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© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.048454
RESEARCH AND PRACTICE |
C. Keith Haddock, L. Carrie Parker, Jennifer E. Taylor, and Walker S. C. Poston are with the University of Missouri, Kansas City, and the Mid America Heart Institute, Saint Luke’s Hospital, Kansas City. Harry Lando is with the University of Minnesota, Minneapolis. Col G. Wayne Talcott is with Brooks Air Force Base, Texas.
Correspondence: Requests for reprints should be sent to C. Keith Haddock, PhD, Department of Psychology, University of Missouri–Kansas City, 4825 Troost Ave, Suite 124, Kansas City, MO 64110 (e-mail: haddockc{at}umkc.edu).
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ABSTRACT |
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Objectives. We sought to gauge the relative attention that tobacco control receives in military newspapers by comparing coverage of tobacco use with that of other health topics of importance to the military.
Methods. We examined tobacco-related articles and industry advertisements in 793 newspapers published during 1 year at 16 representative military installations (4 Air Force, 6 Army, 2 Marine, 4 Navy). Newspaper content was coded with a standardized coding manual developed through previous research.
Results. Tobacco use received the fewest instances of coverage and the least print space in military installation newspapers of all the health topics examined. The primary "message frame" used in tobacco control articles was that smokers are putting themselves at health risk, a theme that has not been found to have a strong effect on smokers. Nearly 10% of the newspapers contained tobacco advertisements.
Conclusions. Tobacco control messages are underrepresented in military installation newspapers compared with other health issues. Furthermore, military newspapers send mixed messages to military personnel by providing advertisements for tobacco while also claiming that tobacco use is harmful.
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INTRODUCTION |
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Tobacco use is the leading preventable cause of premature mortality and morbidity worldwide.1 Smoking is known to cause stroke, heart disease, chronic obstructive pulmonary disease, and many forms of cancer.2 Each year 1 in every 5 deaths—nearly 440000 lost lives—is caused by tobacco use.3 The American Lung Association calculated that adult males and females lost an average of 13.2 and 14.5 years of life, respectively, owing to smoking, excluding life years lost owing to secondhand smoke exposure.1 Despite the staggering impact of smoking on health, 22.8% of adults in the United States continue to smoke.4
One segment of the US population with a disproportionately high smoking rate is the US military.5 From 1998 to 2002, the military witnessed an increase in smoking among active-duty personnel, from 29.9% to 33.8%.6 Among the service branches, the Marine Corps has the highest (38.7%) and the Air Force the lowest (27.0%) percentage of smokers.6 In addition, more than 12% of military personnel report using smokeless tobacco (14.5% among males).6 Of particular concern is that more than 30% of active-duty personnel who smoke report having initiated smoking after entering the military, raising the possibility that the military culture encourages smoking.5–7
The high rate of tobacco use among Department of Defense (DOD) personnel puts a substantial burden on military health care and combat readiness. It has been estimated that smoking-related health care costs and associated lost productivity costs in the military are nearly $1 billion annually.8 Military personnel who smoke are less productive,5 are more likely to miss duty days because of illness,6–9 perform worse on physical fitness tests,5 experience significantly more training injuries,10 and are more likely to be discharged within the first year of service11 relative to nonsmoking personnel.
Several initiatives have been designed to reduce tobacco use in the US military, such as tobacco control policies, bans on smoking during training, and no-cost smoking cessation programs, including pharmacotherapy.6 In addition, the DOD, in collaboration with the Department of Veterans Affairs, has established comprehensive clinical guidelines on tobacco treatment in military medical facilities.6 The DOD also has chartered the cross-service Alcohol Abuse and Tobacco Use Reduction Committee to advance policies that reduce tobacco consumption among military personnel. This effort is consistent with DOD readiness requirements and the military health system strategic plan of creating a healthy and fit fighting force.12 Finally, some individual military services have established their own tobacco control policies. For example, the Air Force’s tobacco policy prohibits smoking in Air Force facilities, mandates provision of smoking cessation services, and forbids tobacco advertising in service publications.13
One tobacco control strategy that has received little attention in the military is the use of the print media. In 2001, the top 5 tobacco companies spent approximately $11.2 billion in advertising cigarettes,14 which is more than the combined total budgets of the US National Cancer Institute and National Heart, Lung, and Blood Institute. Research has documented that industry advertising of tobacco increases the risk of smoking initiation and undermines parental attempts to discourage smoking among teenagers.15–17 In response to this advertising blitz, mass media campaigns designed to reduce tobacco consumption have been developed and tested.18 However, although antitobacco media campaigns can result in more negative attitudes toward smoking and prevent initiation, pro-tobacco advertising may counteract the positive effects of antitobacco messages.16,17,19,20 Industry documents have demonstrated that tobacco companies have targeted the military with pro-tobacco marketing campaigns.21 However, little research has examined how print media are used to discourage tobacco use among military personnel.
