2.AIDS at 21 Media Coverage of the HIV Epidemic 1981 2002 Supplement to the March April 2004 Issue...

7/21/2019 2.AIDS at 21 Media Coverage of the HIV Epidemic 1981 2002 Supplement to the March April 2004 Issue of CJR (1)

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Princeton SurveyResearch AssociatesInternational

too t e . . y surprise in t e 1980s, an it continues to e a

ea t epi emic wit unique c aracteristics. s a news topic,

as not on y een a ea t story, ut a so one a out arts, cu ture, ta oo,

sexua ity, re igion, ce e rity, usiness, an po itics on t e oca , nationa , an

global stage. Media coverage of the HIV/AIDS epidemic has, at times, helped

shape the policy agenda, while also reecting current policy discussions,debates and important events. In many cases, the news media have served as

an important source of information about the epidemic for the public. In an

October 2003 survey by the Kaiser Family Foundation, 72% of the U.S. public

sai t at most o t e in ormation t ey get a out comes rom t e

me ia, inc u ing te evision, newspapers, an ra io

Recently, there has been a growing discussion about the scope and focus of

news coverage of HIV/AIDS by the U.S. news media. Questions have been

raised about whether there is AIDS fatigue on the par t of media organizations.

Journalists report great di culty in persuading their news organizations to run

HIV/AIDS stories. Critics say coverage of global HIV is inadequate and coverageof the HIV epidemic in the United States is disappearing. Some also question

t e a ance o topics covere in news, particu ar y wit regar to coverage

o treatment versus prevention. t ers say t at, in act, t ere ave een ew

un amenta y new scienti c eve opments in t e epi emic recent y, an

t at or t e most part, is not news.

Over the last few years, there has also been a decline in the share of the U.S.

public viewing HIV/AIDS as the nations most urgent health problem (see Public

Opinion side box). It is di cult to measure a cause-eect relationship between

public opinion and media coverage. Yet, the old adage that the media doesnt

tell the public what to think, but does tell them what to think about, suggests

t at ec ining coverage o in t e news mig t ave some re ations ip

to t e pu ics ec ining perception o t e urgency o t e pro em. timate y,

coverage o y mainstream news me ia serves as one important

gauge o ow prominent t e issue is on t e po icy an cu tura agen a o t e

nation, an ow overa attention to t e epi emic as c ange over time, ot

in terms of quantity and content.

The Kaiser Family Foundation, in conjunction with Princeton Survey Research

Associates, conducted a comprehensive examination of media coverage of

HIV/AIDS over the 22-year time period from the rst news reports in 1981

t roug ecem er 2002. is stu y see s to answer questions suc as: as

amount o coverage o t e epi emic increase or ecrease over time ow

ave t e topics covere c ange ow a s coverage o in t e . . are

What about coverage of the global epidemic? How often do stories strive to

educate the public about transmission, prevention, testing, and treatment?

What is the balance of optimism versus pessimism in AIDS coverage? Are thimportant dierences between print and broadcast coverage?

AIDS at 21: Media Coverage of the HIV Epidemic 1981-2002

Mollyann Brodie, Ph.D. Vice President, Director, Public Opinion and Media Research, Kaiser Family FoundationElizabeth Hamel, Senior Research Associate, Kaiser Family Foundation

Lee Ann Brady, Senior Project Director, Princeton Survey Research Associates International

Jennifer Kates, M.A., M.P.A., Director, HIV Policy, Kaiser Family Foundation

Drew E. Altman, Ph.D. President, Kaiser Family Foundation

Publ c Op n on: The proportion of Americans naming HIV/AIDS as the nations numbe

one health problem has been steadily declining over time (Chart 1). In 1987, nearly

seven in ten Americans (68%) named HIV/AIDS as the most urgent health problem

facing the nation in an open-ended question, and it ranked as the number one cited

problem through 1997. By 2002, 17% named HIV/AIDS in the same question, as mor

responses focused on cancer, health care costs, health insurance, and access to health

care. Americans are now more likely to name HIV/AIDS as the most urgent healt

problem facing the world than as the most urgent health problem facing the nation

Chart 1. Percent nam ng HIV/AIDS as the most urgenthealth problem facing the nation/world

0%

10%

0%

0%

40%

50%

0%

Oct-87 Jan-90 Nov-95 ep-97 ug-00 Jun-02

Sources: Gallup Poll Oct-1987; Kaiser Family Foundation surveys 1990-2002

4%

26%

17%

33%37%

...the world

...the nation

Kaiser Family Foundation Health Poll Reportsurvey, conducted October 3-5, 2003.

