Health Promotion International Advance Access originally published online on March 27, 2006
Health Promotion International 2006 21(2):160-168; doi:10.1093/heapro/dal010
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Studying the striving and opposing forces in newspaper journalism: the actantial model of health promotion
Tampere School of Public Health, University of Tampere Finland
Address for correspondence: Pauliina Aarva, Tampere School of Public Health, University of Tampere, FIN-33014, Finland E-mail: pauliina.aarva{at}uta.fi
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SUMMARY |
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The cultural aspects of health promotion are important in policy development as well as in assessing effectiveness of health promotion activities. The discourses on promoting health and well-being in journalism reflect the health promotion culture in society. This article illustrates how health promotion is portrayed by 147 newspaper items from the two Finnish quality dailies during the period 2002–2004 and introduces a semiotic Actantial Model of Health Promotion (AMHP) for studying health promotion cultures. The most popular news themes on health promotion were physical and social environment, welfare services, nutrition and obesity, and mental well-being. The actants (actors, actions and abstract factor) of health promotion were identified and the AMHP with seven key actants (generator, health-object, public, tool, executor, threat and obstacle) was constructed. The model sheds light on two sides of health promotion discourses in journalism. The dominant culture of health promotion was represented by policy actions, information, education and scientific research, which were defined by health experts, decision-makers and researchers. Representations of the opposite culture—‘the otherness’ of health promotion included external harmful factors and unhealthy behaviours, mentalities opposed to being health-oriented, rationally uncontrolled living, disorder, disharmony and insecurity. The opposing factors were presented by people and institutions lacking the will, ability or motivation for a health-oriented life. To understand better the values of health promotion, it is necessary to assess the characteristics of the opposite side of health promotion culture, because the current dominant values can be described more clearly by the boundaries—by ‘otherness’. The study argues that the AMHP can be used as a semiotic method to identify the value dimensions and the boundaries between the dominant and the opposite discourses of health promotion in various communications such as advertising and health education. Also, it provides a tool for the analysis of the media's role in ‘victimization’ or ‘heroization’ of various population groups.
Key words: media; semiotics; culture of health promotion; values
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INTRODUCTION |
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Our everyday lives are conditioned by the mass media. Media texts and images have become important factors creating identities, moulding attitudes and constructing images of the world. Like other media, newspapers reflect and influence current thinking on health promotion.
The role of the media in providing health information has been studied extensively. Research interest has mainly focused on health information and its accuracy, public health campaigns and their effectiveness, the role of the media in health behaviour changes and other impact studies [e.g. (Islam and Hasan, 2000
; Myhre and Flora, 2000; Rimer, 2000; Yanovitzky and Stryker, 2001; Stryker, 2003; Beck et al., 2004; Jones, 2004; McAlister et al., 2004)].
The coverage, accuracy of information and distribution of various health themes in the newspapers are mainly studied by quantitative content analysis [e.g. (Kava et al., 2002; Malone et al., 2002; Hubbel and Dearing, 2003; Rowe et al., 2003; Sato, 2003; Davidson and Wallack, 2004)]. The representations of various health themes in the media, such as determinants of health (Commers et al., 2000; Ratzan, 2002), food risks (Lupton, 2004), the risks of passive smoking (Chapman, 1989; Kennedy and Bero, 1999) and mental health (Hazelton, 1997; Olstead, 2002; Rowe et al., 2003) have been studied using content analysis or discourse analysis.
The past few years have seen a growing interest in cultural studies in health communication with the aim to analyse the discourses and the symbolic side of health in the mass media [cf. (Lule, 2001; Seale, 2002; King and Watson, 2005)]. Semiotics is an emerging field in studying the image of health conveyed by cultural products, such as the newspaper texts. An example of semiotic textual analysis is provided by Törrönen's study of one editorial dealing with values communicated by the text (Törrönen, 2000).
Media texts form and modify the context in which they exist, even though they are themselves the products of the same social context (Fairclough, 1995; Grossberg et al., 1998). Health promotion activities are strongly linked with the social context, among others with the mass media, which is a powerful companion in health promotion actions. Beside explicit health communication there is also plenty of implicit health information in the media, messages which unintentionally and unconsciously are related to health. Talking about health promotion, i.e. health promotion discourse in the media is influenced by cultural determinants, such as societal values, norms and beliefs. Health promotion discourse as a cultural form of ‘social practice’ implies a dialectical relationship between individuals, groups of people, institutions and shared ways of talking about health promotion (Fairclough and Wodak, 1997; Martin and Wodak, 2003).