Newspapers are one of the primary means used by military commanders to communicate information to installation personnel.22 Installation newspapers are used to update and inform military personnel and their families about important health issues such as smoking cessation, drinking and driving, healthy weight objectives, and fitness, to name just a few. According to the federal regulation governing military installation newspapers, "the newspaper provides information to make command members aware of the hazards of the abuse of drugs and other substances, and of the negative impact that substance abuse has on readiness."22
There are 174 military installation newspapers, and surveys suggest that nearly 90% of active-duty military personnel read these publications.23 Thus, military installation newspapers could play a key role in preventing substance abuse by military personnel. No study to date has examined how the military uses newspapers to educate its personnel about the dangers of tobacco use or whether the tobacco industry attempts to promote smoking through military newspapers.
The purpose of this study was to examine tobacco control articles and industry advertisements in military installation newspapers and to compare coverage of tobacco use in military newspapers with coverage of other topics of importance to military health promotion, including alcohol abuse, physical activity, illegal drug use, and seat belt use. It was hoped that this analysis would yield an improved understanding of the amount and type of tobacco-related information that reaches the military population through this important media outlet.
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METHODS |
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Parent Grant
Our study was part of a project to evaluate a community-level tobacco intervention on US military installations. We examined issues of newspapers published during 1 year by 16 military installations (4 Air Force, 6 Army, 2 Marine, 4 Navy) that volunteered to participate in the larger study. To encourage participation in the study as well as open disclosure of health information, an agreement was made to avoid identifying any military installation by name in project publications and presentations.
General characteristics of the 16 participating military installations and their installation newspapers, including the range of issue dates examined, are provided in Table 1
. The dates vary owing to the installations’ staggered participation in the parent study. The number of newspapers received for the study varied by base owing to holidays and newspaper scheduling. Overall, 793 issues of military newspapers (202 Air Force, 297 Army, 102 Marine, 192 Navy) were coded and used in the data set.
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Newspaper Content Coding
Military installation newspapers generally are published every week except for the week including Christmas. We analyzed issues published over the 12-month period prior to each installation’s volunteering for the parent study. We obtained copies of the newspapers from the 16 military installations through the publishers. Newspaper content was coded with a standardized coding manual (available upon request from the authors) developed through methods outlined by Menashe and Siegel.24 Tobacco articles were all those either directly or indirectly related to tobacco issues. Directly related tobacco issues included messages used by public health advocates (such as the benefits of quitting smoking) and by the tobacco industry. Indirectly related tobacco issues involved policy discussions; international tobacco issues (importing and exporting); fires caused by cigarettes; the Bureau of Alcohol, Tobacco, and Firearms; smokeless tobacco; and individual litigation against the tobacco industry.
Antitobacco articles were coded under one of the following "message frames": deceit/manipulation (the tobacco industry manipulates people through its advertising), non-smokers’ rights (nonsmokers need protection from secondhand smoke), children (the tobacco industry targets children as potential smokers), killer (smoking kills; therefore, tobacco should be regulated), outside intruder (the tobacco industry interferes with public health policy), drug delivery device (nicotine is addictive, and companies manipulate nicotine levels in their products; the US Food and Drug Administration should regulate cigarettes for consumer safety), corporate liability (manufacturers are liable for damage caused by their products), costs of smoking (smoking causes economic losses and decreases productivity), and David versus Goliath (antismoking advocates have little money or power in comparison with the vast resources of the tobacco industry).
To compare coverage of tobacco use with that of other health issues, we also examined articles that addressed one of the following issues: exercise/fitness, illegal drug use, seat belt use, and alcohol use. These health issues were selected because of their historic importance to the US military.
We gathered other specific information on all tobacco-related and other health-related articles and advertisements: location within the newspaper, size of the item (width and height rounded to the nearest quarter-inch), headline of article, and whether the article included a photograph. We also observed the frequency of advertisements promoting or discouraging the use of tobacco and alcohol. Advertisements included both paid ads (e.g., offering a discount on tobacco products) and announcements (e.g., smoking cessation class schedule). We selected alcohol-related advertisements for further comparison with tobacco-related ads, given the similarities in media presence and marketing on both the industry and the health advocacy sides. The other health topics we studied do not receive comparable media attention.
