Coverage of Jade Goody's cervical cancer in UK newspapers: a missed opportunity for health promotion?

A simple dose of antibiotics: qualitative analysis of sepsis reporting in UK newspapers

Background

A recent drive to improve sepsis awareness has been accompanied by prolific media reporting about its management in children. Media reporting is known to influence public understanding of health issues and subsequent health-seeking behaviour.

Aim

To examine UK newspaper representations of sepsis in children to better understand how the messages they convey may impact on parents' consulting behaviour and expectations about antimicrobial prescribing.

Design & setting

Qualitative analysis of articles published in 12 UK newspapers from January 1988 to June 2018.

Method

Thematic analysis of 140 articles about sepsis in children identified through a search on the Nexis database.

Results

Reporting about sepsis in UK newspapers was characterised by emotive personal narratives about affected children who have suffered death or disability. These events were frequently presented as resulting from failings within the healthcare system that could have been avoided by early treatment. Health professionals were portrayed as inadequately prepared to recognise and manage sepsis, and as reluctant to prescribe antibiotics, even when necessary. Parents were positioned as advocates for their children, and as being ultimately responsible for ensuring that they receive appropriate treatment.

Conclusion

This research identified messages about sepsis in the UK news media that could influence public attitudes about antibiotic prescribing in acute childhood illness. Public health communications about sepsis awareness must acknowledge the wider implications of unnecessary antibiotic use as a driver of antimicrobial resistance to reduce the risk of damaging efforts to promote rational prescribing.

From sweeteners to cell phones-Cancer myths and beliefs among journalism undergraduates

OBJECTIVE

The media are an important source of health information that can help people make their own medical decisions. However, medical news can also transmit biases produced by different factors, such as the previously held beliefs of journalists. This study identifies which cancer myths are more popular among future journalists and whether their beliefs are related to their chosen source of health information.

METHODS

A survey was conducted among journalism undergraduates (N = 249) to determine which cancer myths existed and how widespread they were. The survey included a list with different sources of health information and eight questions regarding cancer-related myths.

RESULTS

The most extensive myths among the undergraduate respondents were that sweeteners (40.2%) and cell phones (48.2%) produce cancer and that a patient's good or bad attitude can determine the outcome of such an illness (52.2%). Respondents who relied on their family and friends as a source of health information were more prone to believe in cancer myths.

CONCLUSION

This research focuses on future journalists as a group of special interest for improving knowledge about cancer. Future campaigns to debunk cancer misconceptions should pay attention to the role played by family and friends as agents of health information transmittance.

Celebrity Cancer on Twitter: Mapping a Novel Opportunity for Cancer Prevention

Social media platforms have the potential to facilitate the dissemination of cancer prevention and control messages following celebrity cancer diagnoses. However, cancer communicators have yet to systematically leverage these naturally occurring interventions on social media as these events are difficult to identify as they are unfolding and little research has analyzed their effect on social media conversations. In this study, we add to the research by analyzing how a celebrity cancer announcement influenced Twitter conversations in terms of the volume of social media messages and the type of content. Over a 9-day period, during which actor Ben Stiller announced that he had been treated for prostate cancer, we collected 1.2 million Twitter messages about cancer. We conducted automated content analyses to identify how often common cancer sites (prostate, breast, colon, or lung) were discussed. Then, we used manual content analysis on a sample of messages to identify cancer continuum content (awareness, prevention, early detection, diagnosis, treatment, survivorship, and end of life). Chi-square analyses were implemented to evaluate changes in cancer site and cancer continuum content before and after the announcement. We found that messages related to prostate cancer increased significantly more than expected for 2 days following Stiller’s announcement. However, the number of cancer messages that described other cancer locations either did not increase or did not increase by the same magnitude. In terms of message content, results showed larger than expected increases in diagnosis messages. These results suggest opportunities to shape social media conversations following celebrity cancer announcements and increase prevention and early detection messages.

