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Media Messages and Perception of Risk for Ebola Virus Infection, United States

Media Messages and Perception of Risk for Ebola Virus Infection, United States DISPATCHES Media Messages and Perception of Risk for Ebola Virus Infection, United States of risk and 5 risk-minimizing messages with characteris- Tara Kirk Sell, Crystal Boddie, Emma E. McGinty, tics that could decrease perception of risk (online Tech- Keshia Pollack, Katherine Clegg Smith, nical Appendix Tables 2–4), developed according to the Thomas A. Burke, Lainie Rutkow risk perception framework of Slovic (7). To assess inter- News media have been blamed for sensationalizing Ebola rater reliability, we coded a random sample of 15% of in the United States, causing unnecessary alarm. To investi- news stories. Most items met conventional standards gate this issue, we analyzed US-focused news stories about for adequate reliability; κ values were >0.69 (10). For 4 Ebola virus disease during July 1–November 30, 2014. We items, κ values were slightly below this threshold but raw found frequent use of risk-elevating messages, which may percentage agreement was high (90%–94%); therefore, have contributed to increased public concern. these items were also included (online Technical Appen- dix Table 3). We assessed news story content about the he 2014–15 outbreak of Ebola virus disease (EVD) EVD outbreak by calculating the proportion of stories Tgenerated much news media coverage and high- that mentioned each EVD-associated message over the lighted the role of news media with regard to provid- study period. ing information about risks to the public (1–3). Research The volume of US-focused news coverage of the shows that the news media can influence knowledge EVD outbreak peaked slightly after the arrival (August 2, and perceptions about a topic (4–6). The way risks are 2014) of the first patient transported to the United States discussed and communicated (often through news cov- for treatment and increased much more after a case was erage) can also affect how risk is perceived (7–9). Our diagnosed in Dallas, Texas, USA, on September 30, 2014 objective was to analyze the volume and content of mes- (Figure). Overall, 96% of print and television news sto- sages promoted in US news media with regard to risk ries that covered EVD in the context of the United States for EVD and to examine how these messages relate to included >1 risk-elevating messages, 55% of stories con- risk-perception theory. tained >1 risk-minimizing messages, and 53% contained both message types. The most common risk-elevating The Study messages (72%) concerned foreigners or travelers bring- Using established methods, we analyzed EVD coverage ing Ebola virus to the United States. The most frequent from 12 news sources (9 print, 3 television) published risk-minimizing messages (32%) described scientific July 1–November 30, 2014 (online Technical Appendix knowledge about EVD (Table). Table 1, http://wwwnc.cdc.gov/EID/article/23/1/16-0589- Our analysis of news volume suggested that diagnosis Techapp1.pdf). News media stories were collected through of the first EVD case in Dallas and subsequent cases diag - searches of LexisNexis, ProQuest, and NewsBank online nosed in the United States were influential time points in archives by using the term “Ebola.” The search yielded the escalation of EVD outbreak news coverage, although 2,989 news stories, which were reviewed to determine if internationally, the outbreak had reached historic levels they met inclusion criteria (focus on US-associated EVD). months earlier. As noted elsewhere (1,11), the volume of The 374 stories that did not place EVD in a US context EVD news was largely reduced after the US midterm elec- were included in our analysis of news volume only. The fi - tions. This reduction may reflect inclusion of EVD as a nal sample for content analysis included 1,262 news stories campaign issue late in the election cycle or may reflect lack and opinion pieces from print and television sources. of newly diagnosed cases in the United States. Our coding instrument contained 9 risk-elevating mes- The high frequency of risk-elevating messages in news sages with characteristics that could increase perception coverage may have contributed to increased public concern about EVD in the United States, which was greater than Author