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Vaccination rates for the human papillomavirus (HPV) vaccine fall below targets and only 2 states and the District of Columbia require the vaccine for middle school-age children. Messages conveyed through news media—to parents, providers, policymakers, and the general public—may contribute to sluggish vaccination rates and policy action. In this commentary, we review the findings from 13 published studies of news media coverage of the HPV vaccine in the United States since FDA licensure in 2006. We find 2 important themes in news coverage: a rising focus on political controversy and a consistent emphasis on the vaccine as for girls, even beyond the point when the vaccine was recommended for boys. These political and gendered messages have consequences for public understanding of the vaccine. Future research should continue to monitor news media depictions of the HPV vaccine to assess whether political controversy will remain a pronounced theme of coverage or whether the media ultimately depict the vaccine as a routine public health service.

BACKGROUND: State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health. METHODS: A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts. RESULTS: For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences ...

A core principle of policy advocacy is that to engage decision makers in the urgency, complexity, and controversy of problems, advocates must effectively tell the story of those issues. Policy stories, or narratives, paint mental pictures of what a problem is, who is affected, and how it came to be. Yet, the persuasive effects of narratives on one key group, state legislators, remain understudied. Drawing from the Narrative Policy Framework (NPF), media advocacy, and public interest communications, we sought to inform advocacy strategy by illuminating state legislators' responses to messages about public investments in quality childcare for all. Contrary to expectations, we found that narratives can have unintended effects challenging or even diminishing legislator support. We discuss implications for advocacy strategy.

OBJECTIVE: Preventing childhood obesity is an requires innovative, evidence-based policy approaches. This study examines the use of research evidence by obesity policy stakeholders in Minnesota and develops pilot tools for communicating timely evidence to policymakers. DESIGN, SETTING, AND PARTICIPANTS: From November 2012–January 2013, semi-structured interviews were conducted with 51 Minnesota stakeholders in childhood obesity prevention. Interviewees included 16 state legislators and staff; 16 personnel from the Minnesota Departments of Education (MDE), Health (MDH), and Transportation (MNDOT); and 19 advocates for and against childhood obesity prevention legislation (response rate = 71%). MAIN OUTCOME MEASURES: Participants were asked their views on three themes: 1) Whether and how they used research evidence in their current decision-making processes; 2) barriers to using research evidence for policymaking; and 3) suggestions for improving the evidence translation process. All interviews were audio-recorded and transcribed. A team approach to qualitative analysis was used to summarize themes, compare findings across interviewees' professional roles, and highlight unexpected findings, areas of tension, or illuminating quotes. RESULTS: Stakeholders used research evidence to support policy decisions, educate the public, and overcome value-based arguments. Common challenges included the amount and complexity of research produced and limited relationships between researchers and decision-makers. Responding to interviewee recommendations, we developed and assessed two pilot tools: a directory of research experts and a series of research webinars on topics related to childhood obesity. Stakeholders found these materials relevant and high-quality, but expressed uncertainty about using them in making policy decisions. CONCLUSIONS: Stakeholders believe that research evidence should inform the design of programs and policies for childhood obesity prevention; however, many lack the time and resources to consult research ...

Objectives. To examine the public health and policy-relevant messages conveyed through local television news during the first stage of Affordable Care Act (ACA) implementation, when about 10 million Americans gained insurance. Methods. We conducted a content analysis of 1569 ACA-related local evening television news stories, obtained from sampling local news aired between October 1, 2013, and April 19, 2014. Coders systematically collected data using a coding instrument tracking major messages and information sources cited in the news. Results. Overall, only half of all ACA-related news coverage focused on health insurance products, whereas the remainder discussed political disagreements over the law. Major policy tools of the ACA—the Medicaid expansion and subsidies available—were cited in less than 10% of news stories. Number of enrollees (27%) and Web site glitches (33%) were more common features of coverage. Sources with a political affiliation were by far the most common source of information (> 40%), whereas research was cited in less than 4% of stories. Conclusions. The most common source of news for Americans provided little public health–relevant substance about the ACA during its early implementation, favoring political strategy in coverage.

