Expert Commentary

Vaping and tobacco in the news: How media coverage affects public perceptions

How has agenda-setting influenced public perceptions of tobacco control and, more recently, vaping?


Efforts to shape public perceptions of a given issue — also known as agenda-setting — are a mainstay of the tobacco industry, researchers show. Robert Proctor, a professor of the history of science at Stanford University, details the tactics industry executives deployed over more than a century to promote their products and cast doubt on the science documenting tobacco-related health risks in his 2011 book Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition.

“What kinds of strategies are used to manufacture doubt?” Proctor writes in the book. A few tactics used: “Hire journalists to write industry-sympathetic articles in the popular press and pressure media organs to ignore or suppress reports unfavorable to the industry. Threaten to withhold advertising from magazines that give too much attention to tobacco-disease links.” Other strategies: Divert. Distract. Deny.

“People tend to include or exclude from their cognitions what the media include or exclude from their content,” writes media scholar Donald L. Shaw in an influential 1979 paper on agenda-setting in mass communication. “People also tend to assign an importance to what they [the news media] include that closely resembles the emphasis given to events, issues and persons from the mass media.” Accordingly, the tobacco industry’s influence on the media in turn shapes public perceptions of the issues.

One example of agenda-setting that plays out through the media is found in its coverage of corporate social responsibility (CSR) initiatives. Tobacco industry CSR initiatives are projects — philanthropic or otherwise — undertaken “to shape public and policymaker understandings about tobacco control and the industry,” according to the authors of a 2018 study on the topic.

The study looks at 649 U.S. news reports about tobacco industry CSR initiatives published in newspapers, online and in television and radio broadcasts between 1998 and 2014. The news coverage was predominately positive, and rarely quoted tobacco control advocates, researchers found.

To what extent does news coverage still reflect tobacco industry efforts to agenda-set? How has the introduction of e-cigarettes complicated the issue? How has agenda-setting influenced public perceptions of tobacco control and, more recently, vaping?

This research roundup aims to answer those questions by examining studies published in the past five years on media coverage of tobacco and e-cigarettes. We hope to help journalists understand some of the forces that might shape their coverage as well as raise awareness about how the nature and tone of news stories have affected public perception and public policy.

Vaping in the news

Content Analysis of US News Stories About E-Cigarettes in 2015
Wackowski, Olivia A.; et al. Nicotine & Tobacco Research, August 2018.

This paper analyzes news coverage of e-cigarettes provided in 2015 by a variety of U.S. news organizations — four newswires, four online news outlets and the 30 newspapers with the largest circulations. In total, the researchers analyzed 295 articles. They found that 45.1% of stories focused on policy or regulatory issues around vaping. The next most common topics were health effects (appearing in 21.7% of studied articles) and e-cigarette prevalence (featured in 21% of articles). Articles frequently mentioned the following concerns: youth e-cigarette use (45.4%), e-cigarettes as a potential gateway to smoking (33.9%) and the appeal of flavors (22.9%). Articles that focused on Food and Drug Administration regulation of e-cigarettes more frequently mentioned youth prevalence of vaping (61%) than adult prevalence (13.5%).

“News articles more frequently discussed potential e-cigarette risks or concerns (80%) than benefits (45.4%), such as smoking harm-reduction,” the authors write. Similarly, when expert sources such as doctors, researchers and government officials were quoted, they were more likely to cite risks associated with e-cigarettes than benefits, such as avoiding the tar in traditional cigarettes. The researchers conclude, “While such coverage may inform the public about potential e-cigarette risks, they may also contribute to increasing perceptions that e-cigarettes are as harmful as tobacco cigarettes.” 

Youth and Young Adult Exposure to and Perceptions of News Media Coverage about E-Cigarettes in the United States, Canada and England
Wackowski, Olivia A.; Sontag, Jennah M.; Hammond, David. Preventive Medicine, April 2019.

This study analyzes what teens think about e-cigarettes. It looks at online survey data collected from 12,064 teenagers ages 16 to 19 in the U.S., Canada and England. The survey was conducted in July and August of 2017. It asked respondents about their exposure to news about e-cigarettes and their beliefs about the content of these stories. Respondents also answered questions about their perceptions of the harmfulness of e-cigarettes and their intention to use or stop using them. Nearly one-fifth, or 17.1% of respondents, reported encountering e-cigarette news at least “sometimes” over the past month. Most respondents thought the content was either mostly negative (35.7%) or mixed (34.8%). Only 19% viewed the coverage as mostly positive. White respondents were more likely to see negative e-cigarette news than their non-white peers.

