A review of radio coverage of health-related topics in the 20th century.

Abstract: Radio has been an important mass medium since its inception. The purpose of this study is to examine how radio broadcasts were used to disseminate health messages during the 20th century. The main focus is on radio coverage of health topics before television became the dominant medium. Published reports of the time and media histories were the major sources of information. Radio's depictions of health messages in entertainment and educational programming were examined. Implications are discussed for the use of radio by health educators in the 21st century.

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It is generally accepted that radio broadcasting began in the United States in 1920 (Miller, 2003; Potter, 2001; Hilliard & Keith, 2001; Sterling & Kittross, 2002). This medium "made America into a land of listeners, entertaining and educating, angering and delighting, and joining every age and class into a common culture" (Lewis, 1992, p. 26). The purpose of this study is to describe radio coverage of health topics in the 20th century, focusing on radio programming from the 1920's through the 1950's, to provide insight into how radio educated (and sometimes angered) Americans about health topics.

HOW RADIO WAS USED TO DISSEMINATE HEALTH MESSAGES/PROMOTE HEALTH FROM THE 1920'S-1950'S

In the early 1920's, radio in general was said to benefit people's health because it helped hospitalized patients deal with loneliness and boredom (Seeley, 1922) and "radio entertainment provided for the drug addict inmates of Riker's Island ... had a beneficial effect upon the discipline of the institution" ("Radio helps drug addicts," 1925, p. 9). From the 1920's through the rest of the 20th-century, radio programs were developed for educational purposes (Sterling & Kittross, 2002). The New York Academy of Medicine stated in 1945 that "from the beginning, those especially interested in education saw in the radio a very potent instrument ... (a) means for 'spreading knowledge'. Educators began to broadcast as soon as 'live' microphones were open to them" (p. 4).

Radio programming designed to disseminate health information also began in the early 1920's (Laine, 1938; New York Academy of Medicine, 1945). Criticism of the paucity of health-related coverage began soon after the advent of radio broadcasting. According to one source, "one possibility in radio broadcasting which has not been developed nearly as much as is warranted by its importance is the dissemination of information regarding health" ("Broadcasting health," 1922, p. 7). The New York Academy of Medicine made a similar criticism in 1945 by pointing out that "the development of the commercial broadcast far outpaced that of the educational broadcast, and among the latter the health education program lagged behind all the rest" (p. 5).

In 1935, Turner, Drenckhahn and Bates reported that dramatization was the most popular type of radio broadcast when it came to presenting health information, especially among children (p. 594). The New York Academy of Medicine (1945), however, was critical of these attempts at drama:

   It is in the utilization of this technique
   that radio health education miscarries
   most grievously. In most instances the so-called
   drama is not dramatic, but consists
   merely of a motley of situations represented
   in excited chatter. When, as rarely
   happens, the composition is truly dramatic,
   it is almost entirely devoid of health
   education (p. 26).

Willey and Young (1948) stated that, in terms of radio programming, "the responsibility of those sponsoring health education programs is to foster receptive attitudes and constructive health habits for a healthy individual and a healthy nation" (p. 308). While that may have been the goal, Galdston (1945) believed that the health-related programming of early radio generally fell short in these areas because objectives were not clearly identified, and that the broadcasts of the time were typically overloaded with information:

   Our tendency has been to "throw the
   whole book" at the radio listener. We appear
   to labor in the belief that if we can
   pour into the ears of our listeners all that
   we know, say about cancer or tuberculosis
   or ... nutrition, we have done our best
   to educate the public (p. 43).

RADIO'S IMPACT UPON LISTENERS

One of the earliest reports of radio having an impact on individual behavior came in 1926, when an Alabama man entered a physician's office asking if anyone "'inspected the health of school-children'" ("Radiating health," 1926, p. 240). When the physician questioned the man to determine how he learned about the inspections, the man replied:

   Well, some time ago I bought me one of
   these here radio outfits ... and I heard Mr.
   Herbert Hoover in Washington deliver a
   speech on medical inspection of schoolchildren.
   He said that every community
   ought to have some one in it to examine
   the health of their children, to find out if
   there was anything the matter with them
   This struck me as a pretty good idea; so I
   thought to myself, 'The next time I am in
   Andlusia I will find out if there's any of
   these here health doctors who examines
   school-children', and so I have come to
   invite you out (p. 142).