49%

6

Pe

rcentnamingHIV

upp ement to t e arc pri 2004 issue o o um ia ourna ism e


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2

This number is likely to be a slight underestimate, since not all media sources were included in the earliest years of the study see Methodology section for full details.

The analysis presented here is based on a sample of more than 9,000 total

news stories from major U.S. print and broadcast sources, including four

major national newspapers (The New York Times, he Wall Street Journal,

The Washington Post, and USA Today , three major regional papers in areas

particularly hard-hit by the HIV/AIDS epidemic (the San Francisco Chronicle

The Miami Heraldand the Los Angeles Times , and three major network news

programs or ews onig t, vening ews, an ig t y ews .

tories were a so co e rom e on on imes or comparison to . . print

me ia. ote: a n ings re er to coverage rom . . me ia out ets on y, un ess

ot erwise note .

The study covers the time period from 1981 through 2002. For ease of reporting

ndings, certain years were grouped together according to stages and key

events in the epidemic. The groupings used throughout this report are:1981 1986: Early years of the epidemic, the Reagan years

1987 1990: Increased attention to epidemic, advent of AZT, rst Bush presidency

1991 1995: Magic Johnson and Arthur Ashe, Clinton presidency

1996 1999: Introduction of protease inhibitors, more people living with HIV/AIDS

2000 2002: Increased attention to the global epidemic, second Bush presidency

Volume of Coverage Over Time and Key Events

Since the late 1980s, there has been a decrease in total media coverage

o . uring t e 22-year time perio rom 1981 to 2002, t ere were

more t an 41,000 news stories a out in t e se ecte me ia out ets,

inc u ing over 39,000 print stories an more t an 2,000 roa cast stories . or

t e newspapers an roa casts inc u e in t is stu y, tota coverage o

increase uring t e ear y 1980s, pea e at over 5,000 stories in

1987, and declined steadily to fewer than 1,000 stories in 2002. While this

decline in coverage follows a similar pattern to the number of new AIDS cases

being diagnosed in the U.S. (Chart 2), the decline in media coverage began

about 6 years before the decline in cases, and continued even as the cumulative

number of AIDS cases diagnosed in the U.S. rose above 500,000 (Chart 3).

Minor peaks in coverage after 1987 were driven by major developments in t

epi emic, occurring in 1991 agic o nsons announcement t at e was

positive), 1996 (the introduction of highly active antiretroviral therapy), and

2001 (increased attention to the global epidemic).

Coverage reected key news-generating events.Media coverage of

genera y re ecte ey events t at ave occurre over t e istory

o t e epi emic a e 1 . n t e ear y 1980s, me ia coverage o was

ominate y t e initia reports o gay pneumonia 83% o stories

in 1981; 50% in 1982 , stories a out an t e country s oo supp y(peaking at 15% of stories in 1985), the closing of San Francisco bathhouses

(13% in 1984), and the Reagan administrations response to AIDS (6% in

1983). Between 1987 and 1990, there was not a single major story that

dominated media coverage, though there was continued coverage of the

Reagan administrations response (8% of stories in 1987), as well as coverag

of the introduction of AZT (5% in 1989) and the International AIDS Conferen

in an rancisco 7% in 1990 . etween 1991 an 1995, t e iggest

news story was agic o nsons announcement t at e was positive

16% o stories in 1992 . is time perio a so inc u e coverage o tennis

p ayer rt ur s es eat rom 5% o stories in 1992 , t e inton

ministrations response to t e isease 5% in 1993 , an stories a out

HIV/AIDS and U.S. immigration (5% in 1993). Beginning in 1996, coverage

began to focus on the introduction of protease inhibitors and combination

therapy to treat people with HIV (13% of stories in 1997), as well as Magic

Johnsons return to professional basketball (5% in 1996), continued coverag

of the Clinton Administrations response (6% in 1997), and increasing attent

to internationa con erences 6% in 1996 an 1998; 8% in 2000; 11% i

2002 . ina y, etween 2000 an 2002, t e ocus o me ia covera

s i te to t e emerging stories o in rica pea ing at 14% in 200

t e e ate over rug prices an patents 12% in 2001 ; an t e o a un

ig t , u ercu osis an a aria 6% in 2001 .