Reliability Analysis
Each newspaper was analyzed by 2 separate trained coders, whose results were then checked for consistency. The project coordinator (L.C.P.) routinely compared the independent newspaper coding results during the coding process to monitor interrater reliability. When coding differences were identified, items were reassessed until consensus was obtained. If consensus was not obtained, the project principal investigators were asked to make a judgment about the rating. However, given the objective nature of most items assessed, rater consistency was easily obtained. Detailed coding definitions and decision rules were included with the coding manual to assist with proper coding procedures and to minimize interrater differences.
Analysis Strategy
First, we examined the proportion of newspapers with articles on tobacco and other health topics by service. Differences in the rates were analyzed with z tests for proportions. Second, we explored differences in the physical characteristics (i.e., size of article, inclusion of a photo, whether the article was on the first page of the newspaper) of health articles. Third, using the message-frame categories developed by Menashe and Siegel,24 we calculated the proportion of articles within each category. Fourth, we determined the number of advertisements and the proportion of newspapers with tobacco and alcohol advertisements.
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RESULTS |
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Table 2
presents the number and percentage of installation newspaper issues that contained articles addressing tobacco and other health topics. Overall, only 6% of newspapers contained articles addressing tobacco. Among the service branches, tobacco use received the least coverage in Marine newspapers (2.9% of issues included some coverage) and the most coverage in Navy newspapers (10.4% of issues). Among health topics in all branches, tobacco use received the least coverage (5.9%); more than twice as many articles addressed exercise and fitness (12.3%; z = 4.4; P < .001).
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Table 3
presents the physical characteristics of health articles in military installation newspapers, stratified by service and topic. Overall, exercise and fitness articles received almost twice as much space (63.16 in2) as tobacco articles (37.02 in2). The largest article devoted to exercise (600.0 in2) was 4 times the size of the largest tobacco article (143.5 in2). Navy installation newspapers allotted the least amount of print space to tobacco articles (average area=29.54 in2); Army newspapers allotted the most (49.55 in2). After articles about seat belt use, articles about tobacco use were the least likely to include a photo. By contrast, articles on tobacco use were the second most likely (behind articles on drug use) to be on the front page of newspapers; however, the proportion of front-page tobacco articles among all tobacco articles was small (8.33%).
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Three message frames dominated anti-tobacco articles in installation newspapers: (1) smokers at risk (71.4%—the primary message of most tobacco articles in installation newspapers), (2) nonsmokers’ rights (20.4%), and (3) killer (6.1%). Aside from 1 article that focused on the costs of smoking, none of the other antitobacco message frames were used in installation newspaper tobacco articles.
Table 4 presents our findings on pro- and antitobacco and pro- and antialcohol advertisements in military installation newspapers. Overall, 3 times as many newspapers carried antialcohol ads as carried antitobacco ads (z = 13.07; P < .001). In terms of numbers of advertisements, we counted more than 7 times as many antialcohol ads as antitobacco ads. For all services except the Navy, we found significantly more antialcohol articles than antitobacco articles. For instance, 9 times as many Army newspapers featured antialcohol articles as featured antitobacco articles (z = 11.5; P < .001).
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A large number of both pro-tobacco and pro-alcohol ads were found in military newspapers. Overall, more newspapers contained pro-alcohol ads than contained pro-tobacco ads (17.0% vs 9.0%; z = 4.7; P < .0165). More newspapers contained pro-tobacco and pro-alcohol ads than contained articles discouraging their use or abuse. Navy newspapers contained the greatest proportion of newspapers with pro-tobacco ads (16.1%), and Army newspapers contained the greatest proportion of newspapers with pro-alcohol ads (28.2%). Only 2 pro-alcohol ads and no pro-tobacco ads were found in Air Force newspapers.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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In this study we examined tobacco messages in military installation newspapers from across the 4 armed services (Air Force, Army, Marines, Navy). In addition, we compared tobacco-related content in newspapers with content on 4 other important health issues in the military: fitness and exercise, illicit drug use, seat belt use, and alcohol use. Overall, tobacco received the fewest mentions and the least amount of print space in military installation newspapers of all the health topics examined. Tobacco use received particularly low coverage in Army (3.7% of newspapers) and Marine (2.9% of newspapers) installation newspapers. This low coverage is regrettable, because the Marine Corps has the highest rate of current smoking (i.e., having smoked 100 or more cigarettes in one’s lifetime and smoking 1 or more cigarettes in the past 30 days) and heavy smoking (i.e., smoking 1 or more packs of cigarettes per day in the past 30 days) among the military services, and the Army has the second highest heavy smoking rate and the third highest smoking rate.6
Given the impact of tobacco on the military and the increasing prevalence of smoking among military personnel, the low rate of coverage of tobacco use in installation newspapers is problematic, particularly in the context of higher rates of coverage of negative health behaviors of low prevalence. For instance, whereas more than one third of military personnel smoke cigarettes, less than 10% report failure to use seat belts, and only about 3% report having used any illicit drug (including marijuana) during the past month.6 However, those health topics received more coverage than tobacco in this important military information medium.