The Disclosure of Celebrity Major Depressive Disorder Diagnoses in Hong Kong: Its Effects on Public Awareness and Understanding Toward the Illness

This paper aims to examine consumer perception toward celebrity diagnoses of major depressive disorder (MDD) in Hong Kong and to provide insights into the effect of various factors on the persuasive effectiveness of MDD communication. A total of thirty-five interviews were conducted in April 2015. Interviewees in general are aware of celebrity MDD diagnoses, but they do not deem MDD as a threat to themselves. Hence, they are not motivated to learn more about the symptoms. Responses to celebrity MDD diagnoses are mixed. Many interviewees are sympathetic toward ill celebrities diagnosed with MDD, but some of the interviewees are dubious about the true intention behind disclosing their diagnoses to the public. Compared to non-fans, fans reported a greater increase in the level of knowledge of MDD after reading related media stories about celebrity MDD diagnoses. Source credibility is perceived as an important factor in MDD communication. This research suggests that the government or NGOs may use credible celebrities whose image can be associated with MDD and cooperate with fan clubs to spread health-related information. The paper represents the first attempt to investigate the effects of celebrity disclosure of MDD diagnoses on the mental disorder-related perceptions of the general public in Hong Kong.

A Cross-Sectional Review of Cervical Cancer Messages on Twitter During Cervical Cancer Awareness Month

OBJECTIVES

The objectives of this study were to quantify personal stories about cervical cancer and to determine the proportion and sentiment (positive vs negative) of messages ("tweets") that discussed cervical cancer prevention strategies on Twitter.

METHODS

This study was a cross-sectional Twitter review of English-language top tweets about cervical cancer during the Cervical Cancer Awareness month, January 2016. Theme categories were identified, and tweets were independently coded by 2 reviewers; discrepancies in coding were resolved by a third reviewer. Descriptive statistical analyses were performed.

RESULTS

During January 2016, approximately 348 top tweets about cervical cancer were identified. Professional health organizations produced 20.7% of tweets, and individuals identifying themselves as health-care professionals contributed an additional 4%. In addition to the tweet, 45.1% attached a photo or video; 54.6% included links to a larger article. Only 11.2% of tweets included personal stories from cervical cancer patients. Among the top tweets, 70.3% were focused on prevention through screening and/or HPV vaccination, with 97.4% recommending such practices. A substantial proportion of the Twitter traffic (24.7%) referenced the #SmearForSmear campaign by the patient-advocate organization Jo's Cervical Cancer Trust, based in the United Kingdom.

CONCLUSIONS

Analysis of top tweets during the cervical cancer awareness month showed that, although personal stories about cervical cancer were rare, cervical cancer prevention was a popular topic during the cervical cancer awareness month. This was largely driven by a picture-based twitter campaign from a single advocacy organization.

Mass media and risk factors for cancer: the under-representation of age

BACKGROUND

Increasing age is a risk factor for developing cancer. Yet, older people commonly underestimate this risk, are less likely to be aware of the early symptoms, and are more likely to be diagnosed with advanced stage cancer. Mass media are a key influence on the public's understanding health issues, including cancer risk. This study investigates how news media have represented age and other risk factors in the most common cancers over time.

METHODS

Eight hundred articles about the four most common cancers (breast, prostate, lung and colorectal) published within eight UK national newspapers in 2003, 2004, 2013 and 2014 were identified using the Nexis database. Relevant manifest content of articles was coded quantitatively and subjected to descriptive statistical analysis in SPSS to identify patterns across the data.

RESULTS

Risk was presented in half of the articles but this was rarely discussed in any depth and around a quarter of all articles introduced more than one risk factor, irrespective of cancer site. Age was mentioned as a risk factor in approximately 12% of all articles and this varied by cancer site. Age was most frequently reported in relation to prostate cancer and least often in articles about lung cancer. Articles featuring personal narratives more frequently focused on younger people and this was more pronounced in non-celebrity stories; only 15% of non-celebrity narratives were about people over 60. Other common risks discussed were family history and genetics, smoking, diet, alcohol, and environmental factors. Family history and genetics together featured as the most common risk factors. Risk factor reporting varied by site and family history was most commonly associated with breast cancer, diet with bowel cancer and smoking with lung cancer.