affiliations: UPMC Center for Health Security, Baltimore, the situation warranted. Consumers of news media would Maryland, USA (T.K. Sell, C. Boddie); Johns Hopkins Bloomberg have been exposed to risk-elevating messages more often School of Public Health, Baltimore (T.K. Sell, C. Boddie, than risk-minimizing messages, potentially increasing their E.E. McGinty, K. Pollack, K.C. Smith, L. Rutkow); United States perception of risk for EVD. Risk messages of both types Environmental Protection Agency, Washington, DC, USA (T.A. Burke) were more frequently included in television news than in print news, potentially leading to differences in perceived DOI: http://dx.doi.org/10.3201/eid2301.160589 108 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 Media Messages and Perception of Risk for Ebola Figure. News coverage of Ebola virus disease comparing stories about Ebola in the United States and internationally, July– November 2014. Aug 2, first Ebola virus disease patient arrives in the United States; Aug 8, World Health Organization declares public health emergency of international concern; Sep 30, first case diagnosed in Dallas, Texas, USA; Oct 11, first case in healthcare worker; Oct 15, second case in healthcare worker; Oct 23–24, case diagnosed in New York, USA, and nurse quarantined; Nov 4, US midterm elections. EVD risk among consumers of different news types. Al- person, and 48% believed that transmission could occur though many factors can alter a message’s effectiveness, before symptoms appeared (14). In our analysis, only 32% frequency of exposure to risk-related messages can alter of news stories included scientific knowledge such as how public perception and contribute to social amplification of the disease is spread. More in-depth and frequent coverage risk; even when coverage is balanced, reassuring messages of the scientific aspects (and disease contagion pathways in may be less able to counter messages that increase percep- particular) of a public health threat may prevent these types tion of risk (6,9). However, several messages that were of misperceptions. seen significantly more frequently in liberal news sources Our results should be considered in light of several (defined in Table) may have been associated with increas - limitations. First, the sample did not include all news types ing awareness of specific issues, such as medical counter - (e.g., talk radio, social media, local television, blogs) or measure development efforts and large-scale growth of the international news sources. Furthermore, κ statistics for 4 EVD epidemic. items in the coding instrument were slightly below conven- The news media have been blamed for sensational- tional reliability standards; however, these messages were izing the EVD outbreak in the United States and unnec- either very common or rare, which can result in lower κ essarily alarming the public (3). Although the volume of agreement (15). These items were thus included because news coverage may have influenced public attention, the of high raw percentage agreement. Although the process content of analyzed news stories does not necessarily sug- used to create and evaluate the coding instrument should gest that news media were reporting news about EVD in have accounted for risk-elevating or risk-minimizing mes- a hyperbolic or irresponsible manner. Comparison of op- sages used frequently in coverage of EVD, some risk-re- posing messages, such as the ability to stop transmission lated messages may have been unintentionally omitted and or the outbreak in the United States, which was more fre- the imbalanced number of messages may have influenced quently mentioned than the inability to do so, suggests our analysis of the overall frequency of message types. that some concerns may have resulted from the nature of Furthermore, trends in news coverage may have been in- the risk itself, rather than irresponsible news media cover- fluenced by competing issues in the news cycle. Last, this age. Additionally, messages that were most inflammatory study does not provide direct measurement of exposure to (e.g., science not understanding the disease, inability to or influence of messages. Examination of competing mes - stop Ebola in the United States, terrorism/use of Ebola as a sages within news stories and comparison of news sources bioweapon) were mentioned less frequently than nearly all such as blogs