In 1939, 4,000 New York City junior high school students took part in a study to determine if radio seemed to aid in learning about health; half of that group served as a control group. According to a newspaper article, "the health broadcasts, sponsored by the American Medical Association and the National Broadcasting Company, included thirty weekly dramatized health lessons" ("Radio-trained pupils," 1939, p.19). Students who heard the programs scored 3% better on multiple-choice exams than the control group. Radio was said to be more effective when used in classrooms as opposed to its use with larger audiences in an auditorium or gymnasium. The students also scored better on the exam if the teacher discussed the material with students before and after the program ("Radio-trained pupils").

Murray and Turner (1943) surveyed Boston area mothers who attended well baby clinics to determine their radio listening habits and their attitudes about health programming. Eighty-eight percent of the sample "expressed themselves enthusiastically in favor of a health program, 10% stipulating that they would listen if the program proved interesting and entertaining, as well as valuable. Only 2& of the interviewees said they would not listen to a health program" (p. 953). While their attitude toward a health program was positive, the listening practices of this group seemed to reflect something different. According to Murray and Turner, "a low number of interviewees, 9%, reported ever listening to any form of educational broadcasting" (p. 953). This led them to conclude that "there may be a sharp difference between what the mother thinks she might like and what she would listen to if it were on the air.... [T]heir expressed preferences do not square too well with their present listening habits" (p. 953).

HEALTH ORGANIZATIONS AND HEALTH-RELATED PROGRAMMING

The United States Public Health Service began broadcasting health programming in December 1921. The program was scheduled twice per week and gave "advice as to how the average man and woman may insure continued good health" ("Health hints by wireless," 1921, p. 3). The New York State Department of Health began airing health programming in 1922 via a Schenectady radio station (Laine, 1938). Although originally a five minute talk, the Health Department changed the programming format to 15-minute dramatizations in the 1930's. According to Laine:

   Among the topics dramatized [were] the
   following: self-medication and worthless
   patent medicine "cures"; facts and advice
   on measles; suggestions on healthful and
   economical foods; the importance of early
   diagnosis in tuberculosis; protecting public
   water supplies; the common cold and
   its transmission; and venereal disease and
   sex instruction for children.

   The last mentioned topic [was] ... a delicate
   subject in radio dealings. The New
   York State Department of Health, after
   various experiences with broadcasters, arrived
   at the conclusion that local stations
   generally, at least in New York State, [were]
   more ready to cooperate in the dissemination
   of social hygiene information than
   the national companies (p. 140).

The history in Illinois is similar to the history in New York. East (1942) writes that "in the early years of radio education ... the broadcasts were only of the lecture, or at most, interview variety" (p. 4). In the late 1930's there was a shift to dramatization. As the quality of the 15-minute plays improved, the popularity of the programs, also known as the "ILLINOIS MARCH OF HEALTH," increased. While acknowledging that it was difficult to determine the impact of the broadcasts, East held the view that improvements in the health status of Illinois residents in the late 1930's and early 1940's could be linked to radio programming. She summarized by saying "it is felt that in the achievement of these gratifying health records, the Statewide radio education activities of the Illinois Department of Public Health] are more than likely to have played a significant part" (p. 4).

The American Medical Association (AMA) was heavily involved in early radio broadcasts of health material, conducting educational programs on the radio in 1923 (Bauer, 1944). The AMA may have been the most active group in health education via radio (Bauer, 1944; Bauer, Martin, & McKeever, 1947; Willey & Young, 1948). Early programs consisted primarily of "information from HYGEIA and material furnished by the Propaganda Department of THE JOURNAL [of the AMA]" (Bauer et al., 1947, p. 1002.) Hygeia was a health magazine published by the AMA that was intended for the general public.