CONCLUSION

Age and older adults were largely obscured in media representation of cancer and cancer experience. Indeed common risk factors in general were rarely discussed in any depth. Our findings will usefully inform the development of future cancer awareness campaigns and media guidelines. It is important that older adults appreciate their heightened risk, particularly in the context of help-seeking decisions.

Oral cancer: exploring the stories in United Kingdom newspaper articles

Objective Reports suggest that patients with oral cancer delay seeking help because they are unaware of the symptoms. The majority of adults (95%) engage with news reports and 40% read newspapers. Newspaper oral cancer stories may influence awareness and health-seeking behaviour. The aim of this study was to explore how oral cancer is portrayed in UK newspaper print media.Design Qualitative content analysis of articles from ten newspapers with the widest UK print circulation. All articles using the terms 'mouth cancer' and 'oral cancer' over a three year period were retrieved. Duplicates, non-cancer and non-human articles were excluded.Results 239 articles were analysed. Common topics included 'recent research', 'survivor stories', 'health information' and 'celebrity linkage'. Articles were often emotive, featuring smoking, alcohol, sex and celebrity. Articles lacked a proper evidence base and often failed to provide accurate information about signs and symptoms, information about prevention and signposting to treatment.Conclusions Opportunities to save lives are being missed. Further work to improve social responsibility in the media and develop guidance to enhance the quality of information, health reporting and signposting to help are indicated.

Informing or Exploiting? Public Reponses to Giuliana Rancic's Health Narrative

Popular entertainment journalist Giuliana Rancic has shared her struggles with pregnancy loss, infertility, and breast cancer in an array of public forums. In this study, we analyzed online comments responding to public discourses surrounding Rancic's revelations, including her miscarriage and fertility treatments, her breast cancer diagnosis, and her decision to undergo a double mastectomy. Our goal was to explore how the public framed Rancic's health challenges. Using a narrative lens, we argue that online comments reveal the tensions that celebrities like Rancic must manage as they contend with public scrutiny of their stories. Online commenters in this study framed Rancic's narrative as a privileged vantage point in which she exploited her health struggles for personal and financial gain. Our analysis of these comments also demonstrates how Rancic's narrative exists in concert with other discourses that challenge and disrupt her own account of events. The examination of these mediated discourses has implications for understanding the role of celebrity experiences in personal and public conversations about health.

'The secret shame': a content analysis of online news reporting of a celebrity admitting smoking while pregnant

ISSUE ADDRESSED

Around one in 10 Australian women report that they smoke while pregnant, and this may be a significant underestimation. In 2013, Australian celebrity Chrissie Swan announced publicly that she had been smoking during her pregnancy, generating substantial media coverage. This study sought to identify the main themes in the reporting of the 'Swan pregnant and admitting smoking' story by online news media.

METHODS

Between 6 February 2013 and 18 February 2013 inclusively, a content analysis was conducted of Australian online news items using the keywords: 'Chrissie Swan smoking', and 'Chrissie Swan pregnant and smoking'. News items were coded for nine themes.

RESULTS

A total of 124 items were identified. The most frequent themes were: 'celebrity story' (90.32%) and 'societal judgement of pregnant smokers' (69.35%). Less than one-half (45.97%) of the news items included 'quitting is hard' content and only 29.03% of the news items included 'smoking and health' content. Specific quit-referral content was found in only 13.71% of the news items.

CONCLUSIONS

There was a missed opportunity to promote positive, non-judgemental smoking and pregnancy messages and health information that support pregnant women to quit smoking. SO WHAT?: Health promotion strategies are needed to build capacity in advocacy to promote positive health messages and counter societal judgement of pregnant smokers. Formative research into the use of celebrities and other influential women to promote positive empowering messages should be carried out and incorporated in future health promotion campaigns to improve pregnant women's ability to quit smoking.

Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors

This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries.

Representations of minimum unit pricing for alcohol in UK newspapers: a case study of a public health policy debate

BACKGROUND

Mass media influence public acceptability, and hence feasibility, of public health interventions. This study investigates newsprint constructions of the alcohol problem and minimum unit pricing (MUP).

METHODS

Quantitative content analysis of 901 articles about MUP published in 10 UK and Scottish newspapers between 2005 and 2012.

RESULTS

MUP was a high-profile issue, particularly in Scottish publications. Reporting increased steadily between 2008 and 2012, matching the growing status of the debate. The alcohol problem was widely acknowledged, often associated with youths, and portrayed as driven by cheap alcohol, supermarkets and drinking culture. Over-consumption was presented as a threat to health and social order. Appraisals of MUP were neutral, with supportiveness increasing slightly over time. Arguments focused on health impacts more frequently than more emotive perspectives or business interests. Health charities and the NHS were cited slightly more frequently than alcohol industry representatives.

CONCLUSION

Emphases on efficacy, evidence and experts are positive signs for evidence-based policymaking. The high profile of MUP, along with growing support within articles, could reflect growing appetite for action on the alcohol problem. Representations of the problem as structurally driven might engender support for legislative solutions, although cultural explanations remain common.

Factors that influence intent to adopt a hearing aid among older people in Italy

Hearing loss is one of the most prevalent health impairments associated with ageing in developed countries, and it can result in social, emotional and communication dysfunction. Hearing loss in Italy is increasing, yet, despite the availability of free hearing aids and access to qualified community-based health professionals specialising in audiology services, their uptake remains low (about 15%-20%). This paper presents an investigation of the possible reasons why older people in Italy resist adopting a hearing aid. We used the literature to identify factors influencing people with hearing loss's decision-making, and drew on the theory of reasoned action to create an explanatory model. To test our hypotheses, we applied a cross-sectional design. We developed a questionnaire including 13 items related to adopting a hearing aid. Health professionals identified 400 persons aged 60-90 who were candidates for a free hearing aid. Those willing to participate were sent a copy of the questionnaire and telephoned between August and September 2009; a total of 243 responded (response rate of 60.8%). Linear regression analysis highlighted that a person's intention to adopt a hearing aid was positively related to their attitude towards its adoption, but negatively linked to their perceived subjective norms. It was found that trust in the health professional does not moderate the relationship between a person's attitude and their intention to adopt a hearing aid, but trust mitigates the relationship between a person's perceived subjective norms and their intentions. These findings underline the importance of the potential role that the healthcare professional could play in reducing the uncertainty created by external social pressures. For this purpose, stronger collaboration between the various health professionals involved in hearing aid provision, from diagnosis to fitting, is recommended.

'Just that little bit of doubt': Scottish parents', teenage girls' and health professionals' views of the MMR, H1N1 and HPV vaccines

BACKGROUND

Parental decision making about childhood vaccinations is complex and the vaccination schedule ever-changing. Vaccination may be controversial even in countries with historically high vaccination rates such as Scotland. Health behaviour models have aided understanding of individual vaccine intentions for specific vaccines. These are limited in explaining actual behaviours and are divorced from the impact of socio-cultural contexts on vaccination decision making.

PURPOSE

To explore vaccination views in Scotland amongst parents, teenage girls and health professionals across three controversial vaccines: the Measles, Mumps, Rubella (MMR), the Human Papilloma virus (HPV) and the Influenza A (H1N1) vaccine.

METHOD

We used qualitative interviews and focus group discussions in a purposive sample of health professionals (n = 51), parents (n = 15) and teenage girls aged 12-15 years (n = 8) about their views of these vaccines. Discussions were analysed using thematic analysis.