or international sources may be promising other messages analyzed. areas for future research. Although the methods used in this study do not allow for causal inference between news media coverage and Conclusions public polling about EVD, comparison with public polling The 2014–15 Ebola outbreak provides a useful case for may provide useful context. EVD news volume roughly re- studying emerging outbreaks and other public health emer- flected changing levels of concern about EVD ( 1,12,13). gencies. Certain risk messages about Ebola were used more News media coverage could have increased public con- frequently than others by US news media, which may have cern, or public concern could have increased news cover- affected risk perception during the outbreak. age of risks. Despite widespread coverage of EVD, poll respondents were often misinformed about how the disease Acknowledgments was spread; 85% of respondents indicated that a person was We acknowledge the contributions of Amesh Adalja and likely to get EVD via a sneeze or cough from a symptomatic Matthew Watson for their review of the initial coding instrument. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 109 DISPATCHES Table. Risk-related news media messages about Ebola virus disease, July–November 2014* News stories with message, % Ebola National, no case/local Ebola case/ Print, TV, Print and TV, controversy, controversy, Conservative, Liberal, n = n = Messages n = 1,262† n = 655‡ n = 607§ n = 302¶ n = 595# 1,109** 153†† That could increase perception of risk Lack of/limited availability of 17 13 21 11 19 17 20 countermeasures to stop Ebola (p<0.001) (p<0.01) Ebola causes deaths 66 64 68 70 65 66 65 Potential US outbreak/persons in 35 33 36 35 33 34 41 the United States contracting Ebola Inability to stop 7 4 9 4 6 6 7 transmission/outbreak in the United (p<0.01) States Growth of the Ebola epidemic 23 17 30 14 26 21 36 (p<0.001) (p<0.001) (p<0.001) Science does not understand Ebola 8 8 8 7 9 7 13 (e.g., previous knowledge about the (p<0.05) disease was wrong or expert advice was incorrect) Ebola’s potential use in terrorism or 1 1 1 1 1 1 1 as a biologic weapon Ebola has an incubation period 34 34 35 37 33 33 43 (p<0.05) Foreigners or travelers bringing 72 71 74 72 70 71 79 Ebola to the United States (p<0.05) That could decrease perception of risk Lower Ebola death rates in the 5 4 6 3 4 4 10 United States (p<0.001) Ability to stop transmission/outbreak 20 16 24 24 17 18 30 in the United States (p<0.01) (p<0.01) (p<0.01) Low risks related to Ebola (e.g., low 28 25 30 25 27 26 42 risk of the disease coming to the (p<0.001) United States, low risk of someone transmitting the disease, low risks of school children acquiring Ebola) How to prevent spread of Ebola 12 12 13 12 10 11 20 (p<0.05) Description of scientific knowledge 32 30 33 29 30 31 35 about Ebola (e.g., transmission dynamics or other known aspects of the disease) *Time frame selected to capture potential differences before and after key US Ebola events.  tests were used to test differences in the proportion of news stories mentioning each Ebola-related message in compared news sources. †Sources included in all news stories: Atlanta Journal Constitution, Chicago Tribune, CNN Situation Room, Fort Worth Star-Telegram, Fox Special Report, NBC Nightly News, New York Daily News, New York Times, Orange County Register, Portland Press Herald, USA Today, and Washington Post. ‡New sources with an Ebola case or controversy in the locality: Atlanta Journal Constitution, Fort Worth Star-Telegram, New York Daily News, New York Times, and Portland Press Herald. §Nationally produced new sources or those without an Ebola case or controversy in the locality: Chicago Tribune, CNN Situation Room, Fox Special Report, NBC Nightly News, Orange County Register, USA Today, and Washington Post. ¶Conservative news sources: Fort Worth Star-Telegram, Fox Special Report, and New York Daily News. #Liberal news sources: Chicago Tribune, New York Times, and Washington Post. **Print news sources: Atlanta Journal Constitution, Chicago Tribune, Fort Worth Star-Telegram, New York Daily News, New York Times, Orange County Register, Portland Press Herald, USA Today, and Washington Post. ††TV news sources: CNN Situation Room, Fox Special Report, and NBC Nightly News. Dr. Burke contributed to this work while serving as professor disease outbreaks, biosecurity, and public health preparedness. at Johns Hopkins. The views expressed are his own and do not She also publishes an annual analysis of federal funding for necessarily reflect the policy positions of the US Environmental health security. Protection Agency. Support for this research was provided to T.K.S. by the Johns Hopkins Sommer Scholars Program. References 1. Kelly B, Squiers L, Bann C, Stine A, Hansen H, Lynch M. Dr. Sell is an associate at the UPMC Center for Health Security Perceptions and plans for prevention of Ebola: results from a and an associate editor of the peer-reviewed journal Health national survey. BMC Public Health. 