Analyzing Health Portrayals in Advertising and Entertainment

This report delves into the multifaceted influence of media on public health, examining how advertising and entertainment shape perceptions and behaviors. It explores the impact of tobacco and alcohol advertising, highlighting concerns about their effects, particularly on young audiences. The report analyzes pro-social health campaigns, outlining strategies for effectiveness, such as demonstrating a clear threat and providing efficacy. It contrasts successful campaigns, like those from the Meth Project, with less effective ones, like the anti-drug PSAs. Furthermore, the report discusses the use of various persuasive techniques, including linking undesirable behaviors to outgroups, demoralizing unhealthy behaviors, and employing fear or disgust appeals. The report emphasizes the importance of matching the threat with the behavior and concludes with an overview of health portrayals in entertainment and advertising.

Health & Sex p. 1
Health in Advertising
Let's start by exploring how health in the media may influence people in several key
areas. We'll talk a little about public health campaigns. We'll largely talk about how
everyday advertisements and entertainment messages influence our perceptions about
health, which likely play a larger role in our individual health choices.
Why should we study how health is portrayed in the media? For starters, 88% of
Americans say that they get health information from the media - which is a
huge number. Think of how much more time we spend with the media than with
medical professionals. This high number of Americans getting health-related information
from the mass media may be problematic in several ways. First, health information and
behaviors presented to audiences may not be complete or accurate.
Just as we saw with our reality and violence modules - it isn't the job or responsibility of
entertainment and persuasive media content creators to represent a true-to-life, factual
and accurate representation of the real word. Portrayals of health in the media can have
a range of effects on individuals exposed to them - from positive to negative, from
weak effects to strong effects. These effects can also be intentional, i.e. the intended
outcome of the producers of messages may the actual outcome among audiences, but
they can also be unintentional - producers might not set out to be influential in
health areas, but they still may be, or they may have the opposite effect than was
originally intended.
Advertising of tobacco and alcohol and its effects on any number of audiences have
been studied in-depth by researchers over much of the past several decades. Since the
1970’s, the percentage of Americans who smoke cigarettes have declined, but of all
adults nationwide, the percentage of smokers has remained relatively stable at around
20% for some time (this varies across the country, more people smoke in the South, for
example, than they do on the West coast). There is a large public concern about
advertising cigarettes and tobacco to minors. Although cigarette ads have been banned
from broadcast media since 1971, other means have not been banned. Although Joe
Camel has long-been retired, images of him (left) used to be as recognized as images of
Mickey Mouse among children.

Why does it matter if children recognize a smoking camel cartoon more than the
hallmark Disney character? Because numerous studies have shown a link between
increased tobacco symbol and slogan advertising recognition and increased rates of
smoking: The more likely a youth is to recognize smoking slogans and ads, OR view
media with smoking in it, the more likely she is to smoke.
Although banned from broadcast advertising, cigarettes still make their way on various
screens (and less screen-related technology such as sports arenas and in-store display
advertising). Phillip Morris paid $350,000 for cigarette product placement in License to
Kill (a James Bond film), and $50,000 for placement in Spiderman 2, as just two recent
examples. When and how money exchanges hands for product placement in TV and film
is often not public information, so we can't always know when cigarette companies are
paying for, and possibly profiting from placement of ads. It is interesting to think about