While those who closely follow the AIDS epidemic and even some who donot will remember these key events, its important to note that most of th

stories did not account for more than one to two percent of coverage overal

uring t e 22-year time perio agic o nson accounte or t e ig est s

o overa coverage at 3% . n a ition to news-generating events, t ere we

a ew ot er recurring t emes t at i not emerge or ominate in any partic

year, ut i account or sma ut signi cant s ares o coverage overa ,

inc u ing iving wit 5% overa , an t e oo supp y 4%

international AIDS conferences (3%), AIDS activism (2%), and AIDS vaccine

development (2%).

Other stories that might have been expected to emerge as key news-generaevents never garnered more than 5% of HIV media coverage in any given ye

inc u ing stories a out yan ite, an n iana teenager wit emop i ia w

contracte an oug t to e a owe to atten pu ic sc oo pea ing at

3% in 1986 ; t e inci ent in ori a in w ic t e ay ami y was urne out

o t eir ome pea ing at 3% in 1987 ; t e e ms amen ment pea ing at

1% in 1986 ; t e ationa ommission on pea ing at 2% in 1989, 199

and 1992); the case of Kimberly Bergalis, who contracted HIV from her dent

(peaking at 4% in 1991); World AIDS day (peaking at 4% in 1994 and 1998);

and the Presidential Advisory Council on HIV and AIDS (peaking at 1% in 199

and 1998).

Chart 2. Total number of HIV/AIDS news stor es n selected

med a outlets and number of new U.S. AIDS cases d agnosed by year

urce: Centers for Disease Control and Prevention.

000

000

000

000

000

1981

1982

1983

198

1985

1986

1987

1988

1990

1991

1992

1993

199

1995

1996

1997

1999

2000

2002

10

0

0

0

0

0

NumberofAIDScases(thousands)

Number of HIV/AIDSnews stor es

Number of new U.S.AIDS cases diagnosed *


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ent/Recurring Theme 1 98 1 19 82 19 83 1 98 4 1 985 19 86 1 98 7 1 988 19 89 1 99 0 1 99 1 19 92 1 99 3 1 99 4 19 95 19 96 1 99 7 19 98 19 99 2 00 0 2 001 20

tial CDC Reports 83% 50% 4% 3% 1%


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hart 5. Total number of HIV/AIDS news stor es

with domestic vs. global focus by year

000

000

000

000

000

000

1982

1983

1984

1985

1986

1987

1989

1990

1991

1992

1993

1995

1996

1997

2001

2002

Total number of HIV/AIDSstories

Stories with U.S.

perspective only

Stories with at least someglobal perspective

Percentofstorie

1981

198

198

1986

1987

1988

1990

1991

1992

199

1996

1997

1998

1999

2000

2001

20%

30%

40%

60%

70%

80%

90%

10%

0%

U.S. perspective only At least some global perspective Percent of stories with non-U.S

hart 4. Number of HIV/AIDS stories per month,

w th nternat onal AIDS conference months h ghl ghted

00

00

00

00

Jan-

85

Jan-

86

Jan-

87

Jan-

88

Jan-

89

Jan-

90

Jan-

91

Jan-

92

Jan-

93

Jan-

94

Jan-

95

Jan-

96

Jan-

97

Jan-

98

Jan-

99

Jan-

00

Jan-

01

Jan-

02

A r-85

Jun-86

un-

Jun-88Jun-89

Jun-90

Jun-91Jul-92

Jun-93

ug-Jul-96

Jun-98Jul-00

Jul-0

Over time, international AIDS conferences have increasingly become a

key news-generating event. Coverage of international AIDS conferences

ccounted for 3% of all HIV/AIDS news stories, and represented an increasing

hare of coverage over time. News coverage of such conferences accounted for

% of stories in 1996 and 1998, 8% in 2000, and 11% in 2002 (Table 1). This

increase was main y riven y roa cast coverage re ate to t e con erences;

uc coverage accounte or 36% o a roa cast coverage o in

002. er aps more important y, tota me ia coverage o increase

igni cant y uring mont s in w ic t e con erences occurre art 4 .

The number of HIV/AIDS news stories in months in which international AIDS

onferences took place was on average 48% higher than the average number

f stories per month in a given year. World AIDS Day was less of a driver ofoverage, with the average number of stories in December each year being

roughly equivalent to the average number of stories per month for that year.

