The Impact of News Media Frames of Type 2 Diabetes on the Public's Health Policy Opinions.

Public opinion may be an important influence on policy development to improve population health and reduce disparities. Yet little is known about the public’s opinions about the determinants of health or the impact of the news media on their opinions. Through two complementary studies, this dissertation addresses the media’s role in shaping public understandings and policy preferences about type 2 diabetes, an illness for which racial disparities and social determinants are major concerns. The first study evaluated coverage of diabetes in 698 articles appearing in 19 U.S. print newspapers in 2005 and 2006. Content analysis revealed that diabetes’ behavioral causes and individualized remedies dominated coverage. Fewer than 15% of articles identified any social determinants, social policy interventions, or disparities; those that did appeared in a select subset of newspapers. The second study assessed the effects of these media messages on participants’ support for non-medical policy interventions. Study participants (N=2,490) completed a web-based survey in which they viewed a mock news article about diabetes featuring one of four randomly-assigned causal frames (genetic predisposition, behavioral choices, social determinants, or no causal language) and one of three photos (a black woman, a white woman, or a medical device). The experimental results challenge the conventional wisdom that increasing publicity of the social determinants of health will lead to greater public support for health policies. The social determinants framing of diabetes elicited a polarization of opinion, with Democrats more supportive and Republicans less supportive of the policies, compared to those who viewed the frame without causal language. In the full sample, those who viewed the behavioral choices frame were significantly more likely to endorse negative stereotypes about people with diabetes, while blacks who viewed the social determinants frame were less likely to do so. Negative stereotypes predicted reduced support for spending on diabetes research. The race of the person pictured in the article did not influence these attitudes. This research demonstrates that media messages about the causes of diabetes evoke morally- and politically-laden themes. Future research might assess how news media messages interact with political predispositions to shape public opinion about health policy topics.Ph.D.Health Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/61727/1/sgollust_1.pd

Television Advertising and Health Insurance Marketplace Consumer Engagement in Kentucky: A Natural Experiment

BACKGROUND: Reductions in health insurance enrollment outreach could have negative effects on the individual health insurance market. Specifically, consumers may not be informed about the availability of coverage, and if some healthier consumers fail to enroll, there could be a worse risk pool for insurers. Kentucky created its own Marketplace, known as kynect, and adopted Medicaid expansion under the Affordable Care Act, which yielded the largest decline in adult uninsured rate in the United States from 2013 to 2016. The state sponsored an award-winning media campaign, yet after the election of a new governor in 2015, it declined to renew the television advertising contract for kynect and canceled all pending television ads with over a month remaining in the 2016 open enrollment period. OBJECTIVE: The objective of this study is to examine the stark variation in television advertising across multiple open enrollment periods in Kentucky and use this variation to estimate the dose-response effect of state-sponsored television advertising on consumer engagement with the Marketplace. In addition, we assess to what extent private insurers can potentially help fill the void when governments reduce or eliminate television advertising. METHODS: We obtained television advertising (Kantar Media/Campaign Media Analysis Group) and Marketplace data (Kentucky Health Benefit Exchange) for the period of October 1, 2013, through January 31, 2016, for Kentucky. Advertising data at the spot level were collapsed to state-week counts by sponsor type. Similarly, a state-week series of Marketplace engagement and enrollment measures were derived from state reports to Centers for Medicare and Medicaid Services. We used linear regression models to estimate associations between health insurance television advertising volume and measures of information-seeking (calls to call center; page views, visits, and unique visitors to the website) and enrollment (Web-based and total applications, Marketplace enrollment). RESULTS: We found significant dose-response effects of weekly state-sponsored television advertising volume during open enrollment on information-seeking behavior (marginal effects of an additional ad airing per week for website page views: 7973, visits: 390, and unique visitors: 388) and enrollment activity (applications, Web-based: 61 and total: 56). CONCLUSIONS: State-sponsored television advertising was associated with nearly 40% of unique visitors and Web-based applications. Insurance company television advertising was not a significant driver of engagement, an important consideration if cuts to government-sponsored advertising persist

Public and Political Opinion on Medicaid

Medicaid has long been a political litmus test and a target for substantial programmatic changes. But what does the public feel about Medicaid, especially during a pandemic? In this study, the authors analyze more than one million Medicaid-related tweets from December 1, 2018 to September 30, 2020. They found a high volume of political posts on Twitter around Medicaid topics, peaking in January 2020 in the context of news about Medicaid expansion and the prior administration’s Medicaid block grant proposal. As the pandemic hit, the number of Twitter posts about Medicaid and the pandemic increased, and the volume of political tweets on other Medicaid topics dropped. The posts themselves also appeared to be less polarized. These patterns suggest that when the public sees Medicaid operate as a safety net, the program is far less polarizing than partisan politics might indicate. Highlighting Medicaid’s role during the pandemic could help strengthen public support for the program in non-crisis times and better position it to respond to future economic downturns

Hear Our Voices: Case Study Connecting Under-Represented Communities to Research Legislators on Safe Routes to School and Active Transportation

Although research indicates the built environment influences the walkability of a geographic region among a general population, less is known about the built-environment influences among communities that face health and socio-economic disparities. Built-environment initiatives like Safe Routes to School and Active Transportation that do not take into account the unique assets/barriers of these communities can inadvertently widen disparities. With a health equity lens, this project focused on bridging information gaps that exist between underserved communities, research, and health policy-making. Community listening sessions focusing on Safe Routes to School/Active Transportation were held in the spring of 2014. Over 180 participants from some of Minnesota’s communities of color (Native American, Somali/Oromo, and LGTBQ Two-Spirit) generated recommendations for policy and program decision- makers. These recommendations illustrated that in addition to the built-environment Safe Routes to School/Active Transportation address, public safety concerns needed to be addressed for successful implementation of Safe Routes to School and Active Transportation in their communities

