Reporting Childhood Obesity: An Analysis of How the Let’s Move Campaign Has Impacted Today’s Media Landscape and a National Debate Tyler Weingart A Capstone Project Presented to the Faculty of the School of Communication in Partial Fulfillment of the Requirements for the Degree of Masters of Arts in Public Communication Supervisor: Professor Caty Borum Chattoo April 25, 2012 CHILDHOOD OBESITY IN THE NEWS COPYRIGHT© Tyler William Weingart 2012 1 CHILDHOOD OBESITY IN THE NEWS Executive Summary 2 According to the agenda setting theory, the media agenda has the ability to control the public agenda by determining which issues are judged as important. As obesity rates in the United States continue to skyrocket, particularly among young people, it is more important than ever before to understand how the national media is covering the issue of childhood obesity. Now with the emergence of First Lady Michelle Obama’s childhood obesity campaign, Let’s Move, it is equally important to recognize how this national campaign may be impacting the media landscape. To determine the campaign’s influence on the national media conversation, a content analysis of top news outlets was performed. Findings from the study indicated that the Let’s Move campaign altered coverage of childhood obesity in many positive ways, and that coverage regarding the epidemic’s causes and solutions also shifted after Let’s Move was launched in 2010. CHILDHOOD OBESITY IN THE NEWS 3 Table of Contents INTRODUCTION …………………………………………...……………………………………...….. 4 LITERATURE REVIEW …………………………………………………………………………..…. 7 The Current State of Childhood Obesity …………………………………………... 7 Proposed Solutions & Prevention of Childhood Obesity………………….…. 9 Let’s Move ………………………………………………………………………………...…… 10 Behavior Change Communication …………………………………………………….13 Agenda Setting …………………………………………………………………….………….15 Framing ………………………………………………………………………………………….18 METHODOLOGY………………………………………………………………………………..……... 20 RESULTS ……………………………………………………………………………………………..…. 22 DISCUSSION …………………………………………………………………………………………… 28 CONCLUSION ………………………………………………………………………………………….. 33 REFERENCE LIST ………………………...…………………………………………………………...36 APPENDIX (CODE BOOK) .......................................................................................................38 CHILDHOOD OBESITY IN THE NEWS 4 Introduction The fight to end childhood obesity in this country is not a new one. In fact, the battle to reverse the troubling health epidemic has been around for years as federal and state governments partner with public health organizations and experiment with ways to combat its rise. Today, one in three U.S. children are overweight or obese, putting millions of American youth at a much greater risk for asthma, cardiovascular disease, joint problems, diabetes, and a slew of other health problems later in life (Klein & Dietz, 2010). Now considered one of the fattest nations in the world, America’s public health practitioners must examine all angles of the obesity conversation, a debate that continues to be one of the most talked about health epidemics of the 21st century. As the problem grows, so does the curiosity by the public health arena to understand how the issue of childhood obesity is talked about and reported on in mainstream media. Childhood obesity is increasingly a hot topic in the press, and as previous research has shown, “the media controls the public agenda by selecting certain topics for prominent coverage” (Cohen, 1963). Agenda setting, as defined by scholars, is the media’s ability to determine which issues the public judges as important simply by deciding what stories are covered and how they are framed (Cohen, 1963). Understanding the impact the media can have on an issue is more important than ever before as our society continues to be inundated with messages. Due to the range of factors that contribute to childhood obesity, two distinct frames for solutions to the problem have emerged in the media over the years. The first, and traditionally more well known, is the frame of personal responsibility. This narrative implies that obesity is caused by someone’s individual choices, and is something that needs CHILDHOOD OBESITY IN THE NEWS 5 lifestyle changes such as diet, exercise or in some extreme cases, surgery. The opposing frame, and the frame most commonly endorsed by public health practitioners, is the idea of institutional solutions. This narrative attributes responsibility for the obesity epidemic to our governments, and calls for societal-­‐level changes such as increasing access to healthy foods, an overhaul of the school lunch program, or making sure children have safe neighborhoods to run, walk and play in. Over the years the mainstream media have picked up on these opposing frames, and several studies have shown how in many cases the media will favor one narrative over another. This divide is what public health practitioners continue to worry about as a national consensus on how to deal with childhood obesity has yet to be reached. Launched in February 2010, the Let’s Move campaign is Michelle Obama’s signature campaign to end childhood obesity in one generation. A high profile campaign such as this will undoubtedly impact the obesity conversation currently taking place in America. With eight states having childhood obesity rates above 25 percent, and many more with rates between 15 and 20 percent, the demand for change has never been more apparent (Levi et al., 2011). For this study, a content analysis of news articles published around the launch of Michelle Obama’s Let’s Move campaign was conducted to determine how the media landscape might have shifted since the famous campaign to end childhood obesity began. More specifically, this study explores whether or not the Let’s Move campaign has altered media coverage more toward the personal responsibility frame or the institutional changes frame. Determining if the Let’s Move campaign has helped promote one frame above the other will be invaluable information for public health practitioners. Solutions to childhood CHILDHOOD OBESITY IN THE NEWS 6 obesity continue to be debated on the floor of Congress and throughout the public health arena-­‐ understanding what role the media may be playing in all this is extremely crucial. The Let’s Move campaign is the first obesity campaign to come out of the White House; knowing if and how the campaign is impacting the conversation will help shape future debate as America continues to grapple with large-­‐scale solutions. Not only does this content analysis analyze the number of times certain frames are covered in the media, it also examines the existence of possible new frames and paints a before-­‐and-­‐after picture of news coverage surrounding the launch of Let’s Move. Past studies have looked at how news media has framed childhood obesity and have shown how coverage has traditionally sided with the personal responsibility frame time and time again (Kim & Willis, 2007). This project, however, explores a new angle and attempts to draw some correlations between a national White House campaign and its impact on mainstream media’s coverage of a growing health issue. From defining how childhood obesity is measured, to unpackaging the Let’s Move campaign, this capstone’s literature review explores the current state of childhood obesity and applies relevant theoretical frameworks to validate this content analysis. Behavior change communication and a relevant public health case study targeted at youth are then discussed to show how the Let’s Move strategy plans to eradicate childhood obesity in one generation. As previously mentioned, agenda setting and framing are the primary foci of this study, and a discussion of these theoretical frameworks concludes the literature review. Finally, the last sections of this paper include the research methodology and results, followed by a discussion of how the Let’s Move campaign may be impacting the way CHILDHOOD OBESITY IN THE NEWS 7 childhood obesity is covered in mainstream media – as well as implications this may have for the future. Literature Review The Current State of Childhood Obesity According to Jonathan Klein, director for the Center of Excellence at the American Academy of Pediatrics, and William Dietz, director of Nutrition and Physical Activity at the CDC, childhood obesity has become America’s new tobacco (2010). They, like many other public health administrators, fear the obesity epidemic America currently faces will only get worse before it starts to get better. With one in three American children being overweight or obese, the issue has risen to monumental proportions. The problem did not just appear out of thin air, however. Over the past 30 years the rise in obesity rates have steadily increased, and “the fact that the increase in obesity during this period cannot be explained by genetics, and has occurred among all socioeconomic groups provides support for a broad set of social and environmental explanations” (Christakis, 2007). According to the Robert Wood Johnson Foundation’s 2011 “F as in Fat” report, more than two out of every three states have obesity rates above 25 percent. Twenty years ago, no state