Domestic Versus International Focus of Coverage

There has been a recent increase in coverage of the global epidemic an

simultaneous decline in domestic coverage. Media coverage of HIV/A

was mainly U.S.-focused throughout this 22-year time period, with 94% of

ll stories having a U.S. dateline, and 86% presenting a U.S.-only perspectiv

eginning in t e ate 1990s, t ere was a signi cant increase in coverage

presenting a g o a perspective, wit a simu taneous ec ine in coverage o

omestic story art 5 an art 6 . etween 1997 an 2002, t e num er

tories in t e se ecte me ia out ets presenting at east some g o a perspeincreased 118% from 177 to 386, while the number of stories with a U.S.-on

perspective decreased 57% from 1227 to 527. By 2001 and 2002, more tha

ne in ve HIV/AIDS news stories had a non-U.S. dateline, and more than 40

presented at least some global perspective.

e recent ncrease n g o a coverage was ma n y r ven y roa cas

news. roug out t e time perio , an particu ary etween 2000 an

002, roa cast news stories were more i e y to present a g o a perspecti

than print news. From 1981 through 1999, 17% of broadcast news stories

had at least some global perspective, compared with 12% of newspaper

tories. During 2000-2002, 62% of broadcast stories had at least some glob

perspective, compared with 40% of newspaper stories. Broadcast stories d

this time period were also somewhat more likely to have a non-U.S. datelin(25% of broadcast versus 18% of print).

n a ition to i erences etween roa cast an print news, t ere were a s

i erences in . . versus g o a perspectives among t e i erent newspap

amp e . mong newspaper stories, nationa y ocuse papers 19%

were more likely than regionally focused papers (11%) to include a global

perspective, particularly during 2000-2002 (49% of coverage in nationally

focused papers versus 30% in regionally focused papers presented a global

perspective in 2000-2002).

hart 6. Percent of stor es w th U.S. vs. global perspect ve

nd percent with non-U.S. dateline by year


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n or er to provi e an in ication o t e i erences etween . . an uropean

coverage in terms o ocus on t e g o a epi emic, we inc u e 610 stories

rom e on on imesin a comparison samp e or t e same time perio .

roug out t e time perio , coverage in e on on imeswas more i e y t an

U.S. print coverage to present a global perspective. Overall, 36% of on on

imescoverage presented a non-U.K. perspective, compared with 14% of total

U.S. print coverage (and 19% of coverage by nationally focused U.S. papers)that presented a non-U.S. perspective. Similarly, 14% of London Timescoverage

had a non-U.K. dateline, compared with 6% of total U.S. print coverage

(and 7% of coverage by nationally focused U.S. papers) that had a non-U.S.

ate ine. uring 2000-2002, . . print coverage was more simi ar to on on

imescoverage in t e amount o g o a perspective presente . n t ese years,

48% o on on imesstories presente a non- . . perspective, compare wit

40% o tota . . print coverage an 49% o coverage in nationa y ocuse

U.S. papers) that presented a non-U.S. perspective. At the same time, 27% of

London Timesstories had a non-U.K. dateline, compared with 18% of total U.S.

print coverage (and 22% of coverage in nationally focused U.S. papers) that had

a non-U.S. dateline.

ortraya o ecte opu at ons

ortraya o t e a ecte popu at on a so s te towar s a

g o a ocus. irroring t e s i t in coverage towar s t e g o a epi emic,

there was a decrease over time in the focus of media coverage on the U.S.

population as the aected population. Between 1981 and 1986, 18% of stories

focused on the U.S. population as the aected population, compared with 10%

between 2000 and 2002. During this same time frame, there was an increase in

focus on the world population as the aected population (2% to 6%), as well as

non-U.S. populations in general (2% to 7%), and African (1% to 19%) and Asian


6/86

hart 7. Percent of optimistic/pessimistic

tories by period and media type

% 20% 0% 0% 80% 100%

roadcast

Printroadcast

Print

roadcast

Print

roadcast

Print

roadcast

Print

ptimistic Neutral Pessimistic

ver time, t ere were ec ines in stories a out transmission 17% in 1981-

1986 to 3% in 2000-2002 , socia issues suc as iscrimination an ousing

(15% to 4%), and HIV testing (7% to 2%). At the same time, there was a large

increase in stories about government funding/nancing for HIV/AIDS (7% to

18%), including the cost of prescription drugs (


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was possible to be infected by touching a toilet seat . oo ing at coverage

over the entire time period, 36% of stories included at least some consumer

information/education component, though most of these (27% of all

stories) included information/education just as a passing reference. Of those

stories that had at least some educational component, 18% were about HIV

prevention and protection, 13% were about research, another 13% were about

transmission, 10% were a out socia issues suc as iscrimination an stigma,

an t e remain er were a out a variety o ot er topics.

ver time, t e percentage o stories containing at east some consumer

education declined. The period with the highest proportion of stories

containing consumer education was 1981-1986, when 48% of stories contained

an educational component. This proportion fell to 37% in 1987-1990, and has

since declined steadily to 30% in 2000-2002.