According to semiotic thinking each discursive entity creates its own rhetoric and its own communication rules, which reflect societal values and dominating ways of perceiving the world (Lotman, 1990). Health promotion as a discursive entity, ‘a culture’ in semiotic terms, includes various subcultures or anti-cultures with different discursive practices, such as discourses of health education in schools, fitness cultures or vegetarianism. The health promotion discourses in the mass media may also be seen as a journalistic health promotion culture.
The aim of this study is (i) to illustrate health promotion as portrayed by the Finnish newspapers and (ii) to develop a semiotic model for purposes of studying health promotion cultures in newspaper journalism.
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METHODS |
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Data collection
We were interested to see how health promotion is addressed in major newspapers intended for the general public. We studied the two biggest quality dailies in Finland: Helsingin Sanomat (HS), which has some 1.1 million readers and Aamulehti (AL), which has a readership of 322 000 (National Readership Survey 2003/2004, 2004). The population of Finland is about 5.2 million.
The material consisted of news, reports, columns, editorials and letters to the editor published during selected periods of the years 2002–2004. The texts chosen for analysis dealt with health in its broadest interpretation, whereby health was understood as a resource rather than as an absence of illness. This is in line with the broad and multidimensional definition of health promotion by the World Health Organization (World Health Organization, 1986). Taken in its broadest possible sense, virtually all human activities can in one way or another be linked with health promotion. Given these premises it was necessary for us to select our research material in two stages: it would not have been possible to define in advance any unambiguous set of sampling criteria.
In the first stage all texts published in HS and AL in April 2002 on the subjects of health, illness and well-being were collected. This search yielded 414 newspaper items. Based on the analysis of these texts we decided to exclude from the research material those items addressing the treatment of illnesses, the care of terminal patients, hospital waiting lists, the building of hospitals, accidents and crimes (e.g. car crashes and sexual criminality) and include in our material only those texts that dealt with welfare services, disease prevention and health promotion according to the concept of Ottawa Charter (World Health Organization, 1986).
Since the two newspapers dealt largely with the same issues during the same periods and our purpose was not to compare the two newspapers, we then chose to focus on different periods for each of the dailies. The final research material was collected during 1 week of each selected 6 months in the period 2002–2004. The research data comprised 147 newspaper items (Table 1).
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The actantial model
In developing a semiotic model for purposes of studying health promotion cultures in newspaper journalism we consequently adopt semiotic conceptualization of culture as the theoretical orientation of the study. It includes the assumption that patterns and structures of signs in media text condition the meanings which can be communicated and understood (Bignell, 2002
). Furthermore, our starting point is the assumption that health promotion issues are described in the media following a general narrative structure. In the health promotion stories there are various actors.
These actors are called actants by the French semiotician A. J. Greimas, who developed the actantial model (Greimas, 1980 [1966]) based on the studies of Russian formalist Vladimir Propp. He researched the morphology of Russian folktales by breaking the tales down into small narrative units. Propp's seven central units were hero, villain, donor, magical helper, princess, dispatcher and false hero (Propp, 1998 [1928]). Greimas further elaborated the narrative units of the general story structure, which he called seven actants: sender, object, receiver, helper, subject, opponent and anti-subject (Figure 1, in italics). The starting point of Greimas' model is the relationship between the object and the subject. The object is the goal of action that is regarded as important and desirable—in Propp's terms the princess of the fairytale. The subject is the hero who passionately wants to attain the object. The subject receives the authorization and the obligation for the action from the sender—Propp's donor, who in the fairytales is often a king. The sender conveys the messages about the importance of the object to the receivers—Propp's dispatcher. The helper assists the subject in attaining the object and supports the sender in communication efforts. In the Russian fairytales the helper's role is taken by a magical figure, a guardian spirit with supernatural abilities. The opponent strives to prevent actions by creating obstacles and causing difficulties in communication. This is a villain in Propp's parlance. The anti-subject is the negative actor—a false hero according to Propp. It proclaims and gloats on the defeat or the failure of the subject (Greimas, 1980 [1966]; Greimas, 1990; Propp, 1998 [1928]).
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Propp and Greimas both concluded that the actantial structure was not only the structure of a fairytale, but also a universal narrative pattern. Furthermore, Greimas also suggested that the actantial model could be adopted in the research of all kinds of signification systems (Greimas, 1980
[1966]).