had a rate above 15 percent (Levi et al., 2011). Only one state in the nation currently has a childhood obesity rate below 10 percent (Oregon), and the Robert Wood Johnson Foundation found that 16 states significantly increased their obesity rates in just one year from 2010-­‐2011. The prevalence of obesity among children from lower-­‐income families is also on the rise as families struggle to afford high-­‐priced healthy foods. From 1999 to 2009, obesity rates for lower SES children increased from 12 CHILDHOOD OBESITY IN THE NEWS 8 percent to 15 percent (2011). Across all populations in every state, the childhood obesity epidemic has undoubtedly reached an all time high. A child’s obesity level is determined using their body mass index, or BMI. BMI is an individual’s weight divided by their height, and children are defined as being obese when their BMI is at the ninety-­‐fifth percentile or higher. Also, when documenting “childhood obesity,” the common categories are “children” ages 5-­‐9, and “youth” aged 10-­‐17. (Lobstein et al., 2004). Research shows that children who have a higher BMI and are considered overweight or obese, not only have a significantly greater chance of being overweight adults, but are also at a much greater risk of having asthma, joint problems, diabetes, liver disease, cardiovascular disease and an array of other problems later in life (Klein & Dietz, 2010). Today, children have become the group in which the obesity rates are increasing the fastest. This growing population is also starting to impact the country as a whole, transferring their weight of problems onto the rest of the American public. Experts report that direct medical costs from obesity-­‐related health issues are as high as $150 billion a year (Cawley, 2010). These health care expenditures are starting to burden the rest of America, and are costing the government a surplus of expenses today’s economy cannot afford to handle. The overweight American is simply more expensive to care for, and it is beginning to show as more of them fall into a tailspin of health problems. From an increase in daily snacking and a decline in the consumption of three principle meals, to the lack of access to healthy foods and the school lunch program, the causes for childhood obesity are endless (Piernas, 2010). With no one action causing the problem, recommendations to reverse the epidemic are confusing, contradictory and forever CHILDHOOD OBESITY IN THE NEWS 9 changing. Individual responsibility is continuously emphasized into the nation’s treatment for obesity, but with the ever-­‐increasing number of overweight individuals in the United States, “it is imperative to examine environmental contributors to obesity” (Wang & Brownell, 2005, p. 236). Proposed Solutions & Prevention of Childhood Obesity Today, according to a Pew Research Center for the People and the Press (2011) survey, 57 percent of Americans say the government should play a significant role in reducing obesity among children. Identifying effective changes for the future will be the only way to drastically reduce or begin to reverse the current trends in childhood obesity. The notion that obesity is someone’s personal responsibility does not need to be completely ignored, but rather aligned and guided by environmental changes that need to be made. According to Dr. Kelly Brownell, director of the Rudd Center for Food Policy & Obesity, there are two perspectives that are used when dealing with childhood obesity, the medical perspective and the public health perspective. He, like many other experts in the field says, “Obesity is an epidemic that likely will worsen if strong, broad-­‐reaching changes are not made to the current environment. Although treatment of the individual traditionally has been the focus of the obesity field, prevention using a public health model will be essential for making progress” (Wang & Brownell, 2005, p. 250). Because the issue of childhood obesity is increasingly widespread, it will be the environmental changes and legislative efforts Brownell is referring to that will begin to make an impact. Some of the recommendations the Robert Wood Johnson Foundation has, along with many other public health groups, are to protect obesity-­‐related public health funding and to pump obesity awareness programs into our schools, communities and neighborhoods. Other institutional amendments include CHILDHOOD OBESITY IN THE NEWS 10 a revamp of the current school-­‐lunch program, making sure all Americans have access to healthy, affordable food, protecting children from food industry marketing, and creating safe neighborhoods where children can walk, play and live in. These environmental approaches are just some of the more popular solutions that are suggested to fight the war on childhood obesity. These types of recommendations shape the frame of institutional changes, and it will be these narratives that emphasize societal barriers to diet and exercise that may help to generate support for obesity-­‐related policy change (Niedereppe, 2008). With a majority of America now in agreement that something needs to be done, obesity prevention campaigns have been springing up across America for the past decade. From the CDC’s “Verb” campaign to smaller state-­‐level campaigns like Georgia’s “Sugarcoating” campaign, public health groups across the country are working to bring awareness to the issue and simultaneously reverse the troubling trend. Leo Trasande, professor of community and preventative medicine at the Mount Sinai School of Medicine, and colleagues, calculated that spending $2 billion a year on obesity prevention would be cost-­‐
effective if it reduced obesity among twelve-­‐year olds by only one percentage point (Trasande, 2010, p. 375). With promising indicators like this, perhaps the most famous campaign to end childhood obesity has begun. The Let’s Move campaign, which will be examined in the following section, is what everyone is talking about and could be the game changer America has been looking for to tackle childhood obesity. Let’s Move Launched on February 9, 2010, First Lady Michelle Obama’s Let’s Move campaign is the first anti-­‐obesity campaign to come out of the White House. Structured on several different platforms, “the program's main anti-­‐obesity strategies are empowering parents CHILDHOOD OBESITY IN THE NEWS 11 and consumers by revamping the nutritional labeling of products by the U.S. Department of Agriculture (USDA), improving the nutritional standards of the National School Lunch Program, increasing children's opportunities for physical activity, and improving access to high-­‐quality foods in all U.S. communities” (Wojcicki, 2010, p. 1458). The multi-­‐leveled approach is altering the course of the obesity crisis both on an individual level and on the larger societal level as well. “Changing environments so that they support people in making healthy diet and activity choices recognizes that personal choice is only as good as the choices available” (Adler & Stewart, 2009, p. 64). This logic is what seems to be driving the campaign’s infrastructure as it promotes the personal responsibility frame with the institutional changes frame in a seamless, yet cohesive manner. Since its launch just two years ago, the campaign has implemented its intricate approach to leverage support in both the private and public sectors. To promote personal responsibility, Let’s Move has partnered with organizations like the NFL, the NBA and Disney to inspire kids through their favorite actors and athletes to play sports and get active. Through one of the campaign’s sub-­‐campaigns, “Let’s Move Outside,” Obama has even partnered with thousands of mayors and community groups to build or adopt playgrounds so kids have safe places to play and be active (http://www.letsmove.gov/ accomplishments). Perhaps the most visible portions of the campaign, the personal-­‐level changes are not only encouraged by the Let’s Move campaign,, but they are also explicitly endorsed through its now-­‐infamous title. On a more expansive infrastructure level, Let’s Move is also lobbying Congress and making permanent public policy changes to help fight childhood obesity. From $400 million in tax credits to push grocery stores to move into “food deserts” and lower SES CHILDHOOD OBESITY IN THE NEWS 12 communities where people don’t have access to healthy food choices, to budget requests to help schools renovate their kitchens in order to store and make healthy meals, Michelle Obama is “sounding the alarm” and using her position as First Lady to draw Congressional support for the issue (Hall & Hellmich, 2010). Another initiative Let’s Move endorsed was the passage of the Hunger-­‐Free Kids Act, which set health standards for all foods sold on school property-­‐ including those in vending machines (Emanuel, 2012). Making sure children have access to healthy foods is one of the larger components of Let’s Move, an aspect of the campaign’s infrastructure that has created partnerships across all levels of business. From joining forces with three of the largest food service companies that operate school cafeterias, to the campaign’s partnering with companies