How informative on medical conditions and their treatments are black-oriented magazines compared to white-oriented magazines?

Abstract: Context: Racial disparities in health care between African-American women and whites may be attributed in part to socio-economic status or lack of insurance but also may be due to lack of the dissemination of medical information via black oriented magazines (BOM). Objective: Comparison of BOM vs. White-oriented magazines' (WOM) health sections. Design: Descriptive Study. Setting: Morehouse School of Medicine. Main Outcome Measures: Subjective critique of one issue of BOM vs. WOM and objective content analysis of four issues of BOM vs. WOM. Results: Five BOM (Black Woman, Ebony, Black Elegance, Upscale, Essence) and five WOM (Family Circle, Working Mother, Good Housekeeping, Ladies' Home Journal, Woman's Day) were evaluated. For one issue, excluding Essence, the cumulative subjective rating score given by four reviewers was two times higher for WOM vs. BOM. The content analysis revealed that WOM had health sections of longer length with more medical topics, no alcohol advertisements, and more health-related advertisements compared to BOM. Conclusions: The usual monthly health sections of BOM may not be giving the delivery of medical information to their readers as high a priority as articles on hairstyles, fashion, and dating issues. More emphasis needs to be placed on medical conditions and their treatments in BOM.

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Racial disparities in health care for African-American women is well-documented. Even though African-American women have a lower incidence of breast cancer compared to whites, they have a significantly worse prognosis when cancer develops. Moormeier (1996) anlayzed clinical studies and review articles describing breast cancer in women from the 1966 to 1995 Medline database. She found that the five year survival rate for African-American women was 64% compared to 80% in whites which has increased to 71% and 87%, respectively (ACS, 1999). There is still a significant difference between the survival rates of the two races, with African-American women still maintaining a worse prognosis. Furthermore, even when confounding factors such as socioeconomic status, insurance status, and disease stage are controlled, African-American women are still shown to have increased morbidity and/or mortality for certain diseases (Mayberry, et. al. 1999).

Manton, Patrick, and Johnson (1987) proposed that the presence of this racial disparity was partly due to African-Americans' inadequate knowledge of health care. For example, it has been shown that whites are more likely to receive health information on diabetes, even though African-American women are two times more likely than whites to be diabetic and 2 1/2 times more likely to experience a higher mortality (Shoenberg, 1998).

Media outlets such as television, computer, newspapers, and magazines play an important role in the transmission of medical information. In a study by Mosca et. al. (2000), a telephone survey was performed to determine women's health perception and knowledge of heart disease. The 1,000 respondents revealed that health information, specifically heart disease information, was most often obtained from magazines (43%) compared to television and health providers (24%, 18%, respectively). More "do not know" answers and incorrect answers measuring cardiovascular disease were seen in African-American women than whites. It is further stated that health information needs to be culturally relevant so that other races, besides whites, are better able to understand and be more likely to adhere to this health information.

Studies have been done evaluating popular white-oriented magazines (WOM) on health. Whelan (1992) reviewed 10 magazines and compared whether health issues discussed the most preventable deaths. Deaths due to cigarette smoking were being ignored because the magazines carried a total of 147 cigarette advertisements.

Through the years, WOM have evolved into reliable sources for health information. The American Council on Science and Health (ACSH) (Woznicki, 1996) has been evaluating magazines for their nutrition information for 15 years. It was concluded that the nutrition information had improved over this time period. Of the 21 magazines surveyed, most were given a rating of "excellent" or "good". None of these magazines surveyed consisted of the black-oriented women magazines (BOM) used in this study.

Earlier studies have been done evaluating BOM to WOM, in reference to health. A study done by Pratt, et. al. (1996) compared food and nutrition advertisements in BOM and WOM. More advertisements for alcohol than weight-control and nutrition were seen in the BOM compared to WOM.

The most recent study evaluating health information in BOM was done by Hoffman-Goetz (1997). The quantity of health information on cancer was measured for the period 1987 to 1994. A total of 595 magazines were reviewed. There were 84 cancer-related articles compared to 1,477 tobacco advertisements. It was concluded that more emphasis should be placed by these BOM on informing their large readership on cancer.

Previous studies have examined a few BOM for food and nutrition advertisements and articles on cancer. To-date, no studies have evaluated the health sections of BOM and compared those sections to WOM.