Research questions and analysis procedure
To address the aims of the study we formulated the following three research questions:
- Which themes do the newspapers deal with when writing about health promotion?
- What kind of key actants can be found in the newspapers studied?
- What can the semiotic actantial model reveal about the prevailing culture of health promotion reflected in the media?
The analysis was conducted in two phases. First, to illustrate how health promotion is portrayed in the texts, we made a thematic analysis. We coded each article according to the main theme in the headline and in the head-note (two first chapters in the story). The coding list (Table 2) was prepared according to the results of the two surveys on the Finnish population's opinions about factors influencing health, and keeping in mind the concept of health promotion (World Health Organization, 1986). Behavioural factors, in particular nutrition, smoking, alcohol consumption and physical activity and also environmental issues were seen as major causes of diseases and threats to health in public opinion in 2002 (Helakorpi et al., 2002; Aarva and Pasanen, 2005). In addition to these themes we included in the coding list the themes ‘mental health and human relations’ and ‘welfare services’ due to their importance in Finnish health policy. Moreover, health and welfare services enjoy a fast-growing market in Finland (Government resolution, 2001). The theme of drugs was included in the coding list due to the considerably great amount of texts on drugs in the research material. The category ‘others’ comprised all the other health-related themes than those mentioned above.
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In the second phase of the analysis we developed the Actantial Model of Health Promotion (AMHP) based on Greimas' model. First, we determined health as an object of health promotion. Choosing health as the self-evident object in the model is based on the concept of health promotion (Ottawa Charter, 1986) and the notion that health is one of basic human values, which is considered desirable and intrinsically good (Wright von, 1963
). Also, the results of the population surveys indicate that health is one of the key societal values in Finnish society (Torvi and Kiljunen, 2005). Second, in order to understand what should be interpreted as a health promotion actant, we carefully read through the research material and broke it down into smaller actantial units. These were clauses and statements which might include either one or more words or one or more sentences. In accordance with Greimas' actantial model we defined either concrete or abstract features as actantial units. Concrete units were individuals, groups, organizations and institutions and abstract unit factors such as knowledge, attitudes, norms and values. Furthermore, functions, behaviours and activities and their end products, e.g. stopping smoking, could be identified as actantial units. We composed a list of numerous actantial units and classified them into seven AMHP actants according to Greimas' model. The auxiliary analysis questions used in the classification process were as follows:
- What is the key message of the text? (object)
- Is the actantial unit a subject, a sender or a proposed receiver of the message?
- Does the actantial unit help or resist achieving the object? (helper/opponent)
- Is the actantial unit the hindrance for the action or a cause of the resistance? (anti-subject)
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RESULTS |
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Themes of health promotion
The most common main themes concerned environmental issues. Physical environment referred to the prevention of traffic accidents, safety at work and school, the quality of drinking water and radiation. The texts belonging to the thematic group social environment involved social relationships at schools, workplaces and homes. The thematic content of the material is described in Table 2. The number of articles by theme (181) is greater than the total number of journalistic texts analysed (147), because some articles discussed multiple main themes in their head-notes.
The second most common main theme was health and welfare services. It dealt with old and inadequate service systems or the lack of services. Articles discussed statutory welfare services, rehabilitation, services for old people, new technologies and the prevention of health problems.
The texts coded under the theme nutrition and obesity discussed the overweight of the population, which was seen as a very serious problem in the country. Other related issues were harmful ingredients in food, unhealthy food and eating habits in general and advice on healthy eating. The theme mental health related often to the social environment and social services. Articles concerned loneliness, fear, social exclusion, prevention of mental illness or rehabilitation. The theme physical exercise dealt with new hobbies and instructions for exercise, fitness training and the benefits of physical exercise.
Drugs were the most common theme among the intoxicants. The articles dealt with drug addiction, drug dealing, rehabilitation services and the prevention of drug problems. The themes alcohol and tobacco were almost equally popular and mainly concerned with the prevention of the injurious effects of these substances.
The group others included altogether 15 different themes, such as the prevention of infectious diseases and the spread of bacteria and viruses, or issues of sick leaves, mobile phones, organ donation and aging.
Actants of health promotion
As a result of the close reading of the research material we identified seven health promotion actants: health, generator, public, executor, tool, threat and obstacle. The AMHP illustrates the roles and relationships of these actants (Figure 1).