like Walmart, Walgreens and Supervalu, Let’s Move’s initiative to make sure all communities are served healthy foods and have access to healthy foods is well on its way. Walmart, Walgreens and Supervalu have even promised to build or expand 1,500 stores that sell fresh fruits and vegetables in communities without access to healthy food (2012). The list of accomplishments, partnerships and initiatives goes on as the Let’s Move campaign continues to raise awareness on a national platform. With an end goal to eradicate childhood obesity in one generation, Michelle Obama’s initiative has undoubtedly revitalized the conversation of childhood obesity in this country. Just over two years in, the Let’s Move campaign seems to have dramatically shifted the way Americans talk about and understand the epidemic. The Let’s Move campaign is also a prime example of a national behavior change campaign, one that is structured to infiltrate many levels of society. The intricacies of this campaign will be important to note as CHILDHOOD OBESITY IN THE NEWS 13 behavior change communication is discussed next, and later when Let’s Move is analyzed for its impact on mainstream media. Behavior Change Communication The Let’s Move crusade is a classic example of a behavior change communication campaign that is currently taking place. Behavior change communication (BCC) is considered one of the more complex communication strategies, and is a communication technique that not only promotes positive health behaviors, but also provides a supportive environment in which those positive behaviors can be performed and sustained over time (Info Reports, 2008). A dynamic process that motivates individuals and communities to adopt healthy behaviors, BCC is primarily used by public health groups and government agencies for an array of issues (2008). From fully understanding the health issue, to knowing the audience(s) and implementing the appropriate tactics, organizations rely on an array of behavior theories when deciding how a behavior change campaign will work and be successful. The three main theories that are used relative to behavior change are the individual effects model, the social diffusion model and the institutional diffusion model. Whereas the individual effects model focuses on the individual’s shift in knowledge and attitudes from exposure to message effects, the social diffusion model focuses on the process of change in public norms. The institutional effects model, on the other hand, is translated into behavior shifts within the “institution,” including policy changes and government intervention that in turn affect individual behavior (Hornik, 2002). These models of behavior change are implicit in many public health communication campaigns that are structured to understand why a behavior is being performed and what needs to be done in order to change it. CHILDHOOD OBESITY IN THE NEWS 14 Understanding the psyche of an audience is essentially what drives any behavior change campaign, and explains why theoretical frameworks are attached to any given approach. With regard to health campaigns, perhaps the most important model of behavior is the health belief model (HBM). The HBM states that health-­‐related actions depend on the simultaneous occurrence of: 1) sufficient motivation by the individual to make health decisions 2) the belief that one is susceptible to a serious health problem or condition AND 3) following the health recommendation would not only be beneficial, but would incur a “subjectively-­‐acceptable” cost (Rosenstock, 1988). This model is almost always used when designing a health BCC campaign to ensure that the approach not only broadcasts a perceived threat, but that it simultaneously endorses the appropriate efficacy actions that its audiences should be taking in order to avoid the threat. “Theories of behavior guide the selection of the most appropriate communication approaches and help shape effective messages” (Info Reports, 2008). Some of the most well-­‐known examples of behavior change communication campaigns undoubtedly structured their approach from several, if not all, of these behavior change models. Perhaps the most famous campaign that has utilized these theoretical approaches is the American Legacy Foundation’s Truth campaign. Launched in February 2000, Truth was the largest national youth smoking prevention campaign. Structured very similarly to the Let’s Move campaign, Truth was designed to infiltrate both the institutional and personal responsibility levels of society. With a massive, multi-­‐million dollar advertising campaign, Truth saturated national print and broadcast media to deter teens from choosing to smoke in the first place (Mowery, 2004). On an institutional level, The American Legacy Foundation was funded from what is known as the Master Settlement Agreement (MSA), CHILDHOOD OBESITY IN THE NEWS 15 which also pushed for taxes on cigarettes, warning labels, increased funding for anti-­‐
smoking campaigns and new laws to block cigarette advertising from vulnerable populations (children below the age of 18). In a study conducted a few years after the launch of Truth, results showed the campaign accelerated the decline in youth smoking rates between 2000 and 2002. Among all groups in the study, smoking rates among eighth-­‐
grade students declined the most at 45 percent (Farrelly, 2005). Across the board, however, the Truth campaign is directly attributed to twenty-­‐two percent of the overall decline in youth smoking during that time (Mowery, 2004). Mimicking Florida’s successful anti-­‐smoking campaign from the same year, the Truth campaign is the most infamous youth-­‐oriented campaign whose mission was to change a behavior. To achieve the success it did, the Truth campaign certainly applied several of the theories that are associated with behavior change communication. It also understood the power of media dissemination, and the strong role it could play in the campaign. To this day, the Truth advertisements are some of the most talked about ads in America. During its time, the media played a pivotal role in the success of Truth, and was a catalyst for much of the change it created. Not only did American media act as channels for Truth’s messages, but they essentially amplified the conversation of anti-­‐smoking to a whole new level of exposure. In the next few sections, the role of the media will be discussed. From agenda setting to framing, it will be important to understand the role the media can play not only on health campaigns, but also specifically on the issue that campaign is addressing. Agenda Setting Now more than ever, the media conglomerates of America play a pivotal role in just about everything our society sees, hears and inevitably believes. The media potentially has CHILDHOOD OBESITY IN THE NEWS 16 the strength to choose what side of a story they want to be apart of, power that can dramatically shift how an issue is conversed about in larger society. The same is true when it comes to covering the issue of childhood obesity, a topic many policymakers do not agree on with regard to its causes and solutions. In order for campaigns to effectively communicate on the issue of childhood obesity, they must grab the attention of the media from the start. This, however, is not always what happens. In fact, over the years the American media has continued to set a different agenda with regards to childhood obesity. Agenda setting, as it is formally labeled, occurs when the media controls the public agenda by selecting certain issue topics for prominent coverage, prominence that subsequently determines which issues are judged as important (Cohen, 1963). According to Douglas McLeod, public judgments of issue importance follow the prominence that the media agenda is promoting. The causes and solutions that the media report on with regards to the childhood obesity epidemic will drastically influence how the problem is dealt with, and impact what components are primed above others (i.e. the individual vs. the society). Because not only does the media tell people what to think about, it also tells them how to think about it. In a content analysis of newspaper and television news articles published and broadcast, respectively, between 1995 and 2004, Sei-­‐Hill Kim and colleagues found some interesting correlations on how obesity was being reported. First, in 1995, only 277 articles were published about obesity in the six national newspapers analyzed (The New York Times, The Washington Post, Chicago Sun-­‐Times, The San Francisco Chronicle, The Houston Chronicle, and USA Today). By 2004, the number had increased to almost 1000 articles (Kim & Willis, 2007). Network news coverage during that time also increased from 165 news CHILDHOOD OBESITY IN THE NEWS 17 items to nearly 300 by 2004. The issue of childhood obesity has certainly been covered in the American media, coverage that steadily increased with the obesity rates themselves. What concerns public health officials, however, is how these stories of childhood obesity have historically been reported. In the same analysis, personal-­‐level solutions such as diet, exercise and medical treatments were