This research study will perform an objective content analysis on BOM in comparison to WOM, specifically examining each magazine's health sections from June thru September 2000. In addition, four reviewers will subjectively critique the health section of the May 2000 issue of selected BOM and WOM. This study is concerned with assessing whether BOM convey an adequate level of information in their health sections on diseases and medical conditions compared to WOM.

METHODS

The selection of magazines was based on three factors: the target population being predominately women, exclusion of magazines on fitness and health, and the easy accessibility in community neighborhood stores.

This study was designed to evaluate popular women magazine's usual monthly health section. Special health sections were excluded because analyzing the average delivery of health information was an important goal. Furthermore, topics on fitness were not accepted as a health topic because this study was concerned with whether the public was being informed about medical problems and/ or treatments, but not types of exercises.

The five black magazines chosen were Essence, Black Woman, Ebony, Upscale, and Black Elegance. The five white magazines chosen were Woman's Day, Ladies' Home Journal, Working Mother, Family Circle, and Good Housekeeping (Essence was not incuded in the four reviewers critique of the May 2000 issue because it had published a special health section for May 2000).

A two-page quantitative survey was devised to assess the clarity, quality, and quantity of the magazines' health section. The reviewer using a point system graded each magazine. For example, if the health section was considered to be clear, organized, and up-to-date, it was graded with I point. If it was not, then the health section was given 0 points.

After this study was approved for Internal Review Board exemption, four voluntary anonymous surveyors were chosen according to their profession and race. The surveyors consisted of one black male family physician, one white female family physician, one white, and one black female non-health professional (NHP). The diversity of the reviewers' race and gender was determined in order to add different perspectives to the reviewer's analysis. Each surveyor was blinded to which health section was being evaluated. Each magazine's health section was separated from the magazine and any references in the article to the name of the magazine were removed. Each reviewer was given a packet which consisted of one issue of the magazine's health section with an attached survey.

The survey given to the physicians differed slightly from the ones given to the NHPs and included questions about whether or not they felt their patients would benefit from the information provided in each magazine. Each was given a week to return the completed survey to the principal investigator (P.I.).

The objective content analysis was performed on four different issues by the principal investigator and research assistants. Four different variables were documented: number of health topics in the magazines' health section, percentage of the magazine reserved for the health section, number of health-related advertisements in the entire magazine, and number of alcohol-related advertisements.

RESULTS

The circulation and cost of each magazine is shown in Table 1. Average national circulation was obtained from Magazine Publishers of America which was calculated from either Business Publications Auditing International or Audit Bureau of Circulation data for 1998. The price of the BOM ranged from $2.50 to $3.99 compared to the WOM price range of $1.49 to $2.99.

As shown in Table 2 for one issue, survey rating was performed by four different individuals. The average or mean of the numerical ratings for each individual is included. The range gives the lowest number rating given by the reviewer compared to the highest number rating assigned for that particular group of magazines. A consistent decrease in the ratings is demonstrated when comparing the WOM to the BOM health sections. When looking at the cumulative score, WOM received a two times higher rating than BOM. The content analysis of BOM vs. WOM of four issues measured four different points (see Table 3). The first point looks at the percentage of the total magazine making up the health section. It was found that most WOM were more likely to have a larger health section.

The second point analyzed in the health sections was to compare the number of medical topics between magazines. The number of medical topics in a monthly magazine's health section was counted. Again, WOM had as many topics or more than the BOM.

The third and fourth point was to look at advertisements related to health or alcohol. The number of health advertisements, including ads targeted to weight loss, dental hygiene, and low-cholesterol foods was evaluated each month. The data shows the greater number of health-related advertisements were found in WOM. With regards to alcohol sales, no WOM within the four months had any alcohol advertisements compared to the presence of the advertisements in most of the BOM.

DISCUSSION

The data presented has shown a distinct difference between BOM vs. WOM, regarding their emphasis on medical conditions. Most WOM compared to several BOM were found to: be less expensive, have more in-depth health sections and more medical topics, have no alcohol advertisements, and have more health-related advertisements. The subjective critique of one issue gave a two times lower subjective point rating to BOM vs. WOM. Black-oriented magazines in this study appear to provide less positive health advertisements and carry more alcohol-related ads than WOM.

The implications of the results of this study center around the delivery of medical knowledge to the layperson. It is concerning that BOM in their average monthly health sections may not be placing as much emphasis on medical conditions as on hairstyles, fashion, and dating issues. More emphasis needs to be placed on medical conditions and treatments in BOM. According to Mosca et. al. (2000), popular magazines are used as a significant source of health information for women. Black-oriented magazines may be ignoring an opportunity to provide medical informaiton to its readers.