“Participants exposed to mostly negative e-cigarette news were more likely to perceive that e-cigarettes cause at least some harm and, among past 30 day users, have intentions to quit e-cigarettes in the next month,” the authors write. Teens who reported seeing mostly positive news were more likely to report curiosity about trying e-cigarettes than peers who encountered mixed or mostly negative coverage. “E-cigarette news exposure may shape e-cigarette harm perceptions and use intentions, as well as reflect existing beliefs and product interest,” the authors conclude. 

To Vape or Not to Vape? Effects of Exposure to Conflicting News Headlines on Beliefs about Harms and Benefits of Electronic Cigarette Use: Results from a Randomized Controlled Experiment
Tan, Andy S. L.; et al. Preventive Medicine, December 2017.

This randomized, controlled experiment provides a complementary perspective to the more common observational research on the topic of news coverage of tobacco products. In this study, 2,056 U.S. adults between the ages of 18 and 85 responded to an online survey after viewing headlines about the safety of e-cigarettes. Each was assigned to one of four groups, reading headlines reflecting one of four of the following messages about the safety e-cigarettes: positive, negative, conflicting, or no message. Participants focused solely on the headlines and then answered questions about their beliefs about the harms and benefits of using e-cigarettes. The researchers found that participants who read negative headlines reported increased beliefs about harms and decreased beliefs of benefits, compared with participants who viewed positive headlines. These differences held when the researchers further analyzed the responses of only participants who had never used e-cigarettes. Adults who had never used e-cigarettes and read headlines with conflicting messages about e-cigarettes reported lower belief in the benefits of e-cigarettes than those who viewed positive headlines. The researchers suggest these findings demonstrate the link between the tone of news coverage of e-cigarettes and public beliefs about the product.

Tobacco control and industry in the news

A Multi-Year Study of Tobacco Control in Newspaper Editorials Using Community Characteristic Data and Content Analysis Findings
Stanfield, Kellie; Rodgers, Shelly. Health Communication, July 2018.

This study looks at the content of 1,473 editorials published in all Missouri newspapers between 2005 and 2011. Researchers chose Missouri because it has one of the lowest tobacco excise taxes in the country and does not have a statewide indoor smoking ban. At the community level, however, there have been successful initiatives to adopt smoke-free policies, the authors explain.

The researchers found that most editorials were about tobacco restrictions or ordinances, used neutral language and were factual in nature. However, they discovered that most of the editorials that took a position against tobacco control were published in cities with no clean air ordinances and the highest rates of smoking. On the other hand, cities that had low smoking rates and smoke-free policies had the highest percentage of editorials with a positive slant toward tobacco control. “The results show an agenda-setting function at the editorial level and a potential selection bias in selecting editorials according to topic, slant, and tone,” the authors conclude. “Not only were positive tones nearly non-existent in editorials, the majority of negatively slanted editorials were published in cities with the highest rates of smoking and no ordinance.”

Characteristics of Community Newspaper Coverage of Tobacco Control and Its Relationship to the Passage of Tobacco Ordinances
Eckler, Petya; Rodgers, Shelly; Everett, Kevin. Journal of Community Health, October 2016.

This study also looks at Missouri newspaper coverage of tobacco issues, but focuses on articles and editorials. The researchers looked at content published by all 381 Missouri newspapers between September 2006 and November 2011. In total, they analyzed 4,711 tobacco news stories. The researchers found that most were about tobacco control and were positively slanted toward it. “Stories with a positive tobacco control slant had information about enforcement, emphasized the lack of negative economic consequences or the health and economic benefits of policies or worker protection,” the authors write. However, editorials tended to be more negative in tone — in both the headline and text — than news stories.

Newspapers in towns that had smoke-free ordinances ran more stories about tobacco control than those located in towns without smoke-free ordinances. The authors write that this implies a connection between media coverage of tobacco control and the passage of tobacco control policies. Towns without smoke-free ordinances had more “non-tobacco control stories,” including news stories about youth smoking.