As with the New York State and Illinois broadcasts, the 1920% and early 1930's AMA radio programs largely consisted of monologues; however, the broadcasting style changed in the mid 1930%:

   In December, 1935 ... a significant alteration
   in the character of the radio broadcasts
   was instituted. It was recognized that
   the days of monologue presentations of
   health topics was past, and that the general
   public, with so much from which to
   choose on the radio dial, would not listen
   unless health education could be given in
   a more attractive form. AS a result, dramatization
   was introduced in AMA radio
   programs (Bauer et al., 1947, pp. 1004-1005)

The AMA also created several programs in the 1930's and 1940's. Your Health began in the early 1930's ("Broadcasting health material," 1937). The program's focus was changed in 1937 when the AMA decided to focus on high school students as a target audience (Bauer, 1936; Bauer et al., 1947; "Broadcasting health material," 1937). In 1939, Medicine in the News began. This program was "based on news contained in THE JOURNAL [of the AMA] and HYGEIA" (Bauer et al., 1947, p. 1005). Doctors at Work began in 1940, and Doctors at War was broadcast from late 1942 to mid-1943 (Bauer et al., 1947).

The AMA was also involved in the production of a 1952 radio program, hosted by Charles Laughton (Haendiges, 2002; "The Happy Ham," 1952). Medicine USA aired at least six times; the dramas dealt with alcoholism (AMA, 1952a); psychiatry in America (AMA, 1952c); the span of life (AMA, 1952d); the story of contagious diseases (AMA, 1952e); exercise and athletics (AMA, 1952b); and the family doctor (AMA, 1952f). The AMA was not the only group involved in health-related programming nor were programs limited to monologues or plays. Programs devoted to "calisthenics [and] health talks" were commonly aired in the morning during the 1920's (Douglas, 1987, p. 189). Sterling and Kittross (2002) report that "more that 1 1/2% of air time was devoted to health/exercise programs until 1932" (p. 138). Boand (1933) also notes that "the radio gymnasium class first saw the light of day in Chicago in 1923" (p. 523). In 1924, personnel from the YMCA were involved in the first broadcast of a daily exercise program on Chicago's (now Philadelphia's) KYW radio ("A brief history," 2003; Sterling & Kittross, 2002). Beginning in 1925, Metropolitan Life sponsored an exercise program that aired on stations in Boston, Buffalo, New York City, Philadelphia, Pittsburgh, Schenectady, Toronto and Washington, DC (Calderwood, 1932). Exercise programs began to fade in popularity in the 1930's "and by World War II there were very few early morning programs devoted to physical exercise" (Douglas, p. 188).

Radio was also used to promote abstaining from alcohol and prohibition. One article notes that "the Anti-Saloon League of New York adopted a dry campaign program for 1927 which include[d] the spread of propaganda in colleges and universities and the use of both radio and motion pictures" ("Dry league to use radio," 1927, p. 25). The Food and Drug Administration (FDA) was also involved in radio programming in the 1930's. According to Kay (2001), "the FDA made effective use of this medium by broadcasting shows, news bulletins, and product warnings when necessary" (p. 454). The FDA used radio broadcasts to inform the public of its functions and how the agency performed these functions. Radio was also used to garner public support for the agency and for legislation that would increase the FDA's regulatory role. In addition, "speakers were reminded to emphasize the absolute necessity for improved consumer protection through legislation, and to highlight the public's role in the legislative process" (Kay, p. 467).

In the early 1940's NBC aired "Listen, America ... under the auspices of the Women's National Emergency Committee, the U.S. Public Health Service, the U.S. Department of Agriculture, and the Federal Security Agency" ("Re: 'Listen America'," 1941, p. 1214). The Listen America broadcasts emphasized good nutritional practices, stressing "that good health and full strength are based on good food." (p. 1214).

NETWORK PROGRAMS AND HEALTH-RELATED PROGRAMMING

Rural listeners closely identified with Lum and Abner, a popular series that ran for more than twenty years (Lackmann, 2000). The characters were described as "radio rural philosophers from Pine Ridge, Ark." ("Lum and Abner," 1939, p. 31). A 1939 Lum and Abner episode dealt with patient-physician communication. Readers of the AMA'S Hygeia were encouraged to listen to the program and given an idea of what the program was about:

   A feller who won't tell his doctor ever'thing
   that ails him ain't got much right askin'
   for help, says Lum. Ther's too much
   complainin' an' not enough thinkin' goin'
   on. Grannies, some folks 'pear to think a
   doctor ought to read their minds-an' then
   they get mad iffen he does'"("Lum and
   Abner," 1939, p. 31).