predominantly assigned by the media as solutions to the issue. “Attributions of solution responsibility to the food industry (regulations of the food industry) or to schools (changes in the school lunch program) were found far less often, together accounting for only 18% of the total articles and transcripts” (p. 367). When reporting of personal causes significantly outnumber societal changes that need to be made, the fight to end childhood obesity is going to have a much more difficult time securing support from policymakers, local administrators and school officials. It makes the fight against childhood obesity much more challenging, and the need to shape the media coverage increasingly more important. In another content analysis structured very similarly to the aforementioned study – and used as the inspiration for this capstone – Colleen Barry and colleagues from the American Academy of Pediatrics analyzed news stories on childhood obesity published in 18 national and regional news sources in the United States over a ten-­‐year period from 2000-­‐2009. Just as the previous study examined, this content analysis focused on the mention of solutions to the problem of childhood obesity. More specifically, the content analysis honed in on what health organizations deemed the best solutions, and investigated how often “food/beverage industry changes, school changes, and neighborhood changes” appeared in the news over the ten years. Overall, there were significant differences in coverage of potential solutions toward childhood obesity. Both newspapers and television CHILDHOOD OBESITY IN THE NEWS 18 news devoted a much higher level of coverage to behavioral solutions compared to institutional changes. As seen in the graph below, behavioral changes were mentioned more often each year as a solution to the obesity problem compared with any environmental changes (Barry, et al. p. 137). Here, the media is setting the agenda, and priming the general public to imagine that the obesity epidemic should only be personally attributed to the individual, leaving public policy and legislative measures out of the picture. This study (like many others) shows how the media can begin to narrate an issue, and how agenda setting then potentially influences how an issue is managed. In the case of childhood obesity, the media has historically shifted attention away from the societal responses this country needs in order to solve the obesity epidemic. This idea will be important to keep in mind as this capstone explores a potential media agenda shift after the launch of Let’s Move. Framing As previously mentioned, how childhood obesity is framed will be crucial with how individuals, policymakers and society as a whole respond to fix the looming problem. Historically, the media has framed the issue as a health problem caused by individual circumstances such as diet, exercise and genetics. Today, the public health community CHILDHOOD OBESITY IN THE NEWS 19 almost universally agrees that the influx of childhood obesity cases is largely attributed to the environment in which American youth live -­‐-­‐ or, as reflected in the “ institutional frame” campaigns like Let’s Move campaign. A frame, in short, is an “interpretative storyline that sets a specific train of thought in motion, communicating why an issue might be a problem, who or what might be responsible for it, and what should be done about it (Nisbet, 2009). Audiences rely on these frames that the media or organizations create in order to make sense of and discuss an issue. Specific frames also make aspects of an issue more salient, and if crafted effectively, cue the issue to be more accessible and applicable to the audience. Previous research even suggests that public health problems become “amendable to broad policy solutions when those problems can be reframed in systemic terms-­‐ specifically, in terms of involuntary risk, universal risk, environmental risk, and knowingly created risk” (Lawrence, 2004). The framing of an issue, especially one as misunderstood as childhood obesity, has the power to manage the way in which it is discussed and controlled. Today, the childhood obesity frames that are circulating the nation are competing against one another. Some groups are framing it as a biological disorder, while others frame it as being caused by food choice, lack of physical activity, or screen time. Then, of course, there are the organizations that frame the obesity epidemic as a result of fast-­‐food advertising, inequality to access of healthy foods, the school lunch program, or the community in which one lives, works, and plays. So, as this reasoning goes, instead of having control over the message, the true solutions to childhood obesity are being buried in a sea of media noise. CHILDHOOD OBESITY IN THE NEWS 20 The importance of framing, and the role it plays when the media covers a large-­‐scale issue will be necessary to understand when the content analysis for this study examines existing frames and potential new frames on which the media may have picked up since February 2010. Essentially, frames create a story for the public, and understanding what story is being told with regard to childhood obesity will help public health organizations understand what role, if any, the Let’s Move campaign has had on shifting the media landscape. Methodology To determine how Michelle Obama’s Let’s Move campaign has impacted mainstream media’s coverage of childhood obesity, a content analysis with five major U.S. daily newspapers was conducted. The research was designed to examine several areas of coverage, and the main objectives of the content analysis were: 1) to determine whether or not the Let’s Move campaign shifted media coverage more toward the “personal responsibility” frame or the “institutional changes” frame 2) to determine how mainstream media framed proposed solutions to end childhood obesity-­‐ before and after the launch of the Let’s Move campaign AND 3) to determine how news coverage, in general, may have shifted in its tone or areas of coverage with regard to the childhood obesity epidemic. This study essentially examined two opposing frames regarding childhood obesity, personal responsibility and institutional involvement. Grounded by the theoretical frameworks of framing and agenda setting, this content analysis was designed to inform those theories by analyzing a highly contentious debate that is currently at play. The structure for this study was also shaped and influenced by a content analysis conducted in CHILDHOOD OBESITY IN THE NEWS 21 2009 by Colleen Barry and her colleagues from the Johns Hopkins Bloomberg School of Public Health. Published in the Journal of the American Academy of Pediatrics, their study, “News Media Framing of Childhood Obesity in the United States from 2000 to 2009,” not only inspired the design of this project, but was also referenced for coding design and specific areas of analysis. This study adopted the same approach (albeit for a different time period) and added on another level with the Let’s Move campaign. Using BurrellesLuce, one of the nation’s top media monitoring and measurement service providers, newspapers were chosen for the study based on 2012 circulation data. The New York Times, The Los Angeles Times, USA Today and The Wall Street Journal were chosen because these outlets are four of the top five most circulated newspapers in the country (http://www.burrellesluce.com/sites/default/files/ Top_Media_2012_Final_ January_2012.pdf). The Washington Post, ranked eighth in circulation, was also chosen for the content analysis because not only is Let’s Move a national White House campaign, but the Post would also cover the political and legislative conversations regarding childhood obesity. Articles for the study were pulled from LexisNexis Academic, Factiva and ProQuest Newsstand. Factiva was needed to capture Wall Street Journal articles and ProQuest was used to capture Los Angeles Times coverage, as both outlets are unavailable in LexisNexis. For each search, a two-­‐year time period was applied – the entire year before Let’s Move launched (February 1, 2009) to a full year after the launch (February 1, 2011). This two-­‐