what shows like Mad Men, set in time where more people smoked more often, and in
public places, say about smoking cigarettes to its various (likely adult) audiences.
There is also a significant amount of concern about what adolescents may learn about
drinking alcohol from advertising messages. While tobacco is banned from broadcast
advertising, alcohol is not. And it is strong self-regulation by the alcohol industry that
keeps alcohol advertising on air. They follow several industry guidelines, including not
advertising during shows where the audience is deemed to be less than 70% of drinking
age, in order not to ruffle any feathers and invite the government to intervene.
The research here is troubling to those concerned as well - a longitudinal study of youth
looked at exposure to in-store alcohol displays, magazine ads, and beer concessions at
events. Longitudinal studies look at effects over time. This study looked at exposure to
these types of alcohol advertisements in the same group of individuals when they were
in 7th grade, and again when they were in 9th grade. In the measurement at the time
when participants were in 9th grade, they also measured alcohol use.
And, sure enough, those who were exposed to more alcohol advertisements
were also more likely to report more alcohol use and experimentation than
those who were exposed to less advertisements.However, there is some silver lining in
regard to alcohol advertising. There is mainly mixed results in regard to the negative
effects of alcohol advertising on established drinkers. That is, among those who already
drink, there is inconclusive evidence that alcohol advertising influences drinkers to drink
more alcohol than not, or to drink alcohol and then drive.
What does the reading say about the relationship between food advertising and
childhood obesity?
We know that advertising - whether it is explicit commercials, billboards, or in-store
displays can be effective in selling any number of things, we perhaps should not be
alarmed that this works for selling products and services that society would prefer those
under a certain age partake in. Let's take a brief look at suggestions for creating an
effective pro-social health campaign before discussing health portrayals in
entertainment media.
Health & Sex p. 2
Health Campaign Strategies
Many pro-social health campaigns are created by a number of non-profit, for-profit, and
governmental agencies with a larger goal of increasing positive health behaviors
and/or decreasing negative health behaviors. Many of these pro-social messages
take the form of Public Service Announcements, PSA's, which are typically 30s
commercial spots on TV about not smoking, breast cancer awareness, anti-bullying, etc.
Just as the impact of any one 30s advertisement alone likely doesn't have a huge effect
on many people, the effects of one viewing of one PSA also likely has small effects on
audiences that it is targeted to. For any number of reasons, pro-health campaigns,
often fail. One reason may be the relatively smaller fraction of messages that they
make up as compared to advertisements, product placements, and entertainment
messages that are not explicitly working to improve health outcomes. While research
has shown mixed effects for various strategies and mediums of delivery, it is
consistently shown that increased frequency of exposure to health campaigns,
and increased exposure to health campaigns across media (i.e. TV advertisements,

paired with doctor interventions, magazine ads, and other mediums, etc.) can combine
to create larger, more positive effects.
While there are several strategies that can be used that will increase the likelihood of
success of any one campaign, or message, every pro-health campaign MUST do two
things in order to be successful (although just meeting this standard is not enough to
guarantee success, it is a base level of accomplishment that must be there for the spot
to be successful). These two criteria that a pro-health campaign/ message must meet
are:
1. Demonstrate a threat
2. Provide efficacy (make sure that audiences are confident in their
ability to enact behavior that will not let them succumb to the threat)
Let's look at a pair of two classic anti-drug PSAs: Can you identify a clear threat?
http://www.youtube.com/watch?v=nl5gBJGnaXs&feature=related (Links to an external site.)
http://www.youtube.com/watch?v=qyXFN4ocN_o (Links to an external site.)
These spots generated a lot of buzz when they were introduced in the 80's/ 90's, and
became hallmark anti-drug PSA spots sponsored in part by large governmental offices
and non-profits.
The threat does not seem clear to me. If I do drugs, or in the second spot, heroin, will
my brain be cooked sunny side up? Or will my friends and family be smeared across a
kitchen by the actress who starred opposite of Freddie Prinze Jr. in the 90s classic, She's
All That?
The point of these spots is that although you can do some things correctly - like
matching the severity of the threat with the correct emotional tone (doing heroin is very
bad, the tone there is very negative), or doing something attention-grabbing, these
spots do not provide a realistic threat of drug and heroin use. Further, they don't
attempt to provide the viewer with efficacy - they are told not to do something - and not
given the tools to do so or a rationale as to why the suggested remedy will work. Please
view the following one or two of PSA's from the Meth Project (which are disturbing) as a
contrast in demonstrating a threat:

https://www.youtube.com/watch?v=2ZO2Rhqjuw0&list=PL6EEE8723696678F4 (Links to an external
site.)
These give me the chills!
These spots very clearly demonstrate some of the extremely awful threats of doing
meth - suicide attempts, prostitution in order to make money for drugs - let alone what
it does to your body. These campaign spots definitely demonstrate a threat - other parts
of a campaign can demonstrate to others that they personally have the ability to enact
corrective behaviors (self-efficacy) and that the proposed behavioral change - not
doing meth will reduce or prevent the negative consequences of the negative health
behavior, doing meth (response efficacy). Again, a campaign as a whole will need to
express that there are threats associated with a negative health behavior (or not doing
a positive one, such as self-breast exams, or regular STD screening) and that there are
protective behaviors that are not only demonstrated to ameliorate those threats
(response efficacy), but that individuals themselves have the ability to enact those
protective behaviors (self-efficacy).
One type of health campaign strategy used to bolster positive effects of your messages
is to link the undesired behavior to a disliked outgroup. An example of this is
seen int he clip below:
http://www.youtube.com/watch?v=Rh8GbPnoqCI&feature=related (Links to an external site.)
Since Sarah started smoking pot she got "lazy and boring" - these are undesirable out-
group characteristics. Previous research has demonstrated that participants will make
healthier food choices when unhealthy food choices are associated with an undesirable
out-group (the study cited used "online gamers" as one), and that indicate diminished
intentions to binge drink after binge drinking is associated with some undesirable out-
group (here, graduate students were the referent out-group for a study of
undergraduates).
A second strategy of health campaigns that can be used to increase effectiveness is to
demoralize the behavior. When negative health behaviors can be presented as
immoral, or not right to do, they can seem less appealing. The anti-tobacco truth
campaign has done an excellent job of demoralizing smoking behaviors by consistently
showing the message that big tobacco is a corrupt, immoral set of companies that lie
and cheat to their customer base, and it you should not financially support them.
A last strategy discussed here is a fear or disgust appeal - meant to scare or disgust
individuals away from certain behaviors. While your reading says the outcomes of these
campaigns isn't yet well-known, recent research, has, indeed found that emotional
appeals are more effective than non-emotional appeals when attempting to correct

negative health behaviors. The Tips from Former Smokers campaign that debuted in
2012 relied heavily on showing body deformities that occurred as a result of using
tobacco. These images can be powerful persuasive tools:

However, when a fear or disgust appeal exaggerates how scary or disgusting something
can be, there can be boomerang effects, which result from audiences thinking the
effects are exaggerated and judging the messages to not be truthful, actually grow
more positive toward the unhealthy behavior. In order to be effective, the threat must
match up with the behavior. Can you imagine the Meth Project PSA's above having the
same content, but be encouraging audiences not to smoke marijuana? That would not
match up to common perceived threats of marijuana use. But, becoming lazy and
boring as the anti-marijuana ad claimed? Sure, that is a more likely possibility.
Health & Sex p. 3
Health in Entertainment
Just as we've discovered in previous modules that the TV world is more violent than the
real world, we should also recognize that the TV world is much thinner than the
real world. Different mediums and events have been criticized for portraying an
unrealistic body image. Content analyses of TV content show that 12%of characters
have a weight problem. According to the CDC in 2014, over a third of Americans are
obese.
Let's briefly touch base on the paradox surrounding body size and traditional, scripted
TV shows. While TV characters are skinnier, on average, than typical people, they are
almost never shown engaging in healthful behaviors that contribute to being healthy.
While size is not a singular indicator of health, nor does the thinness of some actors
look particularly healthy, there is a large disconnect between seeing healthy looking
people on TV and seeing them do anything to encourage that. When friends on a sitcom
meet up, where do they go? Most often a bar (alcohol has a ton of empty calories), or