Although scholarship on competitive framing acknowledges that framing is a dynamic process in which the early stages may matter most, very little research has focused on the dynamics of issue emergence. In this article, we draw on several literatures to develop theories for how controversy related to new issues will emerge and expand in news coverage. Through a comprehensive content analysis of 101 local newspapers across the fifty U.S. states, we explore the dynamic and evolving process wherein a new issue-the HPV vaccine-emerged into public discourse and a legislative debate over school requirements for vaccination began. We find that coverage of controversy is a function of proximity, driven primarily by events within a state, although external events also influence local coverage. We also find that the legislative discussion in the media did not necessarily start out as controversial, but as the issue evolved, we observe a large increase in the proliferation of both actors taking positions and the types of arguments made to influence debate. The findings yield important insight into issue emergence with implications for how future research might test competing frames to better understand how the presentation of controversy in the mass media affects public opinion. [Reprinted by permission; copyright Sage Publications Inc.]

Although scholarship on competitive framing acknowledges that framing is a dynamic process in which the early stages may matter most, very little research has focused on the dynamics of issue emergence. In this article, we draw on several literatures to develop theories for how controversy related to new issues will emerge and expand in news coverage. Through a comprehensive content analysis of 101 local newspapers across the fifty U.S. states, we explore the dynamic and evolving process wherein a new issue—the HPV vaccine—emerged into public discourse and a legislative debate over school requirements for vaccination began. We find that coverage of controversy is a function of proximity, driven primarily by events within a state, although external events also influence local coverage. We also find that the legislative discussion in the media did not necessarily start out as controversial, but as the issue evolved, we observe a large increase in the proliferation of both actors taking positions and the types of arguments made to influence debate. The findings yield important insight into issue emergence with implications for how future research might test competing frames to better understand how the presentation of controversy in the mass media affects public opinion.

Objective: The purpose of this study is to identify health resources associated with propensity to vote at the local-level among low-wage workers in two United States. cities. Literature confirms individuals of lower income have a lower propensity of turning out to vote, yet few studies have focused on low-income populations to identify the variation in factors associated with voting within this group. Furthermore, few studies have investigated health and voter turnout at the local-level. In this study, we examine factors related to political participation at the local-level within a low-wage sample, examine mental, physical, behavioral, and social health and their association with voter turnout, and assess if these relationships differ by city.Methods: We use cross-sectional survey data from a sample of 974 low-wage workers in Minneapolis, MN and Raleigh, NC. We computed descriptive statistics and employed a logistic regression to predict their likelihood of local voter turnout, with the key independent variables being health resources, such as self-rated health, body mass index (BMI), mental disability, smoking status, and health insurance status. We employed a logistic regression fully interacted with a city indicator variable to assess if these associations differed by city.Results: In both cities, less than 50 percent of respondents reported voting in the last election for mayor or city council. About three-quarters of the sample reported food or housing insecurity and the majority of respondents reported utilizing some government assistance, such as supplemental nutrition programs. BMI greater than 30 was significantly associated with lower likelihood of voter turnout compared to those of lower BMI status (marginal effect = −0.10, p = 0.026). Never smoking or quitting was significantly associated with higher likelihood of voter turnout compared to those who reported being a current smoker (marginal effect = 0.10, p = 0.002). Those with health insurance were significantly more likely to report voting compared to those without any insurance (marginal effect = 0.10, p = 0.022). These results did not significantly differ by city.Conclusions: Our research suggests low-wage workers face significant health burdens which may impact their propensity to vote at the local-level, and these associations do not significantly vary by city despite demographic and political differences between two jurisdictions.