2015;15:1136. Security (formerly Biosecurity and Bioterrorism). Her http://dx.doi.org/10.1186/s12889-015-2441-7 2. Towers S, Afzal S, Bernal G, Bliss N, Brown S, Espinoza B, research focuses on the policy implications of infectious et al. Mass media and the contagion of fear: the case of Ebola in 110 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 Media Messages and Perception of Risk for Ebola America. PLoS One. 2015;10:e0129179. http://dx.doi.org/10.1371/ 11. Gertz M, Savillo R. Ebola coverage on TV news plummeted journal.pone.0129179 after midterms [cited 2016 Jan 4]. http://mediamatters.org/ 3. The medium and the message of Ebola. Lancet. 2014;384:1641. research/2014/11/19/report-ebola-coverage-on-tv-news-plum- http://dx.doi.org/10.1016/S0140-6736(14)62016-X meted-afte/201619 4. Scheufele DA, Tewksbury D. Framing, agenda setting, and 12. McCarthy M. Four in 10 US people fear large outbreak of Ebola. priming: the evolution of three media effects models. Journal of BMJ. 2014;349:g5321. http://dx.doi.org/10.1136/bmj.g5321 Communication. 2007;57:9–20. 13. Dennis B, Craighill PM. Ebola poll: two-thirds of Americans 5. McCombs ME, Shaw DL. The agenda-setting function of mass worried about possible widespread epidemic in U.S. media. Public Opinion Quarterly. 1972;36:176–87. Washington Post. October 14, 2014 [cited 2016 Jan 4]. 6. Chong D, Druckman JN. Framing theory. Annual Review of https://www.washingtonpost.com/national/health-science/ Political Science. 2007;10:103–26. http://dx.doi.org/10.1146/ ebola-poll-two-thirds-of-americans-worried-about-possible- annurev.polisci.10.072805.103054 widespread-epidemic-in-us/2014/10/13/d0afd0ee-52ff-11e4-809b- 7. Slovic P. Perception of risk. Science. 1987;236:280–5. 8cc0a295c773_story.html http://dx.doi.org/10.1126/science.3563507 14. SteelFisher GK, Blendon RJ, Lasala-Blanco N. Ebola in 8. Fischhoff B, Bostrom A, Quadrel MJ. Risk perception and the United States—public reactions and implications. N Engl J communication. Annu Rev Public Health. 1993;14:183–203. Med. 2015;373:789–91. http://dx.doi.org/10.1056/NEJMp1506290 http://dx.doi.org/10.1146/annurev.pu.14.050193.001151 15. Viera AJ, Garrett JM. Understanding interobserver agreement: 9. Kasperson RE, Renn O, Slovic P, Brown HS, Emel J, Goble R, et al. the kappa statistic. Fam Med. 2005;37:360–3. The social amplification of risk: a conceptual framework. Risk Anal. 1988;8:177–87. http://dx.doi.org/10.1111/j.1539- 6924.1988.tb01168.x Address for correspondence: Tara Kirk Sell, Department of Health Policy 10. Landis JR, Koch GG. The measurement of observer agreement for and Management, Johns Hopkins Bloomberg School of Public Health, Rm categorical data. Biometrics. 1977;33:159–74. 513, 624 N Broadway, Baltimore, MD 21205, USA; email: tsell1@jhu.edu http://dx.doi.org/10.2307/2529310 February 2016: Ebola • Ebola and Its Control in • Randomized Controlled Liberia, 2014–2015 Trial of Hospital-Based Hygiene and Water • Epidemiology of Epidemic Treatment Intervention Ebola Virus Disease in (CHoBI7) to Reduce Conakry and Surrounding Cholera Prefectures, Guinea, 2014–2015 • Sustained Transmission Pandemic among Health of Pertussis in Vaccinated, • Hospital Preparations for Plan Members, San 1–5-Year-Old Children in Viral Hemorrhagic Fever Diego, California, USA, a Preschool, Florida, USA Patients and Experience October–December 2009 Gained from the • Molecular • Epidemiology of Serotype Admission of an Ebola Characterization of 1 Invasive Pneumococcal Patient Invasive Streptococcus • Association between Disease, South Africa, dysgalactiae subsp. • Trematode Fluke Landscape Factors 2003–2013 equisimilis, Japan Procerovum varium and Spatial Patterns of • Dogs and Opossums as Cause of Ocular • Population Effects of Plasmodium