The American School of the Air (1930-1948) aired on CBS from 1930-1948 and reached approximately 20,000 schools in the early 1930's (Lackmann, 2000; Sterling & Kittross, 2002). This show offered "a variety of programs of value for the teaching of health" (Barckman, 1945, p. 71). Included among the health topics on this program were "disease prevention and control ... health protection [the role of the] American Red Cross in health education ... and safety & first aid" (Barckman, p. 72).

Cavalcade of America aired from 1935 to 1953 and portrayed individuals and events from history (Grams, 1998). Health-related stories covered in this program included smallpox, Walter Reed's efforts against yellow fever, the discovery of penicillin, the discovery of quinine's effectiveness against malaria, the discovery of anesthesia, and use of DDT (Grams). DDT was positively viewed as a treatment for typhus. In fact, the program was "originally titled 'DDT - the Powder of Life'" (Grams, unpaged).

In 1949 CBS broadcast Mind in the Shadow, a documentary about mental illness, featuring Eddie Albert. According to a New York Times critic (Gould, 1949), the program did

   not uncover any startling new information
   on the deplorable conditions prevailing
   in many state institutions. Rather it
   [hit] hard and often at the points which
   cannot be stressed too much and on the
   radio have been hardly said at all-the
   chronically overcrowded hospitals and
   woefully inadequate staffs which make a
   joke of society's presumption to being civilized
   (p. 11)

CONTROVERSIES RELATED TO HEALTH PROGRAMMING VIA RADIO

Concerns that programming promoted health-related products without first being introduced as advertising date back to at least 1925 ("Gas clinic failure," 1925). Concerns about radio programs being used to transmit quackery date to the 1920's as well (Benjamin, 2001; "Radio drive," 1929; "Seeks to bar radio," 1929). Radio was used to transmit quackery through the broadcasts by John Brinkley and Norman Baker, among others. Brinkley was well-known throughout the country for his claims that goat testes could restore a person's fertility. He used radio to broadcast these messages (Benjamin, 2001; Juhnke, 2002).

Commercial interests could influence what was broadcast in two ways. Brindze (1937) states that products of questionable value were advertised on radio broadcasts on a regular basis, because the makers of these products helped pay the radio station's bills while also improving the bottom line of the product's manufacturing company. Therefore, while radio station owners needed to be aware of the audience and of federal regulators, these stakeholders were not the station owner's major concern:

   There is no question but that the radio
   has given the medicine man's business a
   tremendous boost, and that the buying
   public, for whom the shows are put on,
   has been cheated both because of the exaggerated
   claims for the products and their
   exorbitant price.... The advertiser is the
   one who directly supplies the income [to
   the radio stations] and his interests take
   precedence over those of the public
   (Brindze, pp. 108-109).

The second method commercial interests used to influence radio's content was by controlling what was aired. Bauer (193611971) and Brindze wrote that speakers were sometimes prohibited from making factual statements (or what were considered facts at the time) about health topics if they conflicted with the interests of an advertiser. Brindze provided the following example:

   The U.S. Public Health Service made the
   following statement in a radio broadcast:
   Meat is an active heat-producing food, as
   shown by the fact that natives of the far
   North live entirely on animal products,
   and therefore, the amount of meat eaten
   during the hot season should be less than
   that eaten during colder months.

   The meat packers, who directly support
   broadcasting through advertising, and
   whose financiers are also in many instances
   the financiers of the radio stations, immediately
   protested against the "erroneous"
   advice of the government. Shortly
   thereafter the Department of Agriculture
   attempted to alleviate any harm that had
   been done to the meat interests by broadcasting
   that meat makes a perfect hot-weather
   meal (p. 193).