RESULTS

Two main themes are highlighted: 'vaccine risks revisited' in which we explored how the MMR legacy resurfaced and how worries about vaccine safety permeated the data. 'Vaccine responsibilities' indicated tensions regarding roles and responsibilities for vaccines. An overarching notion of 'just that little bit of doubt' referred to lingering doubts and uncertainties interwoven across the vaccines.

CONCLUSIONS

Public health authorities should remain alert towards pervasive vaccine concerns. It is important for authorities to clarify vaccine roles and responsibilities in the face of new and existing vaccines and to acknowledge public concerns regarding vaccine safety.

Public reaction to the death of Steve Jobs: implications for cancer communication

The present study aimed to examine the public reaction to the death of Steve Jobs, focusing on general and cancer-specific information seeking and interpersonal communication. Shortly after Jobs's death, employees from a large university in the Southeastern United States (N = 1,398) completed a web-based survey. Every employee had heard about Steve Jobs's death, and 97% correctly identified pancreatic cancer as the cause of his death. General (50%) and pancreatic cancer-specific (7%) information seeking, as well as general (74%) and pancreatic cancer-specific (17%) interpersonal communication, took place in response to Steve Jobs's death. In multivariate logistic regression analyses controlling for demographics and several cancer-oriented variables, both identification with Steve Jobs and cancer worry in response to Steve Jobs's death significantly (p < .05) predicted pancreatic cancer information seeking as well as interpersonal communication about pancreatic cancer. Additional analyses revealed that cancer worry partially mediated the effects of identification on these outcome variables. Implications of these results for future research as well as cancer prevention and communication efforts are discussed.

Celebrities and screening: a measurable impact on high-grade cervical neoplasia diagnosis from the 'Jade Goody effect' in the UK

BACKGROUND

The celebrity Jade Goody's cervical cancer diagnosis was associated with increased UK cervical screening attendance. We wanted to establish if there was an increase in high-grade (HG) cervical neoplasia diagnoses, and if so, what the characteristics of the women with HG disease were.

METHODS

We analysed prospective data on 3233 consecutive colposcopy referrals in North East London, UK, from 01 April 2005 to 30 June 2010. Characteristics and outcomes of pre- and post-Goody cohorts were compared.

RESULTS

Goody's diagnosis was associated with an increased incidence of colposcopy referrals in all subsequent annual quarters (incidence rate ratio (IRR) 1.3-1.9, P<0.002-P<0.0005) and increased HG disease diagnoses in the fourth quarter 2008/2009 (IRR 1.3, P=0.05) and first quarter 2009/2010 (IRR 1.3, P=0.07). We observed 1.90-fold (CI: 1.06-3.39), 2.06 (CI: 1.13-3.76) and 2.13-fold (CI: 1.07-4.25) respective increases in the odds of HG disease women being screening-naive in the first and second quarter 2009/2010, and the first quarter 2010/2011 (P<0.04, P<0.02 and P<0.04, respectively). There was a 2.23-fold increase in the odds of screening-naive HG disease women being symptomatic post-Goody's diagnosis (P=0.023). The age distributions of the pre- and post-Goody cohorts did not differ in any study group.

CONCLUSION

Continued publicity about celebrities' diagnoses might encourage screening in at-risk populations.

Public figure announcements about cancer and opportunities for cancer communication: a review and research agenda

Announcements by public figures and celebrities about cancer diagnosis or death represent significant events in public life. But what are the substantive effects of such events, if any? The purpose of this article is to systematically review studies that examined the impact of public figure cancer announcements on cancer-oriented outcomes. Using comprehensive search procedures, we identified k = 19 studies that examined 11 distinct public figures. The most commonly studied public figures were Jade Goody, Kylie Minogue, Nancy Reagan, and Steve Jobs, with the most common cancers studied being breast (53%), cervical (21%), and pancreatic (21%) cancer. Most studies assessed multiple outcome variables, including behavioral outcomes (k = 15), media coverage (k = 10), information seeking (k = 8), cancer incidence (k = 3), and interpersonal communication (k = 2). Results fairly consistently indicated that cancer announcements from public figures had meaningful effects on many, if not most, of these outcome variables. While such events essentially act as naturally occurring interventions, the effects tend to be relatively short term. Gaps in this literature include few contemporary studies of high-profile public figures in the United States and a general lack of theory-based research. Directions for future research as well as implications for cancer communication and prevention are discussed.