Our initial assumption was that the core value of health promotion is health. In the media stories studied ‘health as such’, however, seemed to be very seldom an object-actant. Therefore, the health-object was derived from more concrete ‘subobjects’, such as stopping smoking, losing weight, reducing poverty or preventing drunken driving.
We discovered that the group of specialists and expert organizations assumed the place of the sender. They got a good hearing in the newspapers; their opinions were elicited or they were consulted by the journalists. They were either authorities, officials, experts and specialists, directors of major organizations or politicians. Researchers were usually commentators and their role was mainly to approve and confirm the message. Scientific publications and reports also appeared to be senders in the news stories. We call them the generators because of their prominent role in generating action. When commenting, advising and giving instructions to others they also obligate them to implement the recommended health promotion actions.
The role of the subject belonged to those supposed to follow the instructions and advice given by the generators. They were expected to implement the practical tasks for the purpose of enhancing the health of individuals or groups. They were referred to in the texts by generators but were rarely personally interviewed. They represented large and indefinite groups like health care personnel, organizations, states, communities, associations and the media. We name them executors, since they are the driving force in the practical implementation of health promotion activities. The receivers of the health promotion messages in our material were the readers of the newspaper, most often a rather large and indefinite public that received information from the generators as well as from the executors.
The tools of health promotion, such as various activities and measures, corresponds to the role of helpers in Greimas' model. The tools mentioned in the research material consisted of four main categories as follows: (i) political measures and legislation; (ii) information and motivation; (iii) improvement of services; and (iv) research. Political tools included taxation, penalties, regulations and surveillance. New laws or changes in the existing ones were repeatedly required. Tools to motivate, modify attitudes and increase knowledge were related to various campaigns and programmes, education and warnings. Collaboration and cooperation between different actors of health promotion were considered important in improving services. Research was seen not so much as a way to promote health in itself, but as a method of finding out what other tools were needed.
Opponents of health promotion in the newspaper texts were those who resisted or prevented an executor from reaching the goal. They are called threats. Some of them were very specific and concrete, like well-known viruses or bacteria, drugs, alcohol, tobacco, mould, television, Internet or the use of a mobile telephone. Some were wider threats influenced by multiple factors, like overweight, haste, stress, insecurity, loneliness, molesting, violence or pollution.
The obstacles influencing and causing health threats and complicating the health promotion action were seen as the anti-subjects of Greimas' model. These were often abstract factors, like values, norms, mentalities or attitudes opposing health-oriented life. Those lacking the will to promote health, like drug addicts, smokers or the tobacco and confectionary industries, were also considered to be obstacle-actants.
Driving and opposing forces of health promotion
The purpose of the AMHP is to provide a tool for the analysis of health promotion processes portrayed by the media and thereby reveal the cultural elements of health promotion in the media. The questions inside the boxes in Figure 1 were developed to help with the identification of the health promotion actants and their roles.
The main driving forces of health promotion are located on the left-hand side of the model. In addition to the executors, who are responsible for implementation of health promotion actions, key driving actants are the generators and the tools for implementation. Generators—professionals, decision-makers and researchers—seem to have more symbolic power than other actants, since they are better able to control the communication. While they convey the messages on the importance of health to the readers of the newspaper (the public), they also activate and obligate executors to implement the recommendations and instructions issued by generators. Executors stand for the health goal. They are supposed to be motivated and committed to maintain, improve or increase health. Their actions are guided by will power or a strong sense of duty. The public has a neutral position in the model.
The opposing forces, the threats and the obstacles, reveal various kinds of complications faced by the executors in the quest for the health-object. They describe the dangerous, inferior, unacceptable or forbidden side of the health promotion process.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The aim of this study was to illustrate health promotion in the Finnish newspapers by studying which themes newspapers deal with when writing about health promotion and by constructing a semiotic model to study cultural aspects of health promotion.
The most popular themes in health promotion in our data were physical and social environment and welfare services. These findings are consistent with the results of Commers et al., who analysed Dutch newspapers (Commers et al., 2000). Nutrition and obesity, mental well-being, drugs and exercise were also among the popular themes. It has been argued that the medicalization of everyday life is reflected in the media (Seale, 2002). Our analysis, however, does not suggest that medical views have a prominent role in the news stories. This may have to do with the fact that at the outset we defined health in broader terms than simply the absence of illness. Health promotion was then understood through the broad definition by the World Health Organization (World Health Organization, 1986). This meant that our research material came to include texts that would have been excluded if we had focused solely on the medical prevention of diseases or other medical subjects. Moreover, treatment sensations and other purely medical news were excluded from the data. Therefore, in the light of our analysis it seems that the focus of the health discourse in the studied two dailies is not upon medical issues, but more broadly on public health. Journalism can be seen as polyphonic space where various actors strive to bring their views into the public discussion by competing for the media publicity. Since the very concept of health promotion is essentially polyphonic, this is obviously reflected in the multiplicity of themes covered in the texts.