knowlesi Positive for Vaccinia Inflammation in Children, Influenza A(H1N1) Infections in Sabah, Virus during Outbreak South India Malaysia Affecting Cattle • Feasibility of Xpert Ebola and Humans, Assay in Médecins Sans São Paulo State, Brazil Frontières Ebola Program, • Hemorrhagic Fever with Guinea Renal Syndrome, Zibo • Prognostic Indicators for City, China, 2006–2014 Ebola Patient Survival • African Buffalo Movement • Invasive Group A and Zoonotic Disease Streptococcus Infection Risk across Transfrontier among Children, Conservation Areas, Rural Kenya Southern Africa http://wwwnc.cdc.gov/eid/articles/ issue/22/02/table-of-contents Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 111 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Emerging Infectious Diseases Pubmed Central

Media Messages and Perception of Risk for Ebola Virus Infection, United States

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DISPATCHES Media Messages and Perception of Risk for Ebola Virus Infection, United States of risk and 5 risk-minimizing messages with characteris- Tara Kirk Sell, Crystal Boddie, Emma E. McGinty, tics that could decrease perception of risk (online Tech- Keshia Pollack, Katherine Clegg Smith, nical Appendix Tables 2–4), developed according to the Thomas A. Burke, Lainie Rutkow risk perception framework of Slovic (7). To assess inter- News media have been blamed for sensationalizing Ebola rater reliability, we coded a random sample of 15% of in the United States, causing unnecessary alarm. To investi- news stories. Most items met conventional standards gate this issue, we analyzed US-focused news stories about for adequate reliability; κ values were >0.69 (10). For 4 Ebola virus disease during July 1–November 30, 2014. We items, κ values were slightly below this threshold but raw found frequent use of risk-elevating messages, which may percentage agreement was high (90%–94%); therefore, have contributed to increased public concern. these items were also included (online Technical Appen- dix Table 3). We assessed news story content about the he 2014–15 outbreak of Ebola virus disease (EVD) EVD outbreak by calculating the proportion of stories Tgenerated much news media coverage and high- that mentioned each EVD-associated message over the lighted the role of news media with regard to provid- study period. ing information about risks to the public (1–3). Research The volume of US-focused news coverage of the shows that the news media can influence knowledge EVD outbreak peaked slightly after the arrival (August 2, and perceptions about a topic (4–6). The way risks are 2014) of the first patient transported to the United States discussed and communicated (often through news cov- for treatment and increased much more after a case was erage) can also affect how risk is perceived (7–9). Our diagnosed in Dallas, Texas, USA, on September 30, 2014 objective was to analyze the volume and content of mes- (Figure). Overall, 96% of print and television news sto- sages promoted in US news media with regard to risk ries that covered EVD in the context of the United States for EVD and to examine how these messages relate to included >1 risk-elevating messages, 55% of stories con- risk-perception theory. tained >1 risk-minimizing messages, and 53% contained both message types. The most common risk-elevating The Study messages (72%) concerned foreigners or travelers bring- Using established methods, we analyzed EVD coverage ing Ebola virus to the United States. The most frequent from 12 news sources (9 print, 3 television) published risk-minimizing messages (32%) described scientific July 1–November 30, 2014 (online Technical Appendix knowledge about EVD (Table). Table 1, http://wwwnc.cdc.gov/EID/article/23/1/16-0589- Our analysis of news volume suggested that diagnosis Techapp1.pdf). News media stories were collected through of the first EVD case in Dallas and subsequent cases diag - searches of LexisNexis, ProQuest, and NewsBank online nosed in the United States were influential time points in archives by using the term “Ebola.” The search yielded the escalation of EVD outbreak news coverage, although 2,989 news stories, which were reviewed to determine if internationally, the outbreak had reached historic levels they met inclusion criteria (focus on US-associated EVD). months earlier. As noted elsewhere (1,11), the volume of The 374 stories that did