Blurring personal health and public priorities: an analysis of celebrity health narratives in the public sphere

This article explores the functions of personal celebrity health narratives in the public sphere. This study examines data about 157 celebrities, including athletes, actors, musicians, and politicians, who have shared private information regarding a personal health situation (or that of a loved one) with others in the public domain. Part of a larger project on celebrity health narratives, this article highlights three key functions that celebrity health narratives perform--education, inspiration, and activism--and discusses the implications for celebrities and for public conversations about health-related issues.

The Jade Goody Effect: whose cervical screening decisions were influenced by her story?

OBJECTIVES

In 2009 more women attended cervical screening in England and Wales than in the previous year. Described as the 'Jade Goody Effect' this was attributed to the death from cervical cancer of a UK celebrity. The present study aimed to establish which sociodemographic characteristics were associated with being influenced by Jade Goody's story.

METHODS

Data were collected as part of a Taylor Nelson Sofres (TNS) omnibus survey using random location sampling. Women in England aged 26-64 years were asked to report whether they felt Jade Goody's story had influenced their decisions about cervical screening over the 18 months between her death and the time of the survey.

RESULTS

Data from 890 participants was included in analysis. Over a third of women felt Goody's story had influenced their decisions about cervical screening (40%). Younger women (aged 26-35 years) were more likely to have been influenced by Goody's story than older women (56-64 year olds). There was also evidence of socioeconomic variation with women from lower socioeconomic class groups and those with fewer educational qualifications more likely to say they had been influenced by Goody's story.

CONCLUSIONS

The 'Jade Goody Effect', as acknowledged by women themselves, was more pronounced among young women and influenced screening decisions more markedly among those from lower socioeconomic backgrounds. Narrative communication may be an effective way to encourage attendance at cervical cancer screening and reach groups of the population that are difficult to reach using traditional intervention methods.

Regulation of antibiotic sales in Mexico: an analysis of printed media coverage and stakeholder participation

BACKGROUND

Restricting antibiotics sales to those with medical prescriptions only is a central strategy for promoting appropriate use and containing antibiotic resistance; however, many low and middle income countries have not enforced policies that prevent widespread self-medication with antibiotics. In 2010, the Mexican government announced the enforcement of antibiotic sales regulations, a policy that gained media prominence. This study analyzes media coverage of issues, stakeholder representation, and positions taken during policy agenda setting, drafting, and implementation to shed light on policy making to promote appropriate antibiotic utilization.

METHODS

We carried out a quantitative content analysis of 322 newspaper articles published between January 2009 and December 2010 in 18 national and regional newspapers. Additionally, we conducted a qualitative content analysis to understand the positions adopted and strategies developed by nine key stakeholders. Framing theory guided the analysis.

RESULTS

The Ministry of Health dominated media coverage, justifying the enforcement policy by focusing on risks of self-medication, and to a lesser degree dangers of increasing antibiotic resistance. Pharmacy associations appeared to be the leading opponents, arguing that the policy created logistical difficulties and corruption, and had negative economic impact for pharmacies and their clients. The associations developed strategies against the regulation such as attempting to delay implementation and installing physicians' consultation offices within pharmacies. While medical associations and academic institutions called for a comprehensive strategy to combat antibiotic resistance, improve prescription quality, and create public awareness, these issues had little impact on media coverage. Consumer groups and legislators received very little media coverage.