In addition to a thematic examination we scrutinized how the papers described actants (actors, actions and abstract factors) in health promotion and constructed the AMHP, a kind of core narrative or a dominant story. The model, with its seven actants, helps to identify different actors and their relationships in the mass media. Generators send the messages of health, the public receives them, the executors implement health promotion actions, tools help the implementation, threats impede the attainment of the goals of health promotion and obstacles cause health threats and prevent actions for health. The results indicate that our initial assumption that health is a core value of human life was reflected also in the media publicity, although there are many opposing forces to health promotion.
The AMHP sheds light on two major sides of health promotion reflected in the media publicity. On the one hand, it describes what is considered as accepted, important and valued—those issues which are considered to be good things by generators and executors. The discourse of health promotion in the dailies studied seems to be mainly determined by the generators, who hold the power of communication.
On the other hand, the model reveals the issues which are considered forbidden and wrong in relation to the dominant culture of health promotion. As in fairytales, in the model story of health promotion some are defined as heroes and some as villains. The most interesting, and from the practical point of view, the most challenging actants in the story are the threat and the obstacle. They represent the opposite side of health promotion, which either resists achieving health or causes threats and problems or impedes action to remove these. Representations of the opposite culture included (i) external harmful factors and unhealthy behaviours; (ii) beliefs and mentalities opposed to being health-oriented; and (iii) undefined obstacles to health, such as rationally uncontrolled living, disorder, disharmony and insecurity. The obstacles reveal the forgotten, unknown, uncontrolled and concealed side of human life. They describe ‘otherness’ in relation to the mainstream culture of health promotion and draw the boundary between Good Guys (the donors and heroes in Propp's terms) and Bad Guys (the villains and the false heroes in Propp's terms).
In the dominant story the Good Guys are health experts, decision-makers and research while the Bad Guys are the problems, the people suffering them and the visible or invisible reasons for those problems. The Bad Guys include overweight people, non-achievers, passive people and smokers, especially those who are unwilling or unable to change. Other bad things are alcohol in general, the tobacco industry and the confectionary industry. The main challenge of health promotion is how to deal with the Bad Guys, in particular with those invisible and unconscious reasons for resistance, which cannot be clearly named.
In assessing the results of our study it needs to be borne in mind that we did not explore the intentions of the newspapers. Instead, in line with our theoretical premises, we were interested in the health promotion culture portrayed by newspaper journalism. This in turn reflects the shared health promotion thinking in society, which seems to be defined by science, health experts and decision-makers in Finland today.
The limitations of the study are related to data collection and the applicability of the AMHP constructed. The data collection was based on the concept of health promotion. In the beginning of the selection process it came evident that the concept in its broadest sense was too broad to be adapted as a selection criterion. When selecting materials for the analysis, two researchers constantly changed opinions on whether or not the article belonged to the domain of health promotion. The most unclear cases were related to well-being talk, e.g. mental well-being or environment as health promoter. For example, supportive environments in our understanding could also include such good things as theatres, concerts, art exhibitions, libraries as well as humanitarian or religious activities, which may promote the health of those who enjoy aesthetic, humanitarian or spiritual experiences. We nevertheless excluded these themes from our material. The clarity and the distinctness of the concept of health promotion as a selection criterion would have been fully lost and corrupted if all sources of human, social and religious well-being had been defined as ‘parts of health’. The breadth of the concept of health promotion has its political and strategic advantages in advocating the holistic idea of health. The problems emerged, when we wanted to assess how the holistic concept was reflected in the journalistic texts. To solve the problem we ended up to use the slightly narrower interpretation of health promotion than is the concept of the World Health Organization (World Health Organization, 1986); Commers et al. experienced similar difficulties in coding the newspaper texts on determinants of health for their quantitative content analysis (Commers et al., 2000).