not place EVD in a US context EVD news was largely reduced after the US midterm elec- were included in our analysis of news volume only. The fi - tions. This reduction may reflect inclusion of EVD as a nal sample for content analysis included 1,262 news stories campaign issue late in the election cycle or may reflect lack and opinion pieces from print and television sources. of newly diagnosed cases in the United States. Our coding instrument contained 9 risk-elevating mes- The high frequency of risk-elevating messages in news sages with characteristics that could increase perception coverage may have contributed to increased public concern about EVD in the United States, which was greater than Author affiliations: UPMC Center for Health Security, Baltimore, the situation warranted. Consumers of news media would Maryland, USA (T.K. Sell, C. Boddie); Johns Hopkins Bloomberg have been exposed to risk-elevating messages more often School of Public Health, Baltimore (T.K. Sell, C. Boddie, than risk-minimizing messages, potentially increasing their E.E. McGinty, K. Pollack, K.C. Smith, L. Rutkow); United States perception of risk for EVD. Risk messages of both types Environmental Protection Agency, Washington, DC, USA (T.A. Burke) were more frequently included in television news than in print news, potentially leading to differences in perceived DOI: http://dx.doi.org/10.3201/eid2301.160589 108 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 Media Messages and Perception of Risk for Ebola Figure. News coverage of Ebola virus disease comparing stories about Ebola in the United States and internationally, July– November 2014. Aug 2, first Ebola virus disease patient arrives in the United States; Aug 8, World Health Organization declares public health emergency of international concern; Sep 30, first case diagnosed in Dallas, Texas, USA; Oct 11, first case in healthcare worker; Oct 15, second case in healthcare worker; Oct 23–24, case diagnosed in New York, USA, and nurse quarantined; Nov 4, US midterm elections. EVD risk among consumers of different news types. Al- person, and 48% believed that transmission could occur though many factors can alter a message’s effectiveness, before symptoms appeared (14). In our analysis, only 32% frequency of exposure to risk-related messages can alter of news stories included scientific knowledge such as how public perception and contribute to social amplification of the disease is spread. More in-depth and frequent coverage risk; even when coverage is balanced, reassuring messages of the scientific aspects (and disease contagion pathways in may be less able to counter messages that increase percep- particular) of a public health threat may prevent these types tion of risk (6,9). However, several messages that were of misperceptions. seen significantly more frequently in liberal news sources Our results should be considered in light of several (defined in Table) may have been associated with increas - limitations. First, the sample did not include all news types ing awareness of specific issues, such as medical counter - (e.g., talk radio, social media, local television, blogs) or measure development efforts and large-scale growth of the international news sources. Furthermore, κ statistics for 4 EVD epidemic. items in the coding instrument were slightly below conven- The news media have been blamed for sensational- tional reliability standards; however, these messages were izing the EVD outbreak in the United States and unnec- either very common or rare, which can result in lower κ essarily alarming the public (3). Although the volume of agreement (15). These items were thus included because news coverage may have influenced public attention, the of high raw percentage agreement. Although the process content of analyzed news stories does not necessarily sug- used to create and evaluate the coding instrument should gest that news media were reporting news about EVD in have accounted for risk-elevating or risk-minimizing mes- a hyperbolic or irresponsible manner. Comparison of op- sages used frequently in coverage of EVD, some risk-re- posing messages, such as the ability to stop transmission lated messages may have been unintentionally omitted and or the outbreak in the United States, which was more fre- the imbalanced number of messages may have influenced quently mentioned than the inability to do