year window of analysis with five major newspapers created a sound way of analyzing the before-­‐and-­‐after coverage on a national scale. Using the specified date range and the search term [child* w/5 obesity OR obese OR overweight] for each outlet search, 286 articles were CHILDHOOD OBESITY IN THE NEWS 22 originally collected. Each article was then scanned for relevance. Relevant articles included at least one paragraph about childhood obesity and elaborated on the issue at some level of significance. For the purposes of this project, article types not deemed relevant included letters to the editor, obituaries, advertisements and articles that only mentioned the term “childhood obesity” but did not elaborate on the topic. Once irrelevant articles were discarded, the final relevance sample for study was 169 articles. A comprehensive codebook was then crafted to collect almost 40 separate data points for each article. The complete codebook can be found in the first section of the appendix, but listed below are some of the overarching themes that were collected: • Basic article information (date relative to Let’s Move, publication, etc.) • Personal level causes/solutions present • Societal level causes/solutions present • Article voice (person(s) & organization(s) quoted in the article) • Article theme & lead narrative Results A full list of results can be found in the second section of the appendix, but major highlights are outlined and described below. Articles Out of the 286 articles that were originally pulled for study, only 169 of them were coded in the final sample. The Los Angeles Times yielded the largest sample with 66 articles, and USA Today pulled in the lowest amount of articles with 24. Also, the number of articles CHILDHOOD OBESITY IN THE NEWS 23 reporting on childhood obesity significantly increased from 60 articles before Let’s Move was launched to 109 articles after the Let’s Move launch date (February 9, 2010). The article title and lead was also coded for in the study, where it was analyzed whether or not the phrase “childhood obesity” or other similar catchphrase like “obese children” or “overweight kids” was present in the title of the article or lead paragraph. Overall, 39 percent of the sample articles used “childhood obesity” (or another similar phrase) in its title or lead. For those articles that stated “childhood obesity” in its title or lead paragraph, 38 percent were printed before Let’s Move was launched while 62 percent were published after Let’s Move began. Personal Level Data Points Overall, 61 articles mentioned personal level causes to childhood obesity. Forty-­‐two percent of these articles were published before Let’s Move, while 58 percent of the articles mentioning personal level causes were published after Let’s Move. Individual codes were CHILDHOOD OBESITY IN THE NEWS 24 used for specific personal level causes like diet, parental role and sedentary lifestyle, all of which saw an increase in reporting post Let’s Move. A chi-­‐square test showed that these results were not statistically significant. Personal level solutions were also coded, and 50 percent of articles discussed personal level solutions to end childhood obesity. Thirty-­‐six percent of those articles were published before Let’s Move, and 64 percent were released after Let’s Move began. Individual codes were then used to pick up on what personal level solutions were being reported. From changing one’s diet to increasing daily exercise, all personal level solutions that were being coded saw an increase in reporting post Let’s Move. The personal level solution to end childhood obesity that saw the greatest increase in being mentioned after Let’s Move, however, was parental behavior change, which increased 62.5 percent. A chi-­‐
square test showed that these results were not statistically significant. CHILDHOOD OBESITY IN THE NEWS 25 Societal Level Data Points Societal level causes and solutions to childhood obesity were coded for the same way that personal level actions were analyzed. Similarly to the personal level results, societal level causes and solutions both increased post Let’s Move. Overall, 43 percent of articles discussed societal level causes to childhood obesity. Thirty-­‐nine percent of those articles were published before the Let’s Move campaign and 61 percent were published after the campaign’s launch. The two societal level causes that saw the greatest increase in being mentioned were the school lunch program and the food/beverage industry (specifically nutritional standards and marketing practices). Articles mentioning the school lunch program being the problem increased by six articles, and articles mentioning the food/beverage industry increased by 14 articles. A chi-­‐square test showed that these results were not statistically significant. As previously stated, societal level solutions also increased in mention after Let’s Move was launched. Overall, 72 percent of articles mentioned societal level solutions to end CHILDHOOD OBESITY IN THE NEWS 26 childhood obesity. Thirty-­‐two percent of those articles were published before the Let’s Move campaign and 68 percent afterwards. The two solutions that increased in mention the most, that were also proven statistically significant, were to change the current school lunch program and to regulate the food/beverage industry. Mentions to change the school lunch program and regulate the food/beverage industry both increased by 33 percent after Let’s Move was launched. Article Voice (Quoted Persons & Organizations) Articles were also coded to determine who was being quoted and gave the article a “voice.” More specifically, the coder was looking to see if A) a mother was quoted, B) a family physician or other medical expert (dietician, nutritionist) was quoted, OR C) a government health agency or its employee was quoted in the article. Overall, only 9 percent of articles quoted a mother. Forty-­‐three percent of those articles were published before Let’s Move and 57 percent afterwards. CHILDHOOD OBESITY IN THE NEWS 27 Thirty-­‐three percent of articles quoted a physician or medical expert, with coverage being equal before and after Let’s Move. And 19 percent of articles quoted a government health agency. Forty-­‐four percent of those articles appeared before Let’s Move and 56 percent afterwards. While The Los Angeles Times quoted a mother the most (8 times), the Wall Street Journal quoted a government health agency the most (11 times). Article Theme The final stage of coding determined the overall theme of the article. The theme categories were 1) the article was a general report on the current state of childhood obesity, 2) the article addresses childhood obesity as an individual problem in need of individual solutions, 3) the article addresses childhood obesity as a societal level problem in need of institutional solutions, OR 4) the article addresses childhood obesity as both a personal level and societal level problem in need of individual and environmental changes. Overall, 23 percent of articles addressed childhood obesity as an individual problem needing individualized solutions, while 34 percent of the articles addressed childhood obesity as a societal level problem needing institutional solutions and 16 percent of them addressed the issue as one that needs both personal level and societal level intervention. The theme that saw the greatest shift after Let’s Move began was the “pure societal level” theme (childhood obesity is a societal level problem in need of institutional solutions). Twenty-­‐nine percent of the “pure societal level” themed articles were published before Let’s Move while 71 percent of them were written afterwards. In general, themes of institutional level solutions increased after Let’s Move was launched. CHILDHOOD OBESITY IN THE NEWS 28 45
Figure 5: Article
Theme
40
35
30
25
Published Before Let's Move
20
Published A fter Let's Move
15
10
5
0
Individual Problem Societal Problem
Both Individual & Societal Issue
The following sections examine several of the above highlights and draw conclusions as to how the Let’s Move campaign has impacted today’s media conversation regarding the childhood obesity epidemic. Discussion The ultimate goal of this research was to determine if and how the Let’s Move campaign was shifting the mainstream media agenda on childhood obesity. After reviewing all angles, it is clear that distinct shifts in coverage occurred in the months after Michelle Obama’s public health campaign was launched. The sheer increase in the number of articles covering childhood obesity from 60 (before) to 109 (after) is a strong indicator that the Let’s Move campaign raised awareness of the issue and brought national attention to an increasingly alarming epidemic. Overall, the Let’s Move campaign sparked a new wave of coverage, and the media agenda dramatically shifted. As discussed, agenda setting occurs CHILDHOOD OBESITY IN THE NEWS 29 when the media controls the public agenda by selecting certain issue topics for prominent coverage. Additionally, the media not only has the power to tell people what to think about, it has the ability to drive how they should think about certain issues. The fact that the media’s covering of childhood obesity sharply increased after Let’s Move tells the public health community that America is becoming increasingly interested and concerned with the epidemic. The Let’s Move campaign has essentially become a catalyst for conversation, and has changed the media landscape for the better. It is probably not surprising that a national obesity campaign driven by the White House increased coverage of the childhood obesity epidemic, given the White House’s ability to control the media agenda in general. What is interesting, however, is how certain areas of coverage drove the debate in the months after Let’s Move was launched. More specifically, how the media landscape shifted with regards to what’s causing childhood obesity and what needs to be done in order to fix it. The Let’s Move Campaign is a multifaceted approach that promotes both the personal level responsibility people need to take with regard to their health, as