The limitations related to the applicability of the AMHP are twofold. First, as an analytical tool the model may at first sight appear clear and simple, but it may turn out rather complicated since there are no clear rules to identify actants in journalistic texts. The creative construction of the relationships between the actantial units of the text is always relative and dependent on the constructors' understanding. Also, the nature of language is ever changing and always situational, consequently causing the meanings to change. Commers et al. call the multiplicity of interpretation options as ‘coders’ tendency to read between lines' (Commers et al., 2000). We, however—following the semiotic thinking—understand that there is no single correct way to read media texts and consequently no absolutely right meanings, since the texts always include a lot of interpretation options. Therefore, the exact interpretation rules may never be available, and the analysis must be implemented by perhaps less precise, but available methods. Second, semiotic analysis is an laborious method since it requires the close reading and clear explication of the revealed meanings. The method does not allow the examination of large amounts of text.
Despite the limitations, we argue that the AMHP can be used as a theoretical framework and a semiotic tool to explore various health promotion cultures and value orientations within them. It will enable not only the identification of the dominant story but also many other narratives to describe the normative dimensions of health promotion. As a theoretical framework the AMHP is flexible, so some other subject than health, for example losing weight or stopping smoking, could be selected as the point of departure for analysis. Other potential core values could be freedom, peace of mind, safety or enjoyment. The change in perspective would then change the nature of the entire field examined. This would make it possible to identify and better understand the role of the mass media in health promotion, for example, in ‘victimization’ or ‘heroization’ of various population groups related to health enhancing actions. The model is also applicable for the assessment of other communications than journalistic texts such as advertisements and health education materials.
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ACKNOWLEDGEMENTS |
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This study was financially supported by Academy of Finland during the period 2002–2004.
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REFERENCES |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Aarva P. and Pasanen M. (2005) Public opinion on factors influencing health among the Finnish adult population and changes in public opinion from the year 1994 to the year 2002 (Suomalaisten käsityksiä terveyteen vaikuttavista tekijöistä ja niissä tapahtuneet muutokset vuodesta 1994 vuoteen 2002). Sosiaalilääketieteellinen Aikakauslehti 42:57–71 (in Finnish with the English Summary).
Beck C.S., Benitez J.L., Edwards A., Olson A., Pai A., Torres M.B. (2004) Enacting "health communication": the field of health communication as constructed through publication in scholarly journals. Health Communication 16:475–493.[Medline]
Bignell J. (2002) Media Semiotics: An Introduction (Manchester University Press, Manchester).
Chapman S. (1989) The news on smoking: newspaper coverage of smoking and health in Australia, 1987–88. American Journal of Public Health 79:1419–1422.
Commers M.J., Visser G., de Leeuw E. (2000) Representations of preconditions for and determinants of health in Dutch press. Health Promotion International 15:321–332.
Davidson A. and Wallack L. (2004) A content analysis of sexually transmitted diseases in the print news media. Journal of Health Communication 9:111–117.[Medline]
Fairclough N. (1995) Media Discourse (Arnold, London).
Fairclough N. and Wodak R. (1997) Critical discourse analysis. In van Dijk T.A. (Ed.). Discourse as Social Interaction. (Sage, London).
Government Resolution. (2001) Government Resolution on the Health 2015 Public Health Program. Ministry of Social Affairs and Health Helsinki. 2001:6 http://pre20031103.stm.fi/english/eho/publicat/ehocontents17.htm (searched 15.3.2005).
Greimas A. J. (1980 [1966]) Strukturaalista Semantiikkaa [Semantique Structurale. Recherche de Methode] (Tammer-Paino Oy, Tampere) pp. 201–208.
Greimas A. J. (1990) Narrative Semiotics and Cognitive Discourses (Pinter Publishers, London).
Grossberg L., Wartella E., Whitney D. (1998) Media Making: Mass Media in a Popular Culture (Sage, London).
Hazelton M. (1997) Reporting mental health: a discourse analysis of mental health-related news in two Australian newspapers. Australian and New Zealand Journal of Mental Health Nursing 6:73–89.
Helakorpi S., Patja K., Prättälä R., Aro A., Uutela A. (2002) Health Behaviour and Health Among Finnish Adult Population, Spring 2002 (Publications of the National Public Health Institute, Helsinki) pp. 158.