so, suggests our analysis of the overall frequency of message types. that some concerns may have resulted from the nature of Furthermore, trends in news coverage may have been in- the risk itself, rather than irresponsible news media cover- fluenced by competing issues in the news cycle. Last, this age. Additionally, messages that were most inflammatory study does not provide direct measurement of exposure to (e.g., science not understanding the disease, inability to or influence of messages. Examination of competing mes - stop Ebola in the United States, terrorism/use of Ebola as a sages within news stories and comparison of news sources bioweapon) were mentioned less frequently than nearly all such as blogs or international sources may be promising other messages analyzed. areas for future research. Although the methods used in this study do not allow for causal inference between news media coverage and Conclusions public polling about EVD, comparison with public polling The 2014–15 Ebola outbreak provides a useful case for may provide useful context. EVD news volume roughly re- studying emerging outbreaks and other public health emer- flected changing levels of concern about EVD ( 1,12,13). gencies. Certain risk messages about Ebola were used more News media coverage could have increased public con- frequently than others by US news media, which may have cern, or public concern could have increased news cover- affected risk perception during the outbreak. age of risks. Despite widespread coverage of EVD, poll respondents were often misinformed about how the disease Acknowledgments was spread; 85% of respondents indicated that a person was We acknowledge the contributions of Amesh Adalja and likely to get EVD via a sneeze or cough from a symptomatic Matthew Watson for their review of the initial coding instrument. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 109 DISPATCHES Table. Risk-related news media messages about Ebola virus disease, July–November 2014* News stories with message, % Ebola National, no case/local Ebola case/ Print, TV, Print and TV, controversy, controversy, Conservative, Liberal, n = n = Messages n = 1,262† n = 655‡ n = 607§ n = 302¶ n = 595# 1,109** 153†† That could increase perception of risk Lack of/limited availability of 17 13 21 11 19 17 20 countermeasures to stop Ebola (p<0.001) (p<0.01) Ebola causes deaths 66 64 68 70 65 66 65 Potential US outbreak/persons in 35 33 36 35 33 34 41 the United States contracting Ebola Inability to stop 7 4 9 4 6 6 7 transmission/outbreak in the United (p<0.01) States Growth of the Ebola epidemic 23 17 30 14 26 21 36 (p<0.001) (p<0.001) (p<0.001) Science does not understand Ebola 8 8 8 7 9 7 13 (e.g., previous knowledge about the (p<0.05) disease was wrong or expert advice was incorrect) Ebola’s potential use in terrorism or 1 1 1 1 1 1 1 as a biologic weapon Ebola has an incubation period 34 34 35 37 33 33 43 (p<0.05) Foreigners or travelers bringing 72 71 74 72 70 71 79 Ebola to the United States (p<0.05) That could decrease perception of risk Lower Ebola death rates in the 5 4 6 3 4 4 10 United States (p<0.001) Ability to stop transmission/outbreak 20 16 24 24 17 18 30 in the United States (p<0.01) (p<0.01) (p<0.01) Low risks related to Ebola (e.g., low 28 25 30 25 27 26 42 risk of the disease coming to the (p<0.001) United States, low risk of someone transmitting the disease, low risks of school children acquiring Ebola) How to prevent spread of Ebola 12 12 13 12 10 11 20 (p<0.05) Description of scientific knowledge 32 30 33 29 30 31 35 about Ebola (e.g., transmission dynamics or other known aspects of the disease) *Time frame selected to capture potential differences before and after key US Ebola events.  tests were used to test differences in the proportion of news stories mentioning each Ebola-related message in compared news sources. †Sources included in all news stories: Atlanta Journal Constitution, Chicago Tribune, CNN Situation Room, Fort Worth Star-Telegram, Fox Special Report, NBC Nightly News, New York Daily News, New York Times, Orange County Register, Portland Press Herald, USA Today, and Washington Post. ‡New sources with an Ebola case or controversy in the locality: Atlanta Journal Constitution, Fort Worth Star-Telegram, New York Daily News, New York Times, and Portland Press Herald. §Nationally produced new sources or those without an Ebola case or controversy