The primary message frame of antitobacco articles in military installation newspapers was that of smokers putting themselves at risk because of their tobacco use. A small number of antitobacco articles used the theme of nonsmokers’ rights; other message themes were rarely or never used. The message most consistently found in military installation newspapers—namely, that smoking has long-term negative health effects—is one that has not been found to have a strong impact on smokers, particularly young adults, in research done outside the military.25 By contrast, three message frames that have been found to have a powerful effect on young smokers in civilian populations are (1) nicotine is addictive and is used by the industry to hook smokers, (2) the tobacco industry is attempting to manipulate people and to encourage them to smoke, and (3) a smoker’s nicotine addiction can have harmful effects on others.26 Research has demonstrated that the tobacco industry has employed a central message frame—that Americans are free to pursue happiness and the American dream by making their own choices in an environment of economic prosperity—consistently and effectively over time.24 The antitobacco messages used by the military may also benefit from a consistent and powerful organizing theme or frame.
The military invests significant resources in combating tobacco use among its personnel.6 Despite this investment, some researchers have argued that military culture encourages personnel to smoke.5,7 One part of the military culture that may serve as an incentive for smoking is military installation newspapers. In this study, we found that nearly 10% of newspaper issues contained advertisements that encouraged tobacco consumption (ranging from no ads in Air Force newspapers to ads in nearly 17% of Navy newspapers). It is possible that military personnel who see tobacco products advertised in military newspapers assume that tobacco use is tacitly supported by the military. Furthermore, previous research has suggested that pro-tobacco advertising can counteract tobacco control messages.16 Thus, if a primary mission of military installation newspapers is to "make command members aware of the hazards of the abuse of drugs and other substances, and of the negative impact that substance abuse has on readiness,"22 allowing tobacco advertising may hinder a key purpose of this media outlet. Given that the Air Force has a ban on tobacco advertising in its newspapers13 and has the lowest rate of smoking among the military services, it is unclear why the other branches have not banned tobacco ads in their newspapers as well.
Our study had many strengths, including the analysis of military installation newspapers from all 4 service branches, a coding scheme developed from previous research, coding of health information by multiple independent raters to ensure reliability, and analysis of nearly 800 newspapers. However, our study has at least 2 limitations. First, military installation newspapers were chosen as volunteers for participation in a larger study of a community-wide smoking cessation intervention. Therefore, it is not clear whether the data from this study is generalizable to other installation newspapers. Second, only newspaper issues from a 1-year period were included in the study. It is possible that tobacco use may have received different coverage in previous publication years of the newspapers.
In conclusion, tobacco control messages appear to be underrepresented in military newspapers in comparison with messages about other health issues. More important, military newspapers from the Army, Marines, and Navy may inadvertently send mixed messages to personnel by providing advertisements for tobacco while also reporting that tobacco is harmful. Therefore, installation newspapers provide an opportunity for the military to more effectively address tobacco use among its personnel.
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Acknowledgments |
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This study was funded by the Health Research Group at the University of Missouri, Kansas City.
Note. The views expressed in this article are the authors’ and do not reflect the official position of US Air Force, the Department of Defense, or the US government.
Human Participant Protection
No human participants were involved in this study.
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Footnotes |
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Peer Reviewed
Contributors
C. K. Haddock supervised all aspects of the study and led the writing. L. C. Parker assisted with data collection, data analyses, and writing of the article. J. E. Taylor assisted with data collection and data analysis. All authors helped to conceptualize ideas, interpret findings, and review drafts of the article.
Accepted for publication October 1, 2004.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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