In summary, the usual monthly health section in BOM combined with their type of advertisements may not be delivering an adequate monthly message to African-American women about medical problems, diseases, and treatments. Black-oriented magazines need to increase the number of medical topics with a more thorough evaluation of medical conditions. Health-related advertisements need to be increased and alcohol advertisements need to be eliminated.

Table 1. Circulation and Cost of Black-Oriented and White-Oriented
Magazines.

Black-Oriented Magazines (BOM)    Circulation    Cost in Dollars

  Black Woman *                   1.00 million         3.99
  Ebony                           1.80 million         2.50
  Black Elegance *                0.37 million         3.99
  Essence                         1.00 million         2.75
  Upscale *                       1.2 million          2.75

White-Oriented Magazines (WOM)

  Family Circle                   5.00 million         1.49
  Working Mother                  0.82 million         2.99
  Good Housekeeping              >4.00 million         1.95
  Ladies Home Journal            >4.00 million         2.49
  Womans Day                     >4.00 million         1.49

* Circulation data obtained by telephone contact.
Table 2. Reviewer's Subjective Point Rating of BOM vs. WOM Health
Section, May 2000.

                           BOM               WOM
                       Mean   Range      Mean    Range

White Female NHP        3.0   1.0-5.0    13.6    5.0-25.0
Black Female NHP       10.0   8.0-12.0   14.4    10.0-18.0
Black Male Physician   11.4   0.0-26.0   23.6    8.0-31.0
White Male Physician    9.5   1.0-22.0   19.6    5.0-29.0

Total Mean              8.5              17.8

NHP=Non-Health Professional
Table 3. Content Analysis of Health Section in BOM vs. WOM.

                                       BOM              WOM
                                   Mean   Range     Mean   Range

Number of Pages                     1.9   0.6-2.8    3.0   0.8-7.2
Number of Medical Topics            3.7   1.0-6.0    6.1   1.0-11.0
Number of Health Advertisements     2.7   0.0-9.0    9.5   3.3-33.0
Number of Alcohol Advertisements    1.4   0.0-7.0    0.0      --

REFERENCES

American Cancer Society (1999). Female Breast in Cancer facts and figures available from: URL:http://www3.cancer.org/cancerinfo/ sitecenter.asp?ctid=8&scp=0&scss=0&scdoc=40000.

Hoffman-Goetz, L., Gerlack, K.K., Marino, C., Mills, S. L. (1997). Cancer coverage and tobacco advertising in African-American popular magazines. Journal of Community Health, 22(4), 261-269.

Manton, K., Patrick, C., Johnson, K. (1987). Health differentials between Blacks and Whites: Recent trends in mortality and morbidity. Milbank Quarterly, 65 (Suppl. 1), 129-199.

Mayberry R.M., Mili F., Vaid, I.G.M., Samadi, A.,, Ofili, E.,, McNeal, M.S. (1999). Racial and ethnic differences in access to medical care. Henry J. Kaiser Family Foundation; October.

Moormeier, J. (1996). Breast cancer in black women. Annals of Internal Medicine, 124,897-905.

Mosca, L., Jones, W. K., King, K., B., Ouyang, P., Redberg, R. F., Hill, M. N. (2000). Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. Archives of Family Medicine, 9, 506-515.

Pratt, C.A., Pratt, C.B., Montague, S.N., Salazar, J.C., Graves, M.C. (1996). Do popular magazines promote weight-control messages? Implications of weight-control advertisements for the health of African American women. Howard Journal of Communications, 7(4),349-364.

Schoenberg, N. E., Amey, C. H., Coward, R. T. (1998). Diabetes knowledge and sources of information among African American and white older women. Diabetes Educ May-Jun;24(3),319-324.

Whelan, E. M. (1992). Inverted Priorities; Health Hazards in Women's Magazines. Priorities for Health 4(4),11.

Woznicki, D. Nutritional Accuracy in Popular Magazines (Jan. 1995-Dec. 1996). New York: American Council on Science and Health; 1996.

Shakoora Omonuwa, M.D., F.A.A.F.P. and DiAnne Bradford, Ph.D. are with the Morehouse School of Medicine. Address all correspondence to Dr. Omonuwa at the Department of Family Medicine; Morehouse School of Medicine; 505 Fairburn Road, S.W.; Atlanta, GA; Ph: 404.616.2886; Fax: [phone]; Email: [e-mail].