CONCLUSIONS

The narrowly-focused and polarized media coverage ─centred on problems of self- medication and economic impact ─ was a missed opportunity to publicly discuss and to develop a comprehensive national strategy on antibiotic use in Mexico. It highlights the need for discussing and developing interventions within the framework of a pharmaceutical policy.

Public health benefits and risks of fish consumption: current scientific evidence v. media coverage

OBJECTIVE

To evaluate if and how the current degree of scientific uncertainty about the safety of fish consumption is incorporated at the media level.

DESIGN

We used a dedicated software (TalTac®) to investigate the content of 169 news articles related to ‘mercury and fish consumption’ that appeared from 1990 to 2010 in the two Italian broadsheets with the highest circulation figures, in order to identify journalistic frames used in the coverage of benefits v. risks associated with fish consumption. Hypotheses were made on how the public might change fish consumption patterns as a result of media coverage.

SETTING

Italy.

RESULTS

The two newspapers have different agendas in covering the issue. La Repubblica appears to support the view that, besides health benefits, there may be risks associated with fish consumption, while Corriere della Sera emphasizes health benefits more than possible risks. Depending on the preferred information source, the public could: (i) reduce its fish intake; (ii) increase its fish intake; or (iii) become confused about the problem and sceptical towards the media, as a result of conflicting journalistic frames.

CONCLUSIONS

The Italian media, in cooperation with scientists, public health nutritionists and dietitians, should place more emphasis on the existence of a few fish species with high to very high Hg levels and relatively low contents of beneficial n-3 fatty acids (e.g. swordfish and shark). This would enable consumers to make more educated purchasing decisions to maximize the benefits of n-3 intake while reducing possible risks from consuming Hg-contaminated fish.

Impact of media reporting of cervical cancer in a UK celebrity on a population-based cervical screening programme

Objectives

To determine the impact of media reporting of cervical cancer in a UK celebrity on cervical screening uptake, response time and colposcopy referral and attendance.

Setting

Population-based national cervical screening programme for women in Wales, UK.

Methods

A time series regression analysis of the Welsh national cervical screening and colposcopy databases was used to examine the number of smear tests carried out between 2000 and 2010, stratified by age group and deprivation indicators. Logistic regression was used to analyse colposcopy attendance.

Results

Over 33,000 more cervical screening tests than expected were carried out in the year of media reporting (2008/9), 11,539 (35%) of which were in the month of Jade Goody's death. The largest increase was evident in women aged 35–39 years (475 additional tests per month, 95% CI 331–619). Impacts were similar across deprivation quintiles. Colposcopy referrals increased by 18% during the year of media reporting. Increases were observed for all smear test results in 2008/9, particularly among younger women, and further rises were evident in 2009/10 for smear tests showing borderline changes and mild dyskaryosis. The proportion of women attending colposcopy appointments rose in the year of media reporting (χ 2 = 45.8, P < 0.001).

Conclusions

Mass media reporting of cervical cancer in a UK celebrity was associated with a significant, but transient, increase in screening uptake and colposcopy referral and attendance. Mass media reporting can play a role in enhanced detection of abnormalities, but public health messages must be communicated effectively to minimize anxiety whilst maximizing case-finding and uptake among non-responders.

School nurses' experiences of delivering the UK HPV vaccination programme in its first year

BACKGROUND

In the United Kingdom (UK) in September 2008, school nurses began delivering the HPV immunisation programme for girls aged 12 and 13 years old. This study offers insights from school nurses' perspectives and experiences of delivering this new vaccination programme.

METHODS

Thirty in-depth telephone interviews were conducted with school nurses working across the UK between September 2008 and May 2009. This time period covers the first year of the HPV vaccination programme in schools. School nurses were recruited via GP practices, the internet and posters targeted at school nurse practitioners.

RESULTS

All the school nurses spoke of readying themselves for a deluge of phone calls from concerned parents, but found that in fact few parents telephoned to ask for more information or express their concerns about the HPV vaccine. Several school nurses mentioned a lack of planning by policy makers and stated that at its introduction they felt ill prepared. The impact on school nurses' workload was spoken about at length by all the school nurses. They believed that the programme had vastly increased their workload leading them to cut back on their core activities and the time they could dedicate to offering support to vulnerable pupils.