CONCLUSIONS

ne o t e main questions raise a out me ia coverage o in recent

years is w et er t ere as een me ia atigue in covering t e story. ase on

this study, some might argue that such fatigue did in fact occur, as evidenced

not only by a decline in the total number of stories over time, but also by the

decreased reporting on the domestic epidemic. This decline coincided with

a change in the nature of the HIV/AIDS epidemic in the U.S. from an absolute

death sentence to a chronic disease that more people live with and manage

day to day. Others might argue that this does not amount to AIDS fatigue, and

in act it is t e usua an customary news practice to ocus on ot er t ings

w en an epi emic switc es to a g o a ocus, w en t ere are no major new

eve opments in terms o vaccines an treatment, an w en t e epi emic

a ects a sma an increasing y margina ize popu ation in t e . . e

challenge for journalists covering HIV/AIDS is to nd new ways to keep their

audience engaged in a story that may not meet editorial standards for new

clearly as it once did.

Perhaps a more important trend is the decrease in the number of stories wit

a consumer education component in recent years. This nding is particularl

istur ing w en consi ering t e ac o now e ge a out transmission

cite a ove, an a so w en compare wit t e act t at t e num er o newcases iagnose in t e . . increase 2.2 percent in 2002 accor ing to

, t e rst increase since 1993, an new in ections in t e . . remain

40,000 annually. In addition, while the majority of new HIV infections in th

U.S. occur in people under the age of 25, only 1% of stories in the 2000-2002

time period focused on teenagers and young adults. Though AIDS is now

the leading cause of death among African Americans ages 25 to 44, and they

represent the majority of new HIV infections, only 2% of stories during this t

period focused on African Americans. These ndings raise the ever-present

question o t e appropriate ro e o journa ists, especia y in t e context o a

pu ic ea t epi emic: to w at extent o t e me ia ave a responsi i ity to

e ucate t e pu ic, as oppose to ocusing on y on reporting t e news

For those who would worry about AIDS fatigue, some encouragement can

be found; the data suggest that the news organizations have responded to

signicant changes in the HIV/AIDS epidemic, particularly since 2000. New

stories have emerged, including AIDS in Africa and worldwide eorts to gh

the global epidemic, as well as the emergence of HIV/AIDS as a business sto

an a po itica story. e ocus on t e g o a epi emic is particu ar y import

given its enormity an growing impact in many parts o t e wor . is cou

signa a re irt o t e story, wit a i erent ocus. owever, eeping som

ocus on t e omestic epi emic w i e te ing t ese an ot er new stories w

remain a challenge for journalists competing for limited news space.

Chart 8. Distribution of HIV/AIDS stories by

newspaper sect on over t me

10%

0%

0%

45%

- - - - -

5%

22% 22%

28%8%

2%

6%7%

13%

7%

8%

0%

9%

4%

4%

0%

7%

Percentofnewspaperstor

ies

2%

11%

Metro/Local/Regional

Business

age ne

Style/Life

Sports

National/International

Kaiser Family Foundation National Survey of Americans on HIV/AIDS, conducted August 14-October 26, 2000.


8/88

4Obituaries were excluded from the sample if AIDS was simply included as the cause of death, but were included if part of a larger news event (i.e. the death of a prominent HIV/AIDS activist). Unfortunately, this limits the abilit

this analysis to comment on whether it became more acceptable over time to list AIDS as the cause of death in obituaries.