well as what society and lawmakers need to do in order to make sure individuals have the right tools and opportunities to make healthy choices. These two frames are the storylines and solutions for which the public health community advocates, and as previously mentioned, a frame is an “interpretative storyline that sets a specific train of thought in motion, communicating why an issue might be a problem, who or what might be responsible for it, and what should be done about it” (Nisbet, 2009). After Let’s Move was launched in February 2010, coverage of both the personal level causes frame and the societal level causes frame increased by at least 16 percent. While similar studies have tended to only see coverage of CHILDHOOD OBESITY IN THE NEWS 30 the personal level frame increase, this study clearly shows that coverage of the societal level frame is also increasing at a similar rate. In fact, while mentions of personal level causes increased in coverage by 16 percent, mentions of societal level causes increased 22 percent (slightly more attention given to societal level causes). Public health practitioners have historically struggled with the public perception that obesity is solely caused by poor diet, lack of exercise or genetic predisposition. Now it seems as though the Let’s Move campaign is repositioning America’s thinking, and has facilitated a more balanced frame of what factors are causing obesity in this country. And, as coverage continues to expose the number of societal factors that are causing childhood obesity, the general public may start to embrace the institutional changes that are needed to create lasting change. This dramatic shift shows the power of framing, and illustrates how the campaign’s frames are being adopted into mainstream media. In this sense, the Let’s Move campaign was able to take hold of the childhood obesity issue and frame it for the media in a way that amplifies some of the public health arena’s core messages. Similar to what this study found regarding coverage of causes to childhood obesity, coverage of solutions to end childhood obesity also shifted in the months after Let’s Move began. Perhaps the most polarizing portion of the childhood obesity debate is in fact the proposed solutions to the epidemic. From diet overhauls and increasing physical activity, to restructuring the school lunch program and monitoring the food/beverage industry, solutions to end childhood obesity encompass a broad spectrum. What Michelle Obama has tried to do with her Let’s Move campaign is web these solutions together, and show people that in order to end childhood obesity it is going to take not just one solution, but a mixture of initiatives that touches on many levels of society. As the results of the study show, CHILDHOOD OBESITY IN THE NEWS 31 coverage of both personal level solutions and societal level solutions increased by at least 48 percent in the months after Let’s Move was launched. The fact that some of the top news outlets in the country almost doubled their reporting on solutions to end childhood obesity shows that the media is not only tackling the issue in a much more detailed way, but that more Americans now understand that childhood obesity is a solvable problem. Equally important to discuss are the solutions that were given the most recognition by mainstream media-­‐ overhauling the school lunch program and regulating the food/beverage industry. The food that children eat at school and the fast food marketing they encounter everyday have been questioned and debated for years. With regard to the childhood obesity debate, these are perhaps the two most notorious solutions everyone thinks of when they think of institutional changes. As critical as it is that the Let’s Move campaign is continuing to keep these solutions in the public sphere, it is equally concerning that some of the larger, more complex solutions are continuing to be overlooked. Other solutions that were coded for in the study that received far less coverage included: 1) eliminating access gaps (food deserts) to fresh produce and grocery stores 2) building safer and cleaner neighborhoods for children to play in AND 3) instituting more physical and nutritional education programs in schools. To put it into perspective, while 60 articles in the study mentioned regulating the food/beverage industry as a solution to end childhood obesity, only 18 articles mentioned building safer, cleaner neighborhoods. This difference is alarming, and definitely one that has been seen time and time again. While changes to the school lunch program and regulating the food/beverage industry would cost certain parties monetary loss, the essential driver in these solutions is legislation. All these tactics would require from the majority of Americans is their support CHILDHOOD OBESITY IN THE NEWS 32 of legislation that would make these changes a reality. The other solutions to end childhood obesity that continue to be ignored, however, are a whole new paradigm. Both eliminating access gaps to healthy food and building cleaner, safer neighborhoods would cost the American economy millions, if not billions of dollars. These are also solutions that would take years to develop, and would require completely new infrastructures, construction and patience. With legislation you see the change right away. But with more large-­‐scale environmental changes results could take years, even decades. This study shows that the media is continuing to misrepresent the combination of solutions that are needed in this country because of “popular opinion” that the more large-­‐scale solutions are unrealistic and would cost too much money. In this sense, the media agenda is most definitely helping drive the public’s agenda. As public health officials advocate for the environmental changes needed to stop the epidemic, the mass media is continuing to demonstrate that some of the required solutions are not as important, and should not be considered. Overall, it is clear that the Let’s Move campaign impacted the media conversation in a positive way. More coverage was given to the issue of childhood obesity in general, and outlets elaborated on the problem in much more depth than they have in the past. From what’s causing childhood obesity, to all the dynamic ways in which we can try and solve it, this study shows how a White House campaign can shift a national media agenda. Even though coverage on childhood obesity is not ideal, the public health arena should find this study’s results promising, and a move in the right direction. After all, articles themed on the societal level of causes and solutions increased 41 percent after Let’s Move began. This study also shows that childhood obesity is slowly becoming a staple of concern as national media increasingly reports on it, and is no longer the “silent epidemic” Americans ignored CHILDHOOD OBESITY IN THE NEWS 33 in the past. As campaigns like Let’s Move continue to roll out, the media agenda will only get better. And the national conversation will only continue to shift toward acceptance of the large-­‐scale environmental changes needed to reverse childhood obesity. Conclusion Now considered one of the fattest nations in the world, America’s obesity problem has reached an all-­‐time high. Today, one in three U.S. children are currently overweight or obese, and are costing the healthcare industry billions of extra dollars in medical expenses. To begin to reverse the troubling trend, First Lady Michelle Obama launched the Let’s Move campaign, a national initiative that aims to end childhood obesity in one generation. Structured on many different levels, Let’s Move promotes both the personal level responsibility Americans should take, as well as what society can do in order to alter the state of obesity levels in American children. This study questioned and assessed the impact a campaign like Let’s Move may have on the national media agenda. More specifically, this study was designed to determine if Let’s Move shifted media coverage more towards the personal responsibility frame or the institutional changes frame regarding childhood obesity. Executed through a content analysis of some of the nation’s top media outlets, the topic of childhood obesity and how it was being reported on was analyzed. Studies designed to monitor the childhood obesity conversations that take place in the media are essential signposts for public health practitioners needing to to know where America’s mindset is regarding the issue. Because the media agenda controls the public agenda, knowing how the media are covering the CHILDHOOD OBESITY IN THE NEWS 34 issue provides the public health arena with the knowledge gaps it knows it needs to try and fill. With an all-­‐around increase in coverage on childhood obesity, as well as an increase in coverage on all types of causes and solutions to the epidemic, the Let’s Move campaign definitely impacted the media agenda. With more societal-­‐level causes and solutions being reported after Let’s Move was launched, the content analysis also proved that the campaign shifted the media agenda more toward the idea that childhood obesity is caused (on many levels) by society and is in need of institutional changes. While the media did an adequate job reporting on societal level solutions to end childhood obesity, they are continuing to ignore some of the larger, more costly solutions such as eliminating access gaps/ food deserts and building safer, cleaner environments. Regardless of the critiques, the Let’s Move campaign indisputably shifted the media agenda in a positive direction. Given the sample size of only 169 articles, however, the results from this study cannot be generalized to the entire media landscape of the United States. In fact, the limited sample size also made for several statistically insignificant findings according to a chi-­‐