Much of the other debate in radio broadcasting revolved around discussions of sexuality. According to Benjamin (2001) "in the late 1920s and early 1930s, sex, including honest references to reproduction, was an absolutely taboo radio subject" (p. 158). In November 1929, NBC refused to "broadcast addresses delivered at the National Birth Control Conference" ("Birth control body," 1930, p. 18).

A major controversy in 1934 revolved around Dr. Thomas Parran, then the New York State Commissioner of Health in 1930 and later U.S. Surgeon General in 1936 (Snyder, 1995). In 1934, Dr. Parran was scheduled to speak on CBS Radio about "'Public Health Needs'" ("Syphilis & radio," 1934, p. 48). When CBS officials learned that Dr. Parran intended to discuss syphilis, they asked him to "alter his prepared text to conform with what the company considered good public taste" ("Syphilis & radio," p. 48). When he refused, CBS played music instead of broadcasting his speech (Brandt, 1987; "Honi soit qui mal y pense," 1934; Snyder, 1995; "Syphilis & radio," p. 48).

According to Brindze (1937), Parran had planned to say the following:

   We have made no progress against syphilis,
   though its end results crowd our jails,
   our poorhouses and our insane asylums.
   Yet there are specific methods of controlling
   it, better known to science than the
   methods of controlling tuberculosis. We
   need only to do what we know how to do
   in order to wipe out syphilis as a public
   health problem. In my philosophy, the
   greatest need for action is where the greatest
   saving of life can be made. I consider
   then, that our greatest needs in public
   health are first, the levelling [sic] up of
   present services so that every Radio Coverage
   community may receive the benefits
   that have long accrued to the learners; and
   second, a frontal attack by all communities
   against maternal mortality and deaths
   among new-born infants; against dental
   defects and faulty nutrition; against tuberculosis,
   where splendid gains have been
   made; against cancer and syphilis where
   we have done little or nothing." (p. 187-188)

CBS explained its decision to keep Parran off the air this way:

   Editorial responsibility for what the Columbia
   Broadcasting System puts out over
   the air must be assumed, and is assumed,
   by Columbia itself. In deciding what is
   proper for us to broadcast, we must always
   bear in mind that broadcasting
   reaches persons of widely varying age levels
   and reaches them in family and social
   groups of almost every conceivable assortment.
   For this reason we do not believe
   that it is either wise or necessary to discuss,
   and sometimes even to mention,
   some things which may more properly be
   discussed in print, where each person may
   individually and privately concern himself
   with the subject ("Dr Parran quits council,"
   1934, p. 20; "Syphilis & radio," p.
   48).

Parran responded to CBS's comments by saying:

   A hopeful view of relief from their dangerous
   malady might be more welcome to
   the half million persons in the United
   States who acquire this disease each year
   than the veiled obscenity permitted by
   Columbia in the vaudeville acts of certain
   of their commercial programs ("Dr.
   Parran quits council," p. 20; "Honi soit
   qui mal y pense," p. 1031; "Syphilis &
   radio," p. 48).

Things began changing at the networks in terms of discussing sexually transmitted diseases in the late 1930's. In November 1937, NBC refused to allow General Hugh Johnson airtime "to read a prepared speech, which he had submitted in advance, because it was a discussion of the ravages of social disease" ("Johnson speech banned," 1937, p. 11). Later that month, however, NBC asked Dr. Morris Fishbein, editor of the Journal of the American Medical Association, to speak about STDs ("Gen. Johnson 'satisfied'," 1937). In response to NBC's invitation to Dr. Fishbein, General Johnson said that

      I intended to talk on the subject of
   social disease on my regular network
   broadcast. NBC would not permit me to
   do so. They now state that the highest
   authority should talk on it and, therefore,
   they got Dr. Morris Fishbein. This is satisfactory
   to me. I don't care who discusses
   venereal diseases with the radio audience
   as long as this subject is brought out into
   the open and given full discussion" ("Gen.
   Johnson 'satisfied'", p. 17).