CONCLUSION

Overall the first year of the implementation of the HPV vaccination programme in the UK has exceeded school nurses' expectations and some of its success may be attributed to the school nurses' commitment to the programme. It is also the case that other factors, including positive newsprint media reporting that accompanied the introduction of the HPV vaccination programme may have played a role. Nevertheless, school nurses also believed that the programme had vastly increased their workload leading them to cut back on their core activities and as such they could no longer dedicate time to offer support to vulnerable pupils. This unintentional aspect of the programme may be worthy of further exploration.

"I thought cancer was one of those random things. I didn't know cancer could be caught...": adolescent girls' understandings and experiences of the HPV programme in the UK

BACKGROUND

The UK human papillomavirus (HPV) vaccination programme aims to provide girls aged 12-13 with protection against two of the most carcinogenic strains (types 16 and 18) of this sexually transmitted virus which together account for 70% of cases of cervical cancer. Despite evidence suggesting a general lack of knowledge about HPV and its link with cervical cancer, vaccine uptake rates were generally high in the UK for the first year of the HPV vaccination programme. In countries that implemented the HPV programme ahead of the UK, studies have found that girls' and parents' levels of awareness about HPV have increased since implementation of the programme but that knowledge continues to be limited. This study offers some of the first insights from the UK into adolescent girls' understandings of HPV, its link with cervical cancer, and experiences of vaccination, since the programme was introduced in September 2008.

METHOD

Eighteen focus groups were conducted between December 2009 and May 2010 with schoolgirls aged between 12 and 18 living in various parts of the UK.

RESULTS

Eighty seven girls participated in these discussions. Typically, girls knew very little about HPV or how they could best protect themselves from HPV infection. Although many of the girls linked HPV to cancer, only half specifically associated it with cervical cancer. Most girls had no idea how long the vaccine would offer them protection. They assumed that HPV vaccination must be important for their health because it was recommended by people they trusted, namely parents and immunisation experts. Just over half of the girls were aware that in the future they would need to attend for cervical screening. Key concerns which girls expressed about HPV vaccination reflected their anxieties about needles, anticipated pain on injection, privacy during vaccination and fears about needle cleanliness.

CONCLUSION

Our data point to a need to continue to address gaps in knowledge about HPV and to provide information to address girls' concerns about vaccination. This could be achieved through targeted campaign materials and by ensuring those involved in delivering the programme are aware of girls' anxieties to prevent limited knowledge and fears about vaccination becoming barriers either to HPV vaccination.

The school nurse, the school and HPV vaccination: a qualitative study of factors affecting HPV vaccine uptake

School nurses in the United Kingdom are largely responsible for delivering the human papillomavirus (HPV) vaccine to 12-13 year old girls. In order to assess the impact of HPV vaccination on school nurses' roles, we gave a questionnaire to all 33 school nurses who offered Cervarix ™ in two Primary Care Trusts one year ahead of the national vaccine programme. Key organisational issues raised by the school nurses were the size of the team and its skill mix. A few found their schools uncooperative and were dissatisfied with mechanisms for problem resolution. On average, nurses spent an additional 69 h (0.80 h per child) on vaccine-related activities. In semi-qualitative interviews (n=17), school nurses complained of work overload and described the difficulties of establishing good relationships with some of their schools. Nurses expected schools to take some responsibility for ensuring good uptake and were frustrated when help was not forthcoming. We conclude that variation in uptake between schools in part reflects a difficult relationship with the school nurse which may be attributed to characteristics of the school, schools' attitudes towards health interventions, organisational problems, multiple school nurse roles and/or personal ability. Some of these issues will need to be addressed to ensure continued high vaccine coverage as HPV vaccination becomes a less prioritised, routine activity.