square test. In order to make broader generalizations for the entire media landscape, more articles would need to be analyzed, as well as additional outlets across all geographic markets. Additionally, lack of a second coder for the content analysis limits the reliability of the coding scheme. In order to verify the results, a separate coder would need to re-­‐
examine the original sample of articles to rule out any biases. Finally, the Let’s Move campaign was not specifically coded for in the original analysis. For later studies, it will be increasingly important to code each article for explicit mentions of the campaign. CHILDHOOD OBESITY IN THE NEWS 35 For future research, it will be crucial to understand exactly how the information that is being reporting on regarding childhood obesity is being processed, remembered or acted upon. This second phase of research will draw clear correlations between the media agenda and any concrete actions that are being done to solve childhood obesity. It is also recommended that future studies examine other national and state level obesity campaigns to determine how they may be impacting local coverage of the issue. Future researchers will also need to analyze the media agenda on all levels, including print, television, radio and online channels. As the communication networks in America continue to grow, studies will need to keep this complexity in mind in order to get a clear and full understanding of how a national health issue is debated and discussed in the public sphere. Nonetheless, this study has offered insight into how a national health campaign impacted the media agenda on several significant levels. Future public health efforts and the obesity debate are not likely to disappear anytime soon. Understanding how these initiatives may be affecting the media landscape and a national conversation will be increasingly important to know as American legislators and policymakers grapple with large-­‐scale solutions to the obesity problem. In the end, it will be the public health community and its synergistic relationship with American media that will begin to create this collective force needed to reverse the childhood obesity epidemic. CHILDHOOD OBESITY IN THE NEWS 36 References Adler, N., & Stewart, J. (2009). Reducing Obesity: Motivating Action While Not Blaming the Victim. The Milbank Quarterly, 87 (1), 49-­‐70. Barry, C., et al. (2011). News Media Framing of Childhood Obesity in the United States from 2000 to 2009. Journal of the American Academy of Pediatrics, 128 (1), 132-­‐145. Cawley, J. (2010). The Economics of Childhood Obesity. Health Affairs, 29 (3), 364-­‐371. Christakis, N. (2007). The Spread of Obesity in a Large Social Network over 32 Years. The New England Journal of Medicine, 357, 370-­‐379. Cohen, B.C. (1963). The press and foreign policy. Princeton, NJ: Princeton University Press. Emanuel, E. (2012, Feb. 13). Let’s Move, She Said — and We Have. The New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2012/02/13 /lets-­‐move-­‐she-­‐
said -­‐and-­‐we-­‐have/ Farrelly, M., et al. (2005). Evidence of a Dose–Response Relationship Between “truth” Antismoking Ads and Youth Smoking Prevalence. American Journal of Public Health, 95 (3), 425-­‐431. Hall, M, and Hellmich, N. (2010, Feb. 9). Michelle Obama aims to end child obesity in a generation. USA Today. Retrieved from http://www.usatoday.com/news/ health/weightloss/2010-­‐02-­‐09-­‐1Afirstlady09_CV_N.htm Hornik, R. (2002). Public Health Communication: Evidence for Behavior Change. Wahwah, NJ: Lawrence Erlbaum Publishing. Info Reports. (2008). The John Hopkins Bloomberg School of Medicine Info Project: Center for Communication Programs, 16. Kim, S., & Willis, L. (2007). Talking about Obesity: News Framing of Who is Responsible for Causing and Fixing the Problem. Journal of Health Communication, 12, 359-­‐376. Klein, J., & Dietz, W. (2010). Childhood Obesity: The New Tobacco. Health Affairs, 29 (3), 388-­‐392. Lawrence, R. (2004). Framing Obesity: The Evolution of News Discourse on a Public Health Issue. The Harvard International Journal of Press, 9 (56), 56-­‐75. CHILDHOOD OBESITY IN THE NEWS 37 Levi, J., et al. (2011). F as in Fat: How Obesity Threatens America’s Future. The Robert Wood Johnson Foundation. Retrieved December 5, 2011, from http://healthy americans.org/assets /files/TFAH2011FasInFat10.pdf Lobstein, T., et al. (2004). Obesity in children and young people: a crisis in public health. Obesity Review, 5, 4-­‐85. Mowery, P., et al. (2004). Legacy First Look Report. American Legacy Foundation. Niederdeppe, J. (2011). Qualitative Research About Attributions, Narratives, and Support for Obesity Policy. Preventing Chronic Disease, 8 (2), 39-­‐50. Nisbet, M. (2009). Communicating Climate Change: Why Frames Matter for Public Engagement. Environment. Retrieved from http://www.environmentmagazine.org/ Archives/Back%20Issues/March-­‐April%202009/Nisbet-­‐full.html Piernas, C. (2010). Trends in Snacking Among U.S. Children. Health Affairs, 29 (3), 398-­‐404. Rosenstock, I., et al. (1988). Social Learning Theory and the Health Belief Model. Health Education Quarterly, 15 (2), 175-­‐183. The Pew Research Center for the People and the Press. (2011). Most Favor Government Role in Reducing Childhood Obesity. Retrieved from http://pewresearch.org/pubs/1916/obesity-­‐children-­‐government-­‐role-­‐poll. Trasande, L. (2010). How Much Should We Invest In Childhood Obesity? Health Affairs, (29) 3, 372-­‐ 378. Wang, S., & Brownell, K. (2005). Public Policy and Obesity: The Need to Marry Science and Advocacy. Psychiatry Clinics of North America, 28, 235-­‐252. Wojcicki, J., & Heyman, M. (2010). Let’s Move — Childhood Obesity Prevention from Pregnancy and Infancy Onward. New England Journal of Medicine, 1457-­‐1459. CHILDHOOD OBESITY IN THE NEWS 38 Appendix Code Book Each row of the spreadsheet corresponds to a new article. Each column of the spreadsheet corresponds to the rules below. Irrelevant articles will be disregarded. The codebook is divided up into 5 sections: general article information, causes of childhood obesity, solutions to childhood obesity, article voice and article theme/topic. General Article Information A: Publication 0-­‐ The New York Times 1-­‐ The Washington Post 2-­‐ USA Today 3-­‐ The Wall Street Journal 4-­‐ The Los Angeles Times B: Article publication date relative to the launch date of Let’s Move 0= Article was published before February 9, 2010 1= Article was published on or after February 9, 2010 C: The title of the article or lead paragraph has “childhood obesity” or similar wording such as “overweight children, obese children, etc.” present? 0= No, “childhood obesity” or similar variation is not in the title or lead 1= Yes, “childhood obesity” or similar variation is in the title or lead Causes of Childhood Obesity D: Article mentions personal-­‐level causes to childhood obesity? Personal-­‐level such as unhealthy diet, parental behavior, genetics, sedentary lifestyle, stress, depression, addiction, etc. These causes must be explicitly attributed on personal-­‐level situations. 0= No, personal-­‐level causes are not mentioned 1= Yes, personal-­‐level causes are mentioned Article mentions any of the following as causes to childhood obesity 0= No 1= Yes E.: Poor diet (0 1) F: Dietary role of parent (0 1) G: Sedentary lifestyle (0 1) H: Genetics (0 1) CHILDHOOD OBESITY IN THE NEWS 39 I: Depression, stress or other mental illness (0 1) J: Other (0 1) K: Article mentions societal-­‐level causes to childhood obesity? Societal-­‐level such as the school lunch program, neighborhood environment (especially lower SES causes), the food/beverage industry (fast food marketing as well), ‘food deserts’/ lack of access to healthy food, etc. These causes must explicitly describe societal causes (local, state and national level causes). 0= No, societal level causes are not mentioned 1= Yes, societal-­‐level causes are mentioned Article mentions any of the following as causes to childhood obesity 0= No 1= Yes L: The school lunch program (0 1) M: Natural environment/neighborhoods (0 1) N: Food & beverage industry/ marketing (0 1) O: Access to healthy foods/ food deserts (0 1) P: Other (0 1) Solutions to Childhood Obesity Q: Article discusses personal-­‐level solutions to end childhood obesity? Solutions such as changing diet, increasing physical activity, surgery, parental behavior change, exercise, etc. These solutions must be individual choice or action. 