Study Three

The purpose of Study Three is to evaluate the relationship between the characteristics of POS-news messages and public opinion towards POS policies. Study Three has two aims; each is described further below. The study design is experimental, and will involve a total of 8 unique news message conditions.

3.2.3.1 Aim 1

Public health practitioners partner frequently with media outlets to “earn media” and offer content within news stories.[4] Two content factors that can be readily manipulated by public health advocates are frame and the degree of localization. This study employs a series of factorial experiments to test the relationship between exposure to a news message and support for POS policy. Aim 1 of this study is describe the main effects of message factors (a) frame and (b) degree of localization on POS policy support among a convenience sample of US adults. Ultimately, the goal of Aim 1 is to provide insight into how different news characterizations of the problem of tobacco in the retail setting are associated with varying degrees of public support for POS policy solutions. Hypotheses under this aim suggest that different levels of the message factors (a) frame (health or economics) and (b) localization (local or not local) are associated with different levels of POS policy support.

Factor A in this study is frame, and includes two levels: health and economics. A

frame is the way an issue is described, or packaged, as it is being communicated. Frames organize central ideas, define issues to “resonate with core values and assumptions” (p. 56),[53] and affect the extent to which the message receiver supports – or does not support – the issue.[52] Frames also imply solutions to problems.[22] Simplified ‘health’ and

‘economic’ frames are used in this study for several reasons. First, the health and economic frames represent the best distillation of the most common frames identified in past news content. Early analyses of tobacco related news content identified and measured the

prevalence of nearly a dozen tobacco control and tobacco interest (pro-industry) frames.[22, 23] However, over time, the most prominent tobacco industry frames were ‘positive

example ‘nonsmoker’s rights’ and ‘kids’. Second, the health and economic frames are generally slanted for or against tobacco control efforts. Economic frames are often used to support the tobacco industry and tobacco retailers, and health frames are used to support public health efforts.[57, 66, 67] Finally, this approach is feasible for experimental testing. Given the important role of framing in shaping the discourse within a competitive media environment, testing the impact of frames that are readily translatable to media advocacy practice is helpful for future implementation. In this study the level 1 frame, health, is the traditional frame of tobacco control advocates[22] and speaks to the health effects of smoking among youth and adults.[23] The level 2 frame, economics, speaks to dollars and cents, and is a traditional tobacco industry appeal to freedom, the American dream, and earning a living. Within the context of this study, I hypothesize that:

H1: Adults who are randomized to receive a news message with a dominant health frame will have higher POS policy support scores across all other factors and levels, compared to adults who are randomized to receive a news message with a dominant economics frame.

Factor B is degree of localization, and has two levels within this messaging experiment: level 1 is localized and level 2 is not localized. The use of local sources and a local story angle can add to the public health impact of messages and shape the support of the public and policy makers,[50, 58] likely by increasing the perceived relevance of an issue. Given this, I hypothesize that:

H2: Adults who are randomized to receive the localized news message will have higher POS policy support scores across all other factors and levels, compared to adults who are randomized to receive a non-localized news message.

A third factor, source, will not be manipulated but rather held constant in the experiments. A source is a person or organization who gives information to news reporters and who is identified either by quote or paraphrase.[54] Within each of the prepared news messages that will be used in this study, the number and type of sources will be held constant. Each manipulated message will appear like a realistic, fair and balanced news article and will include one statement from a public health advocate (e.g. the Centers for Disease Control and Prevention) and one statement from the tobacco industry and their retail partners (e.g. The National Association of Tobacco Outlets). The presence of sources in news media content can shape the discourse and influence public support for the issue.[13, 19, 95] For example, articles originating from doctors, health workers or health agencies are

generally positively slanted for tobacco control, and articles originating from the tobacco industry or articles simply without health sources are more negatively slanted.[73, 77] The inclusion of both source types is an attempt to neutralize the message prior to the addition of other content factors. Source is not a manipulated variable in this particular study because of the risks for confounding the effects of message factors; manipulating messages to conduct a

frame by source or localization by source factorial experiment would be virtually impossible because of the combinations required (e.g. an “health” framed news article with only a tobacco industry source).

3.2.3.2 Aim 2

Factorial designs like the one proposed here, where each level of each factor is exposed to all levels of all other factors,[97] allow for statistical testing of interaction effects in addition to main effects. Interaction effects occur when the effects of one factor are not constant over the levels of a second factor, or in other words, where the second factor

moderates the relationship between the first factor and the outcome. Aim 2 of this study is to determine the extent to which the message factors (a) frame, and (b) localization interact with one another to effect POS policy support among a convenience sample of US adults. The goal of Aim 2 is to identify evidence of interaction between message factors for enhanced communication planning. Hypotheses under this aim are exploratory and suggest that message factors (a) frame and (b) localization do interact to effect POS policy support:

H3. Among a convenience sample of US adults, the relationship between localization and POS policy support will vary based on frame, such that, adults who are exposed to the local and health frame message will have higher levels of POS policy support than adults who are exposed to the local and economic frame message.

CHAPTER 4 MANUSCRIPT 1 SETTING THE AGENDA FOR A HEALTHY