Media sources were selected to present a meaningful assessment of content

presented by news outlets widely available to the public. Selections were

made on both a geographic and a demographic basis, as well as diversity of

ownership.

r nt sources

ources c osen: e ew or imes, e a treet ourna e as ingtonost, an o aywere se ecte to represent pu ications most i e y to e

circulated among policy makers and the public on a nationwide basis. The os

Angeles Times, The Miami Herald, and theSan Francisco Chroniclewere selected

to provide an examination of how coverage might or might not have diered

between and among distinct metropolitan areas that were particularly hard-hit

by the HIV/AIDS epidemic. The London Timeswas selected to provide a contrast

etween . . news me ia an a non- . . pu ication. ote: un ess ot erwise

note , a n ings inc u e ere are ase on . . me ia sources on y.

uant cat on an amp ng: ssessment egan y quanti ying t e artic es

that appeared in each publication from January 1, 1981 through December

31, 2002. The LEXIS-NEXIS database was used to quantify coverage for all

publications except The Wall Street Journalfor which the Dow Jones DataBase

was utilized, and The Miami Heraldwhich was accessed via the DIALOG

database. Search language was designed to cast the widest net possible in

order to capture pertinent stories (search terms included not only AIDS and

, ut a so terms suc as aposis sarcoma, an com inations o gay or

omosexua wit cancer, sarcoma, virus, etc. in or er to capture stories

pu is e e ore t e terms an were wi e y use .

e ew or imes e as ington ostan e a treet ourna were

accessible via electronic database searches for the complete timeframe. The

San Francisco Chronicleis also included for the entire 1981-2002 study period,via a combination of NEXIS searches and the papers in-house archives. Other

papers were phased-in based on availability as follows: Miami Herald(1983);

e on on imes 1985 ; os nge es imes 1985 ; o ay 1989 .

n or er to reac t e project target t at 90% o a cases e rawn rom print

sources, a strati e samp ing p an was imp emente . ecause t e amount

of coverage was limited during earliest part of the studys timeframe, and the

number of searchable newspapers was limited, all stories available during that

period (1981-1984) were selected for full coding. During peak years of coverage

(1985-2000), sample was constructed by selecting every 7th story within each

newspaper. For the remaining years (2001-2002), story selection was returnedto total-universe levels, and all stories for all newspapers were selected.

creen ng an nc us on: ewspaper stories were rst screene or inc usion.

a se rops, etters to t e e itor, news igests, etc. were remove rom t e

samp e . ac case was t en examine to etermine w et er or not

topics and issues were prominently featured within the story. When necessary,

coders used the following rule to make those decisions: If 50% or more of the

article was direct reporting on HIV/AIDS topics, that story was included/fully

coded; or if 33% of the article plus the headline (not the sub headline) was

direct reporting on HIV/AIDS topic, that story was included/fully coded. The

resulting newspaper sample totaled 8,783 stories.

roa cast sources

uant cat on an amp ng: roa cast news stories rom or

ews onig t, vening ews, an ig t y ews were acquire romt e an er i t niversity e evision ews rc ives. o review a stories t a

appeared January 1, 1981 - December 31, 2002, the Vanderbilt Archives we

searched for all stories where the index monograph included the terms HIV

or AIDS. Supplemental searches were applied to the 1981-1984 database,

utilizing the following additional search terms: gay and cancer, gay and vir

homosexual and cancer, homosexual and virus, Karposi, pneumocystis

cytomega ovirus or ymp a enopat y . is resu te in a tota universe

o 2,522 stories. ecause networ news programs pro uce a re ative y sma

num er o stories as compare to t eir newspaper counterparts, a ig er

percentage o stories were se ecte or t e samp e. it an esta is e targ

of 10% of the projects total sample to be drawn from broadcast sources, all

stories available during the earliest part of the studys timeframe (1981-198

were selected. To construct the sample for the remaining years (1985-2002

every 3rd story was selected.

Screening and Inclusion: After viewing by senior sta, false hits were

e iminate using t e esta is e inc usion ru e. e resu ting networ new

samp e tota e 882 stories.

e g t ng an ata na ys s

Prior to data analysis, cases representing the 1985-2000 sample were weigh

in order to bring those years up to full value in the dataset. The analysis citethis report is based on the weighted dataset.

nterco er re a ty

nterco er re ia i ity measures t e extent to w ic co ers, operating

autonomous y, co e or c assi y t e same story in t e same way. nterco er

reliability tests were performed throughout this study, with senior sta acti

as the control coder; no signicant dierences were found to exist on a recu

basis. Selected stories were double-coded in their entirety, and overall

intercoder reliability exceeded 85% for all variables.

The Kaiser Family Foundation is a non-prot, private operating foundation

e icate to provi ing in ormation an ana ysis on ea t care issues to

po icyma ers, t e me ia, t e ea t care community, an t e genera pu ic.

e oun ation is not associate wit aiser ermanente or aiser n ustries.

Additional copies of this publication (#7023) as well as topline results (#702

and a full methodology report (#7026) are available on the Kaiser Family

Foundations website at www.k.org.

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