0= No, personal-­‐level solutions are not mentioned 1= Yes, personal-­‐level solutions are mentioned Article mentions any of the following as solutions to end childhood obesity 0= No 1= Yes R: Diet (0 1) S: Parental behavior (0 1) T: Exercise (0 1) U: Surgery (0 1) V: Other (0 1) W: Article discusses societal solutions to end childhood obesity? Solutions such as changes in schools and nutrition education, regulating the food/beverage industry (marketing as well), eliminating gaps in accessing healthy foods/ eliminating ‘food deserts’, creating safe, healthy neighborhoods, etc. These solutions must be institutional changes. 0= No, societal solutions are not mentioned CHILDHOOD OBESITY IN THE NEWS 40 1= Yes, societal solutions are mentioned Article mentions any of the following as solutions to end childhood obesity 0= No 1= Yes X. Revamp the school lunch program (0 1) Y. Nutrition Education in schools (0 1) Z. Physical Education in schools (0 1) AA. Regulation of the food & beverage industry/ marketing (0 1) AB. Eliminating access gaps/ food deserts (0 1) AC. Developing safe/clean environments for outdoor recreation and travel (0 1) AD. Other laws or regulations (federal or state level) AE. Other (0 1) Article Voice AF: A mother is quoted in the article? 0= Yes, a mother is quoted in the article 1= No, a mother is not quoted in the article AG: A medical expert such as a family physician, dietician, nutritionist or fitness trainer is quoted in the article? (NOTE: This expert must NOT be affiliated with a government agency) 0= No, a medical expert was not quoted in the article 1= Yes, a medical expert was quoted in the article AH: A state or national government health agency is quoted in the article? (Agencies such as the CDC, HHS or CPHD-­‐ The agency or one of their federal employees) 0= No, a government health agency is not quoted 1= Yes, a government health agency is quoted Article Theme & Topic The general topic/ theme of the article is? 0 = Not present 1 = Present AI: General reporting on the current state of childhood obesity. (0 1) AJ: Childhood obesity is an individually based problem in need of individualized solutions. (0 1) AK: Childhood obesity is a societal problem in need of institutional solutions. (0 1) CHILDHOOD OBESITY IN THE NEWS 41 AL: Childhood obesity is in need of both personal-­‐level solutions and societal-­‐level solutions. (0 1) AM: Other Theme Present (0 1) Overall Findings/ Frequency Tables Note: These tables are not sorted by date relative to the launch of Let’s Move. Publication Valid Frequency Percent Valid Percent Cumulative Percent The New York Times 28 16.6 16.6 16.6 The Washington Post 15 8.9 8.9 25.4 USA Today 24 14.2 14.2 39.6 The Wall Street Journal 36 21.3 21.3 60.9 The Los Angeles Times 66 39.1 39.1 100.0 169 100.0 100.0 Total Published Before or After Let's Move Frequency Before Let's Move Valid Percent Valid Percent Cumulative Percent 60 35.5 35.5 35.5 After Let's Move 109 64.5 64.5 100.0 Total 169 100.0 100.0 Title or Lead Mentions 'Child Obesity' Valid Frequency Valid Percent Cumulative Percent No 104 61.5 61.5 61.5 Yes 65 38.5 38.5 100.0 169 100.0 100.0 Total Percent CHILDHOOD OBESITY IN THE NEWS 42 Article Mentions Personal Level Causes Valid Frequency Percent Valid Percent Cumulative Percent No 108 63.9 63.9 63.9 Yes 61 36.1 36.1 100.0 169 100.0 100.0 Total Article Mentions Poor Diet Valid Frequency Percent Valid Percent Cumulative Percent No 130 76.9 76.9 76.9 Yes 39 23.1 23.1 100.0 169 100.0 100.0 Total Article Mentions Role of Parent Valid Frequency Percent Valid Percent Cumulative Percent No 133 78.7 78.7 78.7 Yes 36 21.3 21.3 100.0 169 100.0 100.0 Total Article Mentions Sedentary Lifestyle Valid Frequency Percent Valid Percent Cumulative Percent No 144 85.2 85.2 85.2 Yes 25 14.8 14.8 100.0 169 100.0 100.0 Total Article Mentions Genetics Valid Frequency Valid Percent Cumulative Percent No 161 95.3 95.3 95.3 Yes 8 4.7 4.7 100.0 Total Percent 169 100.0 100.0 CHILDHOOD OBESITY IN THE NEWS 43 Article Mentions Mental Health Valid Frequency Percent Valid Percent Cumulative Percent No 167 98.8 98.8 98.8 Yes 2 1.2 1.2 100.0 169 100.0 Total 100.0 Article Mentions Other Personal Level Causes Valid Frequency Percent Valid Percent Cumulative Percent No 159 94.1 94.1 94.1 Yes 10 5.9 5.9 100.0 169 100.0 Total 100.0 Article Mentions Societal Level Causes Valid Frequency Percent Valid Percent Cumulative Percent No 97 57.4 57.4 57.4 Yes 72 42.6 42.6 100.0 100.0 100.0 Total 169 Article Mentions School Lunch Program Valid Frequency Percent Valid Percent Cumulative Percent No 137 81.1 81.1 81.1 Yes 32 18.9 18.9 100.0 169 100.0 100.0 Total Article Mentions Neighborhood/Environment Valid Frequency Valid Percent Cumulative Percent No 150 88.8 88.8 88.8 Yes 19 11.2 11.2 100.0 169 100.0 100.0 Total Percent CHILDHOOD OBESITY IN THE NEWS 44 Article Mentions the Food/Bev/Mktg Industry Valid Frequency Percent Valid Percent Cumulative Percent No 131 77.5 77.5 77.5 Yes 38 22.5 22.5 100.0 100.0 100.0 Total 169 Article Mentions Access Gaps/ Food Deserts Valid Frequency Percent Valid Percent Cumulative Percent No 155 91.7 91.7 91.7 Yes 14 8.3 8.3 100.0 169 100.0 Total 100.0 Article Mentions Other Societal Level Causes Valid Frequency Percent Valid Percent Cumulative Percent No 154 91.1 91.1 91.1 Yes 15 8.9 8.9 100.0 169 100.0 Total 100.0 Article Mentions Personal Level Solutions Valid Frequency Valid Percent Cumulative Percent No 84 49.7 49.7 49.7 Yes 85 50.3 50.3 100.0 169 100.0 100.0 Total Percent CHILDHOOD OBESITY IN THE NEWS 45 Article Mentions Diet Valid Frequency Percent Valid Percent Cumulative Percent No 123 72.8 72.8 72.8 Yes 46 27.2 27.2 100.0 169 100.0 100.0 Total Article Mentions Parental Behavior Valid Frequency Percent Valid Percent Cumulative Percent No 117 69.2 69.2 69.2 Yes 52 30.8 30.8 100.0 169 100.0 100.0 Total Article Mentions Exercise Valid Frequency Percent Valid Percent Cumulative Percent No 129 76.3 76.3 76.3 Yes 40 23.7 23.7 100.0 169 100.0 100.0 Total Article Mentions Surgery Valid Frequency Percent Valid Percent Cumulative Percent No 165 97.6 97.6 97.6 Yes 4 2.4 2.4 100.0 169 100.0 Total 100.0 Article Mentions Other Personal Level Solutions Valid Frequency Valid Percent Cumulative Percent No 150 88.8 88.8 88.8 Yes 19 11.2 11.2 100.0 100.0 100.0 Total Percent 169 CHILDHOOD OBESITY IN THE NEWS 46 Article Mentions Societal Level Solutions Valid Frequency Percent Valid Percent Cumulative Percent No 48 28.4 28.4 28.4 Yes 121 71.6 71.6 100.0 Total 169 100.0 100.0 Article Mentions School Lunch Program Valid Frequency Percent Valid Percent Cumulative Percent No 116 68.6 68.6 68.6 Yes 53 31.4 31.4 100.0 169 100.0 100.0 Total Article Mentions Nutrition Education Valid Frequency Percent Valid Percent Cumulative Percent No 125 74.0 74.0 74.0 Yes 44 26.0 26.0 100.0 100.0 100.0 Total 169 Article Mentions Physical Education Valid Frequency Percent Valid Percent Cumulative Percent No 146 86.4 86.4 86.4 Yes 23 13.6 13.6 100.0 169 100.0 100.0 Total Article Mentions Regulating Food/Bev/Mktg Industry Valid Frequency Valid Percent Cumulative Percent No 109 64.5 64.5 64.5 Yes 60 35.5 35.5 100.0 169 100.0 100.0 Total Percent CHILDHOOD OBESITY IN THE NEWS 47 Article Mentions Eliminating Access Gaps/ Food Deserts Valid Frequency Percent Valid Percent Cumulative Percent No 140 82.8 82.8 82.8 Yes 29 17.2 17.2 100.0 100.0 100.0 Total 169 Article Mentions Building Safe, Clean Neighborhoods Valid Frequency Percent Valid Percent Cumulative Percent No 151 89.3 89.3 89.3 Yes 18 10.7 10.7 100.0 169 100.0 100.0 Total Article Mentions Other Laws & Regulations Valid Frequency Percent Valid Percent Cumulative Percent No 117 69.2 69.2 69.2 Yes 52 30.8 30.8 100.0 169 100.0 100.0 Total Article Mentions Other Societal Level Solutions Valid Frequency Valid Percent Cumulative Percent No 145 85.8 85.8 85.8 Yes 24 14.2 14.2 100.0 169 100.0 100.0 Total Percent CHILDHOOD OBESITY IN THE NEWS 48 Article Quoted a Mother Valid Frequency Percent Valid Percent Cumulative Percent No 153 90.5 90.5 90.5 Yes 16 9.5 9.5 100.0 169 100.0 Total 100.0 Article Quoted a Physician/Dietician/Nutritional Expert. Valid Frequency Percent Valid Percent Cumulative Percent No 113 66.9 66.9 66.9 Yes 56 33.1 33.1 100.0 169 100.0 100.0 Total Article Quoted a Gov't Health Agency Valid Frequency Percent Valid Percent Cumulative Percent No 137 81.1 81.1 81.1 Yes 32 18.9 18.9 100.0 169 100.0 100.0 Total General Report/Obesity Background Article Valid Frequency Percent Valid Percent Cumulative Percent No 157 92.9 92.9 92.9 Yes 12 7.1 7.1 100.0 169 100.0 Total 100.0 Individually Based w/ Individual Solutions Valid Frequency Valid Percent Cumulative Percent No 130 76.9 76.9 76.9 Yes 39 23.1 23.1 100.0 100.0 100.0 Total Percent 169 CHILDHOOD OBESITY IN THE NEWS 49 Societal Problem Needing Societal Solutions Valid Frequency Percent Valid Percent Cumulative Percent No 111 65.7 65.7 65.7 Yes 58 34.3 34.3 100.0 169 100.0 100.0 Total Both Personal & Societal Level Problem Valid Frequency Percent Valid Percent Cumulative Percent No 142 84.0 84.0 84.0 Yes 27 16.0 16.0 100.0 169 100.0 100.0 Total Other Article Theme Valid Frequency Valid Percent Cumulative Percent No 136 80.5 80.5 80.5 Yes 33 19.5 19.5 100.0 169 100.0 100.0 Total Percent