out to eat food that is not baked chicken and steamed vegetables. How many times
have Scandal fans seen Olivia Pope, who is thin and beautiful, go to CrossFit as
compared to having a glass of wine? I don't know the ratio, but we definitely see many
characters on TV spending an evening with a drink or a few drinks as compared to at
the gym. For an extreme example of this paradox of size on TV, please view the
commercial below:
http://www.youtube.com/watch?v=zvz63nkDcMM (Links to an external site.)
Does Padma Lakshmi (and Paris Hilton before her) really eat Hardee's bacon
thickburgers? I don't know. I'm willing to bet she doesn't eat them often and skip the
gym. Even further complicating the paradox of the thin-but-never-working-on-it TV
character, is that those who view more TV are more likely to internalize the thin
standard portrayed on TV - just like under cultivation theory - when you watch more TV,
you are more likely to believe that the real, social world is more similar to the TV world
than non or light viewers do. And, they (those who watch more TV) are also more likely
to personally struggle with weight problems.
One area of TV content not addressed in the reading that may present a little bit
different of a picture may be reality TV programming. I've seen highlight reels of
the Kardashian sisters really eating salads from their various shows, for example. Shows
like the Biggest Loser highlight weight-loss specifically, many lifestyle and competition
shows feature athleticism and healthy choices, sometimes inadvertently.
The TV world shows various other health disparities. For example, for every one doctor
we see on TV, we see two sick people. We know that there are more sick people than
physicians in the real world. The presentation of suicides in entertainment (and news)
content is also troublesome - without helpful advice as to where to seek help,
entertainment content featuring suicides have preceded actual spikes in real world
suicide attempts on more than one occasion. Content creators always need to
provide a hotline or follow-up information when suicide-related content
appears in news or entertainment messaging.
While health portrayals in entertainment media can result in unintended, unhealthy
influences on individuals, there is also a push in entertainment-education, or the
building of pro-social messages into narrative content, to increase positive
health behaviors among viewers.
Other examples of successful pro-social messages being built into entertainment
content include a story line about syphilis infections on ER, and a rise in syphilis testing
among at-risk groups. The key to successful entertainment-education message is that
the narrative can stand on its own. When writers get too consumed in presenting
accurate or complex health messages and let the pot of characters fall though the
cracks, audiences can be perceive it and discount the message. An already strong set of
characters and plot lines are the best to house pro-social health messages.

Health & Sex p. 4
Sexual Content in the Media
After starting with some basic definitions and numbers on sexual portrayals in media
content, we'll talk about the possible effects of these portrayals. We're focusing on the
"why should we care" and "to what effect." We're going to largely focus about concerns
over the effects of sexual content in the module. But please review the patterns about
sexual portrayals across media types in the reading.
Sex! After studying the effects of violent media, this is the sexiest and most risque topic
we cover. It's a topic with varied opinions - some of you may wish for more modesty and
less explicitness of all sex/ sexuality related content in popular media, and some of you
are avid pornography enthusiasts. The great thing is A.) There's a middle ground, like
always, and B.) We don't have to disclose where we stand on that continuum! This unit
looks at sexual content over time, and empirical evidence about sexual content in the
media and it's effects. So, the Ted Bundy scary quote about porn is just that - a scary
quote about porn.
The chapter and module contain research data - not anecdotes and personal opinions -
that I encourage you to use to shape your own opinions.
The primary public concern related to sexual portrayals in the media is: Where do
children and adolescents primarily learn about sex? When asked for the primary
source of information about sex, youth responded this way:
 Parents: 7%
 Schools: 3%
 Friends: 45%
 Media: 30%
A whopping 35% of youth reported that the media was their primary source of
information about sex, and 45% said their friends were. Friends, who surely learned
some of what they know from the media as well. This presents an issue, because just
like other types of issues and specifically health issues, portrayals in entertainment
media are often not true to life and may have unintentional consequences on
audiences. The logical follow-up question about the effects sexual content in general is
how viewing it might media influence sexual behavior and norms across
society?
First, distinctions in types of sexual content must be made:
 Pornography is defined as "graphic and explicit depictions of sexual activity"
 Obscenity content is a legal qualification, and a 3 or 4 part definition with
stipulations on content having prurient interest in sex; being patently offensive
beyond the contemporary community standards regarding depictions of sexual
content; and lacking all other literary, artistic, political, or scientific value. (this last
part is the hardest criteria to argue).
 We're focusing mostly on portrayals of sexual behaviors and/ or nudity in popular
entertainment media (not XXX rated adult content). Our focus on sexual themes in
popular media is based on public concern about several areas:

o There is a definite focus on visual explicitness in popular media. Innuendo
and verbal discussions and descriptions of sex often fly under the radar, though
virtually any nudity can be criticized. (This sounds familiar to sanitized violence
and verbal aggression, no? Remember that these "less explicit" types of content
also effect us over time in small ways as well.)
o The FCC is the regulating body of note in regard to nudity and explicit
sexual acts, but that is it. They have regulatory control of traditional broadcast
(broadcast radio and broadcast network TV - but not cable, satellite, and
premium cable TV, nor do they control games or film).
o The last large issue of note here is that the media is a large source of
social information about what others are doing sexually. Children and adults
learn about cultural norms regarding sex and sexual behaviors from the media.
An important first thing to realize about sexual content in popular media is how
drastically it has changed over time, and while there is definitely more sexual content
available now than in times past, how much and what type of sexual content is
portrayed in popular media reflects societal norms in large part.
 The 1950's saw the "Golden Age of Television," where many shows revolved
around the family. Even married couples were always shown sleeping in separate
twin beds. This was not a sexually adventurous time on television or film.
 In the 1960's we start to see evidence of the cultural revolution taking place in
the U.S. We see more revealing clothing, and definitely more rebellious music with
sexual overtones.
 The 1970's saw the war between VCR/VHS and Beta Max. Although many
financial tidbits of info are not publicly known, the porn industry's backing of the
VHS over Beta Max is often given credit for that technology winning out over Beta
Max.
 In the 1980's, we saw somewhat of a conservative wane. The fear surrounding
AIDS and resulting sexual health campaigns effectively put a small damper on
continuing risque content.
 In the 1990's we see sexual content being at the forefront of material on the web
in the early days of the Internet. In TV, we see the emerging visibility of non-
heterosexual identifying characters (Ex. Ellen, Will & Grace)
 In the early 2000's we see a lot of explicit content on premium cable and cable
network series, and talk about sex is the rise,
 But, interestingly, your text reports that a meta-analysis of network TV shows an
overall decline in sexual content on network television from 1975 to 2004.
Just as the case could be made for reality TV programming perhaps demonstrating
some real-to-life health choices and behaviors, the case could be made that reality TV
serves both to push the sexual envelope (Does MTV still have The Challenge or Road
Rules or The Real World? I am old, but these lifestyle shows about young people
partying and hooking up aren't completely gone, Are they?). But, perhaps it can show a
true-to-life modesty, or sexual restraint. The clip below is from Duck Dynasty, when a
Dad of a teenager wants her to pick a dress that covers up a little more than her
original choice:

http://www.youtube.com/watch?v=VWE6QfNkQBE (Links to an external site.)
So, reality content might show a broader range of less sex and nudity to more sex and
nudity than traditionally scripted reality content.
Also of interest is debating whether less sexual content on network TV is as
noteworthy as it seems. Is that the media children are accessing? There is no clear
causal links between sexual content and sexual activity among teens, but it should be
noted that less teenagers are sexually active now than in previous decades,
and the teen pregnancy rate is at it's lowest in 30 years.
BTW, multiple sources, including Pew Research data, the New York Times, and the
Washington Post (graph below with projected number of sexual partners) have all
confirmed that millennials are having less sex, with fewer partners, than the previous
two generations.
So, oddly, the media in general may be showing more sex (although not uniformly
across platforms), but sexual behaviors are actually trending toward less permissive.
Health & Sex p. 5
Sexual Content in Media part 2
Please make sure to review your text about sexual content across music videos, porn,
TV, and the Internet. Where is there increasing amounts? Where is there decreasing
amounts?
Effects of Exposure to Highly Explicit Sexual Content