Significado clínico de un Índice Tobillo-Brazo elevado

Agenda Setting is a theory of media effects developed by mass communication scholars to explain the process of political and social change as influenced by mass media content. Rogers and Dearing explain agenda setting simply as the process of influence in American democracy; the study of agenda setting is the study of social and political change or stability.[12] Agenda setting tells us that the amount and nature of news media content – generated frequently by media advocacy activities - is a contributor to public attitudes and opinions[44] which also influence the public policy process. More broadly, a media effects framework studies the attitudinal, behavioral and knowledge outcomes of mass media themes, symbols and images.[45] As shown in Figure 2.2, the agenda setting process has three main components: the media agenda, the public agenda and the policy agenda.

The media selects, defines, emphasizes and covers issues (themedia agenda), which then influence public priorities, beliefs and opinions (the public agenda) and, in turn, policy considerations, decision-making, implementation and adoption (the policy agenda). The process is both linear and reciprocal: the media agenda directly influences the public agenda and the policy agenda, the public agenda mediates the relationship between the media agenda and the policy agenda, and the policy agenda influences the media agenda. Within the

agenda-setting system, people are not passive consumers of information but rather active seekers and users of information; a relationship also exists between media audiences – the public, and their agenda - and the media themselves (arrows not shown in model). A seminal agenda-setting study was conducted in Chapel Hill, NC by McCombs and Shaw during the 1968 Presidential election: findings from 100 personal interviews and an analysis of local news media content indicated a strong positive (0.967) correlation between issues covered in the media and the issues the voters said were ‘important’;[46] hundreds of agenda-setting studies have been published since.[12]

Additional factors play a role in the agenda setting process, as shown in Figure 2.3: gatekeepers and focusing events, interpersonal communications, and real-world indicators. Gatekeepers of the media agenda include media leadership, sponsors and editorial staff, each with unique values, routines and cultures that allow or disallow and shape news content.[44] Focusing events also influence the agenda: these are rare events that reveal harm or potential harm to society and may be especially problematic for specific population groups or

geographic areas.[47] Further, focusing events prompt changes in the issues present on the media, public and policy agendas, and mobilize interest groups to either expand or contain the issue.[47] Next, interpersonal communication (e.g. education of journalists by health

advocates) can dictate the salience, or relative importance, of issues and events throughout the agenda-setting process. Among the general population, the process of engaging in interpersonal communication about a topic on the media agenda can make the topic more personally relevant or place it firmly on the public agenda; also, interpersonal

communication among elite people can facilitate the inclusion of topics into the public and policy agendas.[48, 49] Finally, real-world indicators play a role in the development of media, public and policy agendas. Real-world indicators are objective measures of the severity or risk of an agenda issue, event or social problem.[12] For example, in tobacco control, results of population-based studies indicating tobacco consumption rates among children or billions of dollars spent on tobacco-related health care costs annually are a real- world indicators of the problem.

Public health advocates must engage in the agenda setting system, because it has profound potential to impact health policies and behaviors. The mass media play a powerful role in establishing issues or problems as important in the eyes of the public.[45] People and institutions, either for, against, or neutral to health promoting initiatives, shape the media, public and policy agendas by producing focusing events and real-world indicators that identify and define problems, and through prompting conversations and experiences (e.g., agenda-setting events) that increase the salience of issues. In applied practice, public health workers use media advocacy to garner media attention, partner with the media to serve as news sources, work with concerned citizen coalitions to define issues and solutions, and employ persuasive communication strategies such as framing to package issues in

meaningful ways.[45] Of course, other community groups, businesses and institutions also compete for time and attention within the media agenda. The problems that are identified in

the media agenda are constructed by society and reflect this competition between varying stakeholders.[13, 46] This mass media push-pull, therefore has the power to either advance or detract from the sociopolitical changes needed to improve health.

A series of factors play a role in whether issues that surface on the media agenda are translated to the public and policy agendas. First, stories with higher prominence in the paper are perceived as more important;[46] prominence has to do with the location of the story within the paper, story length, and whether or not the story includes an image or graphic.[50] Second, content framing, meaning the way an issue is described or packaged as it is being communicated[51] provides meaning around an issue and has implications for how the issue is interpreted,[52, 53] the extent to which an issue is supported by the public and decision makers,[52] and the solutions that are implied.[22] Often, public health advocates and the tobacco industry vie for shaping a discussion in hopes that audiences remember the issue, identify with it, and share the view of one side of the argument or the other. Third, an

important tool for promoting policy changes is the presence of public health advocates in the media as sources who shape the discussion.[7, 13] A source is a person or organization who gives information to news reporters, who is often explicitly identified, either by quote or paraphrase.[54] Sources of interest in tobacco policy debates include: educational institution, health care provider, public health advocacy or nonprofit group, community member/citizen, government/health department official, tobacco retailer, tobacco industry. Fourth, stories with a higher amount of information within the story encourage greater learning on the part of the public.[46] The use of research or evidence in either a narrative or data-driven format can support the diffusion of health policies[55, 56] by helping to characterize the problem and solutions.[57] For example, the presentation of relevant research evidence can properly

identify a problem, aid in the development of solutions, and improve knowledge and support from policymakers.[50, 58] Fifth, the extent to which articles are developed with local quotes and local story angles also shapes support from the public and policy makers.[50, 58]

Frames, the presence of sources, the use of narrative and data-driven research evidence, and the degree of localization can also impact the overall slant of an article, either positive or negative for tobacco control efforts.[59, 60] In sum, many characteristics of news coverage (the media agenda) have the potential to contribute to the ultimate success or failure of health policy interventions. Persuasive, impactful media coverage impacts public opinions and policy development: this is the agenda-setting function of the mass media. For public health researchers, then, measuring the media agenda via content analysis is a first step in studying an agenda setting process to promote health.[54]

2.4 Measuring the Media Agenda: Content Analysis of Newspaper Coverage of Tobacco