Hubbel A. P. and Dearing J. W. (2003) Local newspapers, community partnership, and health improvement projects: their roles in a comprehensive community initiative. Journal of Community Health 28:363–376.[CrossRef][Web of Science][Medline]
Islam M. and Hasan A. (2000) Mass media exposure and its impact on family planning in Bangladesh. Journal of Biosocial Science 32:513–526.[Medline]
Jones S. A. (2004) Coverage of breast cancer in Australian print media—does advertising and editorial coverage reflect correct social marketing messages? Journal of Health Communication 9:309–325.[Medline]
Kava R., Meister K. A., Whelan E. M., Lukachko A. M., Mirabile C. (2002) Dietary supplement safety information in magazines popular among older readers. Journal of Health Communication 7:13–23.[Medline]
Kennedy G. and Bero L. (1999) Print media coverage of research on passive smoking. Tobacco Control 8:254–260.
King M. and Watson K. (2005) Representing Health. Discourses of Health and Illness in the Media (Palgrave Macmillan, New York).
Lotman Y. M. The semiosphere. In Lotman Yuri M. (Ed.). Universe of the Mind(I.B. Tauris & Co. Ltd, London) pp. 123–214.
Lule J. (2001) Daily News, Eternal Stories. The Mythological Role of Journalism (The Guilford Press, New York).
Lupton D. (2004) ‘A grim health future’: food risks in the Sydney press. Health, Risk & Society 6:187–200.[CrossRef]
Malone R. E., Wenger L. D., Bero L. A. (2002) High school journalists' perspectives on tobacco. Journal of Health Communication 7:139–156.[CrossRef][Web of Science][Medline]
Martin J. R. and Wodak R. (2003) Re/reading the Past: Critical and Functional Perspectives on Time and Value (John Benjamins Publishing Company, Amsterdam/Philadelphia).
McAlister A., Morrison T. C., Hu S., Meshack A. F. (2004) Media and community campaign effects on adult tobacco use in Texas. Journal of Health Communication 9:95–109.[Web of Science][Medline]
Myhre S. L. and Flora J. (2000) HIV/AIDS communication campaigns: progress and prospects. Journal of Health Communication 5:29–45.[Web of Science][Medline]
National Readership Survey 2002/2003. (2004) Finnish Audit Bureau of Circulations http://www.levikintarkastus.fi/ (searched 15.3.2005).
Olstead R. (2002) Contesting the text: Canadian media depictions of the conflation of mental illness and criminality. Sociology of Health and Illness 24:621–643.[CrossRef]
Propp V. (1998 [1928]) Morphology of the Folktale 2nd edition (University of Texas Press, Austin).
Ratzan S. C. (2002) Public health at risk: media and political malpractice. Journal of Health Communication 7:83–85.[Medline]
Rimer B. K. (2000) Use of multiple media and breast cancer screening: an introduction. Journal of Health Communication 5:113–116.[Medline]
Rowe R., Tilbury F., Rapley M., O'Ferrall I. (2003) ‘About a year before the breakdown I was having symptoms’: sadness, pathology and the Australia newspaper media. Sociology of Health and Illness 25:680–696.[CrossRef]
Sato H. (2003) Agenda setting for smoking control in Japan, 1945–1990: influence of the mass media on national health policy making. Journal of Health Communication 8:23–40.[CrossRef][Web of Science][Medline]
Seale C. (2002) Media & Health (Sage, New Delhi).
Stryker J. (2003) Articles media and marijuana: a longitudinal analysis of news media effects on adolescents' marijuana use and related outcomes, 1977–1999. Journal of Health Communication 8:305–328.[CrossRef][Web of Science][Medline]
Törrönen J. (2000) The passionate text. The pending narrative as a macrostructure of persuation. Social Semiotics 10:81–98.[CrossRef]
Torvi K. and Kiljunen P. (2005) Onnellisuuden vaikea yhtälö. EVAn kansallinen arvo- ja asennetutkimus Yliopistopaino. Available at: http://www.eva.fi/files/1110_onnellisuuden_vaikea_yhtalo.pdf (last accessed 9 March 2005).
World Health Organization. (1986) The Ottawa Charter for Health Promotion. International Conference on Health Promotion: The Move Towards a New Public Health.The Ottawa Charter for Health Promotion (World Health Organization, Health and Welfare Canada, Canadian Public Health Association, Ottawa).
Wright von G. H. (1963) Varieties of Goodness (Routledge & Kegan, New York).
Yanovitzky I. and Stryker J. (2001) Mass media, social norms, and health promotion efforts: a longitudinal study of media effects on youth binge drinking. Communication Reseach 28:208–239.
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