in the locality: Chicago Tribune, CNN Situation Room, Fox Special Report, NBC Nightly News, Orange County Register, USA Today, and Washington Post. ¶Conservative news sources: Fort Worth Star-Telegram, Fox Special Report, and New York Daily News. #Liberal news sources: Chicago Tribune, New York Times, and Washington Post. **Print news sources: Atlanta Journal Constitution, Chicago Tribune, Fort Worth Star-Telegram, New York Daily News, New York Times, Orange County Register, Portland Press Herald, USA Today, and Washington Post. ††TV news sources: CNN Situation Room, Fox Special Report, and NBC Nightly News. Dr. Burke contributed to this work while serving as professor disease outbreaks, biosecurity, and public health preparedness. at Johns Hopkins. The views expressed are his own and do not She also publishes an annual analysis of federal funding for necessarily reflect the policy positions of the US Environmental health security. Protection Agency. Support for this research was provided to T.K.S. by the Johns Hopkins Sommer Scholars Program. References 1. Kelly B, Squiers L, Bann C, Stine A, Hansen H, Lynch M. Dr. Sell is an associate at the UPMC Center for Health Security Perceptions and plans for prevention of Ebola: results from a and an associate editor of the peer-reviewed journal Health national survey. BMC Public Health. 2015;15:1136. Security (formerly Biosecurity and Bioterrorism). Her http://dx.doi.org/10.1186/s12889-015-2441-7 2. Towers S, Afzal S, Bernal G, Bliss N, Brown S, Espinoza B, research focuses on the policy implications of infectious et al. Mass media and the contagion of fear: the case of Ebola in 110 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 Media Messages and Perception of Risk for Ebola America. PLoS One. 2015;10:e0129179. http://dx.doi.org/10.1371/ 11. Gertz M, Savillo R. Ebola coverage on TV news plummeted journal.pone.0129179 after midterms [cited 2016 Jan 4]. http://mediamatters.org/ 3. The medium and the message of Ebola. Lancet. 2014;384:1641. research/2014/11/19/report-ebola-coverage-on-tv-news-plum- http://dx.doi.org/10.1016/S0140-6736(14)62016-X meted-afte/201619 4. Scheufele DA, Tewksbury D. Framing, agenda setting, and 12. McCarthy M. Four in 10 US people fear large outbreak of Ebola. priming: the evolution of three media effects models. Journal of BMJ. 2014;349:g5321. http://dx.doi.org/10.1136/bmj.g5321 Communication. 2007;57:9–20. 13. Dennis B, Craighill PM. Ebola poll: two-thirds of Americans 5. McCombs ME, Shaw DL. 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Biometrics. 1977;33:159–74. 513, 624 N Broadway, Baltimore, MD 21205, USA; email: tsell1@jhu.edu http://dx.doi.org/10.2307/2529310 February 2016: Ebola • Ebola and Its Control in • Randomized Controlled Liberia, 2014–2015 Trial of Hospital-Based Hygiene and Water • Epidemiology of Epidemic Treatment Intervention Ebola Virus Disease in (CHoBI7) to Reduce Conakry and Surrounding Cholera Prefectures, Guinea, 2014–2015 • Sustained Transmission Pandemic among Health of Pertussis in Vaccinated, • Hospital Preparations for Plan Members, San 1–5-Year-Old Children in Viral Hemorrhagic Fever Diego, California, USA, a Preschool, Florida, USA Patients and Experience October–December 2009 Gained from the • Molecular • Epidemiology of Serotype Admission of an Ebola Characterization of 1 Invasive Pneumococcal Patient Invasive Streptococcus • Association between Disease, South Africa, dysgalactiae subsp. • Trematode Fluke Landscape Factors 2003–2013 equisimilis, Japan Procerovum varium and Spatial Patterns of • Dogs and Opossums as Cause of Ocular • Population Effects of Plasmodium knowlesi Positive for Vaccinia Inflammation in Children, Influenza A(H1N1) Infections in Sabah, Virus during Outbreak South India Malaysia Affecting Cattle • Feasibility of Xpert Ebola and Humans, Assay in Médecins Sans São Paulo State, Brazil Frontières Ebola Program, • Hemorrhagic Fever with Guinea Renal Syndrome, Zibo • Prognostic Indicators for City, China, 2006–2014 Ebola Patient Survival • African Buffalo Movement • Invasive Group A and Zoonotic Disease Streptococcus Infection Risk across Transfrontier among Children, Conservation Areas, Rural Kenya Southern Africa http://wwwnc.cdc.gov/eid/articles/ issue/22/02/table-of-contents Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 1, January 2017 111

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