“We conclude that the tobacco industry may have had success in impacting news stories in no-ordinance cities by diverting attention from tobacco control to secondary topics, such as youth smoking, which meant stories had fewer public health facts and fewer positive health benefits in towns that may have needed these details most,” the authors write.

Setting the Agenda for a Healthy Retail Environment: Content Analysis of US Newspaper Coverage of Tobacco Control Policies Affecting the Point of Sale, 2007–2014
Myers, Allison E.; et al. Tobacco Control, July 2017.

This study looks at media coverage of point-of-sale tobacco control policies — interventions targeted at the place where people purchase tobacco products. Some examples are requirements for tobacco retailers to acquire licenses, prohibitions on the redemption of coupons for tobacco purchases and restrictions on the sale of tobacco in pharmacies.

This study looked at 917 news articles on point-of-sale tobacco control policies published in 268 regional newspapers and five national newspapers between 2007 and 2014. Nearly half of these articles focused on tobacco retailer licensing. Just over half had a mixed, neutral or anti-tobacco control slant. Articles that were framed in terms of politics, rights, or regulation, or that quoted anti-tobacco control sources (e.g., tobacco industry sources, tobacco retailers or tobacco users) were much less likely to have a pro-tobacco-control slant.

Tobacco retailers were cited in 39.6% of the stories studied, second only to government sources (52.3%) and followed by tobacco industry sources (22.0%). On the other hand, stories that focused on health issues and featured research and sources in favor of tobacco control tended to support tobacco control.

Trends in US Newspaper and Television Coverage of Tobacco
Nelson, David E.; et al. Tobacco Control, January 2015.

This study looks at newspaper, newswire and television coverage of tobacco issues in the U.S. between 2004 and 2010. The researchers looked at data from the U.S. Centers for Disease Control and Prevention’s Office on Smoking and Health’s news media surveillance system. The CDC created this system in 2004 to track tobacco stories in the news. The system identifies tobacco news stories in 10 major newspapers, two major newswires and six national television networks. They found that, on average, there were three newspaper stories, four newswire stories and one television story on tobacco each day. Television stories tended to focus on addiction or health effects and were less likely to focus on secondhand smoke or tobacco regulation than newspaper and newswire stories. Newspaper and newswire coverage of tobacco issues varied more than television coverage. “Newspaper editors and television producers have an important agenda-setting role, serving as gatekeepers who make decisions about whether a topic or event is ‘newsworthy,’ and thus, reported at all,” the authors write. “Differences in tobacco themes among individual newspapers and newswire services also strongly suggest that news editors differ in whether and how they choose to report tobacco stories.”

US Media Coverage of Tobacco Industry Corporate Social Responsibility Initiatives
McDaniel, Patricia A.; Lown, E. Anne; Malone, Ruth E. Journal of Community Health, February 2018.

The tobacco industry’s corporate social responsibility (CSR) initiatives are projects meant “to shape public and policymaker understandings about tobacco control and the industry.” They include food aid, arts funding, youth smoking prevention programs, disaster relief, employee volunteer programs and research efforts.

This study looks at 649 U.S. news reports about tobacco industry CSR initiatives — including newspaper articles, online news stories and transcripts of television broadcasts and NPR broadcasts — available through online media databases. Publication dates ranged from 1998 through 2014. Tobacco industry CSR coverage was predominately positive, and rarely quoted tobacco control advocates. Local newspapers provided most of the coverage of tobacco industry CSR.

The most common initiatives featured were unrelated to tobacco and aided “non-controversial” beneficiaries such as students, the elderly and arts organizations. Positive coverage was more common in the South — where many tobacco companies are headquartered — than in the West. When tobacco control advocates were quoted, news coverage was less likely to have a positive slant.

“The absence of tobacco control advocates from media coverage represents a missed opportunity to influence opinion regarding the negative public health implications of tobacco industry CSR,” the authors conclude. “Countering the media narrative of virtuous companies doing good deeds could be particularly beneficial in the South, where the burdens of tobacco-caused disease are greatest, and coverage of tobacco companies more positive.”

Read more: Teen vaping: Is it really a gateway to cigarette smoking?; ‘Causes’ vs. ‘contributes to’: Strong causal language on product warning labels more effective; E-cigarettes aren’t better at helping smokers quit than other strategies

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