Effect of advertising for a state-based health insurance marketplace on information-seeking behavior

Introduction • Kentucky was an early success stories under the Affordable Care Act through its statebased marketplace, known as kynect • The state sponsored an award-winning multimedia campaign to create awareness and educate its residents about the opportunity to gain coverage • In 2015, the new administration failed to renew a contract that resulted in the cancellation of television advertising for the final four weeks of the 2016 open enrollment period • We leverage this change to identify whether a dose-response relationship exists between state-sponsored television advertising and information seeking about health insurance Methods • Advertising data from 10 media markets across Kentucky was obtained for October 2013 through January 2016 from Kantar Media/CMAG through a partnership with the Wesleyan Media Project • State-level information-seeking was derived from reports made by the Office of the Kentucky Health Benefit Exchange to the Centers for Medicare and Medicaid Services obtained via public records request • Policy variable – state-level population-weighted average count of kynect ads per week • Outcomes – 1) calls to the kynect call center, 2) page views (number of individual pages viewed), 3) visits (including repeats from the same IP address), 4) unique visitors (excluding repeats) for the kynect web site • Linear regression models used to describe how changes in kynect advertising volume affected these outcomes, adjusting for other advertising (healthcare.gov, insurers, insurance agencies, nonprofits, and other state governments), open enrollment periods, and other relevant time periods (e.g., week of Thanksgiving, week of Christmas, etc.) Results • Advertising for kynect fell from an average of 58.8 and 52.3 ads per week during the 2014 and 2015 open enrollment periods, respectively, to 19.4 during the first nine weeks of the 2016 open enrollment period and none during the last four weeks • Each additional kynect ad per week during open enrollment was associated with – 7,973 additional page views for kynect website – 390 additional visits for kynect website – 388 additional unique visitors for kynect website • Advertising was not significantly associated with calls to the kynect call center Conclusions • State-sponsored television advertising was a key driver of information-seeking behavior in Kentucky during the 2014-2016 open enrollment periods • Our findings add to previous evidence indicating that government-sponsored media campaigns are associated with increased enrollment for health insurance exchanges • Reductions in public outreach efforts could have negative effects on the individual market if consumers are uncertain about the continued availability of coverage and so-called “healthy procrastinators” fail to enroll as a result, contributing to lower enrollment and potentially a worse risk pool for insurers Implications • Misconceptions about eligibility and deadlines for enrollment in health insurance coverage are barriers to having all eligible individuals covered • Given the uncertain future of the ACA and the individual non-group market for health insurance in the United States, our findings indicate that state-sponsored media campaigns can be an effective strategy for encouraging information-seeking behavio

Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75478/1/j.1748-720X.2007.00188.x.pd

Communicating with providers about racial healthcare disparities: The role of providers’ prior beliefs on their receptivity to different narrative frames

Objective Evaluate narratives aimed at motivating providers with different pre-existing beliefs to address racial healthcare disparities. Methods Survey experiment with 280 providers. Providers were classified as high or low in attributing disparities to providers (HPA versus LPA) and were randomly assigned to a non-narrative control or 1 of 2 narratives: “Provider Success” (provider successfully resolved problem involving Black patient) and “Provider Bias” (Black patient experienced racial bias, which remained unresolved). Participants' reactions to narratives (including identification with narrative) and likelihood of participating in disparities-reduction activities were immediately assessed. Four weeks later, participation in those activities was assessed, including self-reported participation in a disparities-reduction training course (primary outcome). Results Participation in training was higher among providers randomized to the Provider Success narrative compared to Provider Bias or Control. LPA participants had higher identification with Provider Success than Provider Bias narratives, whereas among HPA participants, differences in identification between the narratives were not significant. Conclusions Provider Success narratives led to greater participation in training than Provider Bias narratives, although providers’ pre-existing beliefs influenced the narrative they identified with. Practice implications Provider Success narratives may be more effective at motivating providers to address disparities than Provider Bias narratives, though more research is needed

Consumer Perspectives on Access to Directâ toâ Consumer Genetic Testing: Role of Demographic Factors and the Testing Experience

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137391/1/milq12262.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137391/2/milq12262_am.pd

Analysis of the capacity of google trends to measure interest in conservation topics and the role of online news

With the continuous growth of internet usage, Google Trends has emerged as a source of information to investigate how social trends evolve over time. Knowing how the level of interest in conservation topics--approximated using Google search volume--varies over time can help support targeted conservation science communication. However, the evolution of search volume over time and the mechanisms that drive peaks in searches are poorly understood. We conducted time series analyses on Google search data from 2004 to 2013 to investigate: (i) whether interests in selected conservation topics have declined and (ii) the effect of news reporting and academic publishing on search volume. Although trends were sensitive to the term used as benchmark, we did not find that public interest towards conservation topics such as climate change, ecosystem services, deforestation, orangutan, invasive species and habitat loss was declining. We found, however, a robust downward trend for endangered species and an upward trend for ecosystem services. The quantity of news articles was related to patterns in Google search volume, whereas the number of research articles was not a good predictor but lagged behind Google search volume, indicating the role of news in the transfer of conservation science to the public