In 1948, ABC Radio aired a series of programs about syphilis. This was "the first full network documentary on the problem of venereal diseases" ("VD," 1948, p. 9; see also Barnouw, 1948). The series was a collaboration between Columbia University and the United States Public Health Service (Barnouw, 1996; "Record Drive on VD,"1948). Originally, the programs were offered to NBC and then to CBS; both declined to air the programs. Eventually, the program was offered in 47 of the 48 states, excluding the state of Maine "which said it did not have a syphilis problem" (Barnouw, 1996, p. 104).

While radio programmers became more open regarding what could be aired as the century progressed, programmers still experienced problems regarding health-related topics. In 1989 ABC Radio began a program titled The American Agenda Radio Special (Lipman, 1989, p. B1). The program was intended to address various topics and would be hosted by different ABC News reporters. The first program, hosted by Barbara Walters, was about abortion. The network, however, had one difficulty, "advertisers [were] staying away from ABC's abortion program even though it [had] all the earmarks of a hit" (Lipman, p. B1).

20TH CENTURY RADIO AND HEALTH EDUCATORS IN THE 21ST CENTURY

Tapes and compact discs of radio broadcasts from the 1930's, 1940's and 1950's can be obtained and "used as teaching tools to learn about the period when radio was king" (Turner & Hickey, 1991, p. 6). Programs, newscasts and advertisements of the era can be played to provide students with insights into health issues of the time, how they were handled and how listeners might have responded to them. Yellow fever, penicillin's development and the use of DDT are among the topics that can be examined (see Grams, 1998 and Haendiges, 2002 for additional information about these and other programs). Newscasts may be difficult to obtain, but this idea could be applied to events such as early use of insulin as a treatment for diabetes, water fluoridation controversies, or the first kidney transplant (Means & Nolte, 1987).

A comparison of what topics could be discussed in radio programs and how what is permissible has (or hasn't) changed would be beneficial to students, especially when accompanied by a discussion of whether or not issues that cause controversy have changed. Partly in response to the Parran controversy mentioned earlier, a commentary appeared in Collier's in 1937 entitled "Are we a nation of prudes?" (p. 66). Harvey (1999) wrote that "the United States is among the more prudish of modern societies" (p. 48). Discussions about what topics could and could not be aired in the last century would help "students learn how radio reflected and influenced the tastes and even the moral character of the whole country" (Turner & Hickey, 1991, p. 6).

A discussion of how media (all media, not just radio) reflect our values today could also be held to discuss recent controversies such as the 2004 Super Bowl halftime where Justin Timberlake removed part of Janet Jackson's top and revealed her right breast, as well as the implications of this incident. Similarly, in February 2004 NBC deleted part of an ER episode where the breast of an older woman was visible (Bauder, 2004). In June 2004 MTV deleted a scene from the "2004 Movie Awards ... [where Eminem] pulled down his trousers and flashed his bare backside at the audience" ("Eminem's behind gets the boot," 2004, p. A-2). In October 2004 Howard Stern signed a contract effective starting in 2006 to leave broadcast radio for satellite radio. Satellite radio is not regulated by the Federal Communications Commission (FCC), though some radio executives recommend that satellite radio be regulated as well (McFeatters, 2004).

As television and radio programmers tighten standards and Congress and the FCC appear set to more strictly enforce regulations regarding indecency, points raised in Collier's in 1937 and by Harvey in 1999 are worthy of discussion (Ahrens, 2004; McFeatters, 2004), Are we a nation of prudes? What is prudishness and are the Super Bowl, ER and Eminem events examples? How does U.S. society compare to other societies in terms of what's considered acceptable? For most of the 20th century radio was a dominant mass medium. Radio broadcasts have served as "a major resource to inform and educate the public" about health (James, 1989, p. 66). Radio programs and commercials can be a valuable source of information to help students to comprehend how health issues were viewed in past decades.

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CHES AREAS

Responsibility 1--Assessing Individual and Community Needs for Health Education

Competency B--Distinguish between behaviors that foster and those that hinder well-being

Subcompetency 4--Analyze social, cultural, economic, and political factors that influence health

Alan J. Sofalvi, PhD is affiliated with the Department of Health at SUNY Cortland. Address all correspondence to Alan J. Sofalvi, PhD, Department of Health, SUNY Cortland, 104 Moffett, Cortland, NY 13045; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].