The production of health policy-relevant research is necessary, but not sufficient, to promote its utilization in policy. Our objective was to understand the perspectives of United States' state-level policy makers and health researchers on the barriers and facilitators to the translation of health evidence into the policy process, with a particular focus on issues related to relationship building. We conducted interviews with 215 US health services and health policy researchers and 40 state-level staffers and legislators. Researchers and policy makers faced the same major barrier to research translation: lack of dedicated time to do so. Some policy makers questioned the credibility of research, and researchers questioned policy makers' authentic desire to use evidence in decision making. For some study participants, a mutual mistrust of the other group challenges stronger relationship formation. Interventions are needed to help both groups understand a broader role that research plays in policy making and to increase personal contact, and ultimately trusted relationships, across various actors in the policy process.

Objectives. We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking.

Purpose. To describe how research evidence and non–research-based information are used in testimony and other legislative documents used in arguments for and against physical activity–related bills in Minnesota. Design. Content analysis Setting. Documents and oral testimony archived by the Minnesota State Legislature from 2007 to 2011. Subjects. Not applicable. Measures. A coding instrument was developed to measure descriptive features of materials (e.g., length, document type) and the presence or absence of certain types of research evidence and non–research-based information. Analysis. Frequencies of variables and measures of associations using Pearson χ2 tests. Results. Over a third (36%) of the sample contained research evidence, and 88% of the sample contained non–research-based information. Compared to materials related to physical activity, materials related to built environment were significantly less likely to reference research evidence. Conclusion. Despite an abundance of evidence, research evidence was present in only about one-third of the sample. There may be opportunities during legislative discussions on the built environment for obesity-related data to help make the case for sound policies.

POLICY POINTS: Political advertising can influence which issues are public policy priorities. Population health–relevant issues were frequently referenced in televised political advertising in the 2011‐2012 and 2015‐2016 US election cycles, with about one‐fourth of all ads aired mentioning traditional public health and health policy topics and more than half referencing broader determinants of population health. The volume of population health–relevant issues referenced in political ads varied by geography, political office, political party, and election cycle. Ads referencing broader determinants of population health (such as employment, education, or gender equality) rarely tied these determinants directly to health outcomes. CONTEXT: Political discourse is one way that policymakers and candidates for public office discuss societal problems, propose solutions, and articulate actionable policies that might improve population health. Yet we know little about how politicians define and discuss issues relevant to population health in their major source of electoral communication, campaign advertisements. This study examined the prevalence of references to population health–relevant issues conveyed in campaign advertising for political office at all levels of government in the United States in 2011‐2012 and 2015‐2016. Understanding advertising as part of the political discourse on topics of relevance to population health yields insights about political agenda‐setting and can inform efforts to shape opinion. METHODS: We conducted a content analysis of all English‐language, candidate‐related campaign advertisements aired on local broadcast, national network, and national cable television in the 2011‐2012 and 2015‐2016 election cycles (3,980,457 and 3,767,477 airings, respectively). We analyzed the volume of coverage in these ads about issues relevant to population health, including narrowly defined public health issues as well as a broad range of other social, economic, and environmental factors that affect ...

AbstractPolitical candidates use campaign communication to signal to the public which policy issues they consider important. However, the factors that shape political discourse related to the social determinants of health have not been adequately studied. We examined the volume and predictors of attention to three issues—jobs, income inequality, and early childhood education—among campaign ads in 2011–2012 (N = 10,467 ads, aired 4,025,771 times) and in 2015–2016 (N = 9926 ads, aired 3,809,887 times). While attention to jobs was common in campaign ads (41% and 21% of ads in 2011–2012 and 2015–2016), attention to economic inequality (11% and 4%) and early childhood education (0.4% and 0.9%) was much less common. Campaign‐related factors (especially partisanship) explain much of the variation, as compared to community demographic conditions, although campaign ads referenced jobs more often in areas with higher unemployment in 2015–2016. Future research should explore political responsiveness to the factors that shape health in communities.