for key themes or frames that might emerge in coverage of childhood nutrition issues. Frames are central arguments or perspectives on a news story, that might shape the perspective of the news audience on the issue. The following themes emerged:
Of particular interest here is that one of Project LEAN's key action-oriented talking points, that appealing, affordable, convenient alternatives should be made available, was one of the common themes in this coverage, even in stories that were not specifically on the topic of schools. The idea that healthy options must be available, if we expect people to make healthy choices, appeared in 17% of the coverage.
Obesity as a public health epidemic did not appear as frequently as we expected, perhaps reflecting the dominant frame of obesity as an individual problem. Given the large number of articles related to school-based meals, we were surprised not to find more mentions of the important, research-based links between nutrition and learning. The relatively weak concept that we must invest in children because "children are our future" appeared almost as often.
Who is responsible?
We also coded for attributions of responsibility. That is, to what do sources quoted in the newspaper attribute the problem of childhood obesity or other nutrition problems, and what suggestions or policies do they suggest to remedy the problem? The findings are listed in Tables D and E.
The sources quoted in our sample (including those who wrote letters to the editor) attributed childhood obesity and nutrition problems to many factors. The fact that overweight is a simple matter of more food taken in than calories burned was mentioned frequently in the sample. But most articles also went beyond this to examine the environmental factors that contribute to the problem.
The most common environmental factor was a sense that the government was failing at its oversight responsibilities. Stories including this perspective included pieces on: food safety (focusing on a judge who allowed schools to serve meat processed in a plant that had failed salmonella tests); fraud in the child care food program; and mismanagement of school breakfast programs that left many children without a meal in the morning. This frame can be seen as positive from a public health sense because it reinforces the idea that institutions, not just individuals, have an important role to play in ensuring the health and nutrition of children. However, the frame is problematic in that it undermines trust in the ability of government to remedy the problem.
Other factors seen as contributing to the problem include a culture that encourages media usage instead of outdoors play; the prevalence of fast food outlets and soda availability; parents who work too hard to pay adequate attention to their children's nutrition needs; large portions served in American restaurants; cuts in PE hours at school; genetics, race, and ethnicity; the prevalence of food advertising; and the incidence of crime making it dangerous for children to play outdoors. Other contributing factors cited included poverty, body image problems related to media images of women, and high stress levels driving people to overeat for psychological reasons.
In contrast to the wide-ranging environment-based attributions of responsibility for causing the problem, when it came to attributing solutions, the single most common answer by far was individual: people must change their eating and exercise habits. Nearly one-third of pieces in our sample made this the only recommendation, even if the rest of the piece considered some of the complex causal factors described above. Another 17% of pieces had no solutions whatsoever to propose; they merely described the problem without suggesting any remedies. Almost half (48%) of the childhood nutrition stories focused on individual actions or offered no solution to the problems raised.
Other solutions discussed did get into social policy, from making healthier options available for school lunch to regulating food advertising aimed at children. However, many of these ideas appeared in just a few pieces; that is, if the piece described one systems-level proposal, it was likely to include several. The effect was that solutions that called on institutions to take part in creating change were concentrated in a relatively small percent of the sample.
Implications
These findings suggest some interesting characteristics in the news coverage of childhood nutrition issues. First, while there is not much news on nutrition policies, what does exist is substantive and well placed. News coverage included in-depth pieces on fast food in schools, school breakfast programs, objections to pouring contracts, pediatricians' recommendations on children's media usage, and other topics. Many of these pieces were a direct result of public health professionals' efforts to attract news attention to these critical issues. Second, despite advocates' good work on gaining access to the news for some childhood nutrition stories, an individual responsibility frame dominates. We were surprised to find that advice to parents is the single largest subject in the sample ÛÓ despite the fact that we deliberately devised a key word search structure that would maximize the number of policy-related stories in the sample and eliminate most individual-oriented "news you can use" pieces. Finally, it appears that nutrition advocates are themselves helping to reinforce the individual-oriented response to nutrition problems. Many news pieces quote advocates describing the complex environmental factors that contribute to childhood obesity, such as pervasive marketing of fast foods, lack of availability of healthy options in many neighborhoods, and the elimination of PE from school schedules. Yet when it came to describing solutions, it seems that most suggestions are oriented to what individual children and parents could do to be healthier. Policies such as improving school lunch options or simplifying food labeling are rarely discussed, let alone more controversial approaches such as regulating food advertising aimed at children or charging a "fat tax" based on nutrient values of packaged foods. These findings have significant implications for what advocates and journalists must do to paint the picture of environmental changes that could improve nutrition and health for all children. If reporters are to convey the public health approach to nutrition and public will is to be galvanized to promote such changes, advocates must become better spokespeople for the policies that can make a difference for all children.Recommendations for advocates
Work to pitch local stories to reporters or connect national stories to the local scene. The stories in our sample that resulted from proactive efforts to pitch a locally newsworthy story ÛÓ for instance, the Public Health Institute's Fast Food survey ÛÓ generated in-depth, substantive coverage that advanced population-based public health solutions. Other coverage not stimulated by advocates' proactive efforts were more likely to be superficial "food features" that resorted to traditional advice about diet and exercise habits.- Recruit and prepare new spokespeople for the issue. In our sample, relatively few politicians were quoted; advocates can do more to stimulate their interest in and leadership on policy issues. Similarly, advocates can work with children and youth who are advocates for improved nutrition policies, to prepare them to speak to reporters, and can offer this valuable source to the reporters to whom they pitch stories.
- Most importantly, pitch stories about policies that could improve health, and be prepared to describe solutions beyond individual efforts. Policies such as improving school lunch options or regulating food advertising aimed at children are both good stories and good solutions; don't hesitate to interest reporters in these angles.
Recommendations for journalists
Childhood obesity rates continue to rise. If this continues unabated, the costs to society for medical care and lost productivity will be enormous, as will the loss to families and individuals as their loved ones suffer from preventable disease. The research presented here indicates that the public health story ÛÓ what can be done to prevent childhood obesity ÛÓ is not being told. Policy makers will not understand the importance of their role, or what they can do to arrest the rise in childhood obesity, unless print and broadcast journalists ask better questions and tell more complete stories about childhood nutrition. Reporters could investigate:- What has changed in children's lives since childhood obesity rates have risen?
- How much time is devoted to physical education in schools now? Is it mandatory? Does it differ in different school districts? Do teachers notice a difference in their students' behavior?
- What food is offered at local schools? Is school food service contributing to or draining the school budget? Has this always been the case?
- What are the health consequences of pouring contracts? What are the consumerism arguments? Who benefits from the pouring contracts? Why are soda companies willing to spend millions in individual school districts and schools?
- Do primary school teachers notice who is hungry? Does the breakfast program make a difference to attention span, behavior, and response in the classroom?
- What is the local angle on national nutrition stories? The prevalence of wire stories in this study suggests that newspapers run nutrition stories but could do more to make those stories specific to their local readership.