Politics, propaganda, and public health a case study in health communication and public trust

Politics, Propaganda, and Public Health LEXINGTON STUDIES IN HEALTH COMMUNICATION Series Editors: Leandra H Hernández and Kari Nixon National and international governments have recognized the importance of widespread, timely, and effective health communication, as research shows that accurate, patient-centered, and culturally competent health communication can improve patient and community health care outcomes This inter-disciplinary series examines the role of health communication in society and is receptive to manuscripts and edited volumes that use a variety of theoretical, methodological, interdisciplinary, and intersectional approaches We invite contributions on a variety of health communication topics including but not limited to health communication in a digital age; race, gender, ethnicity, class, physical abilities, and health communication; critical approaches to health communication; feminisms and health communication; LGBTQIA health; interpersonal health communication perspectives; rhetorical approaches to health communication; organizational approaches to health communication; health campaigns, media effects, and health communication; multicultural approaches to health communication; and international health communication This series is open to contributions from scholars representing communication, women’s and gender studies, public health, health education, discursive analyses of medical rhetoric, and other disciplines whose work interrogates and explores these topics Successful proposals will be accessible to an interdisciplinary audience, advance our understanding of contemporary approaches to health communication, and enrich our conversations about the importance of health communication in today’s health landscape Recent Titles in This Series Politics, Propaganda, and Public Health: A Case Study in Health Communication and Public Trust By Laura Crosswell and Lance Porter Communication Studies and Feminist Perspectives on Ovarian Cancer By Dinah Tetteh Reifying Women’s Experiences with Invisible Illness: Illusions, Delusions, Reality Edited by Kesha Morant Williams and Frances Selena Morant Politics, Propaganda, and Public Health A Case Study in Health Communication and Public Trust Laura Crosswell and Lance Porter LEXINGTON BOOKS Lanham • Boulder • New York • London Published by Lexington Books An imprint of The Rowman & Littlefield Publishing Group, Inc 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowman.com Unit A, Whitacre Mews, 26-34 Stannary Street, London SE11 4AB Copyright © 2018 by The Rowman & Littlefield Publishing Group, Inc “Inoculating the electorate: a qualitative look at American Corporatocracy and its influence on health communication” by L Crosswell and L Porter, 2016, Critical Public Health, 26(2), p.207–220 Copyright 2016 by Taylor & Francis Reprinted [or adapted] with permission http://www.tandfonline.com All rights reserved No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the publisher, except by a reviewer who may quote passages in a review British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Names: Crosswell, Laura, author | Porter, Lance, 1969- author Title: Politics, propaganda, and public health : a case study in health communication and public trust / Laura Crosswell and Lance Porter Description: Lanham : Lexington Books, [2018] | Series: Lexington studies in health communication | Includes bibliographical references and index Identifiers: LCCN 2018011190 (print) | LCCN 2018011813 (ebook) | ISBN 9781498553001 (Electronic) | ISBN 9781498552998 (cloth : alk paper) Subjects: | MESH: Pharmaceutical Preparations—economics | Direct-to-Consumer Advertising | Health Knowledge, Attitudes, Practice | Health Communication—methods | Patient Acceptance of Health Care | United States Classification: LCC HF6161.D7 (ebook) | LCC HF6161.D7 (print) | NLM QV 736 AA1 | DDC 659.19/61510973—dc23 LC record available at https://lccn.loc.gov/2018011190 The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences— Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992 Printed in the United States of America Contents Contents Acknowledgments Preface The Doctor, the Baker, and the Medicine Maker An American System of Pharmaceutical Influence Deconstructing Merck’s Awareness Campaign Social Trust and Public Health Consumer Perspectives Pharmaceutical Conglomerates and American Politics Global Implications of American Medicalization The Genderization of a Vaccination Conclusion References Appendix A: Commercial Transcripts for Pre-FDA Messages Appendix B: Moderator Guide for U.S Focus Groups Appendix C: Additional Material/Questions for International Focus Groups Appendix D: Moderator Guide for Co-Ed Marketing Focus Groups Appendix E: Demographic Survey for all Focus Groups Appendix F: Eye Tracking Materials About the Authors Acknowledgments We would first and foremost like to thank Lexington Books for giving us a platform to share our work and thoughts on commercial influence in the health care industry Specifically, we would like to acknowledge our acquisitions editor, Nicolette Amstutz, and her assistants, Jessica Thwaite and James Hamill, as they were instrumental in bringing this book to fruition We would also like to thank the proofreaders at Lexington Books, as well as our anonymous peer reviewers for their valuable contributions during the revision and editing process This work would not have been possible without the help and support from the Reynolds School of Journalism at the University of Nevada, Reno, and the Manship School of Journalism at Louisiana State University We’d specifically like to thank the Center for Advanced Media Studies at the Reynolds School and the Mary P Poindexter Professorship in the Manship School, for providing us with funding for this book’s production In addition, we would like to express our appreciation to the LSU Media Effects Lab for the administration of our experiments We also want to extend our sincere thanks to our colleagues, supervisors, and mentors for offering us guidance, advice, and feedback throughout the publication process We would like to acknowledge the editors at Critical Public Health and Taylor and Francis Material included in chapter of this book originally appeared in Critical Public Health and is reprinted here with their permission (Inoculating the electorate: a qualitative look at American corporatocracy and its influence on health communication, by L Crosswell and L Porter, 2016, Critical Public Health, 26(2), p 207–220 Copyright 2016 by Taylor & Francis Reprinted [or adapted] with permission www.tandfonline.com) We thank both parties for allowing us to include our previously published work in this book The authors would also like to thank Dr Meghan Sanders for her work on the original publication of the data in chapter (Crosswell, L., Porter, L & Sanders, M., 2018) Out of sight, out of mind?: Addressing unconscious brand awareness in healthcare communication In H D O’Hair, [Ed.] Risk and health communication in an evolving media environment, New York: Routledge) Additionally, we extend our sincerest gratitude to Kristi Barber for her copyediting work and moral support during each stage of the manuscript’s development We would also like to thank Joel DesOrmeau for his extensive proofreading and Kari Barber for her help with photo editing and image resizing Finally, we would like to thank our families and friends for their unconditional love, support, and patience as we worked to finish this book We could not have done it without you Preface In his book Land of Desire, William Leach traces the conception of America’s consumption-based culture back to the 1800s The author documents the cultural rise of consumer capitalism in the United States and exposes ways in which consumer-oriented institutions, democratized desire, and customer imagination shape societal values Mirroring Leach’s concern for America’s consumer-driven ethos, this book takes an in-depth look at commercialized health messaging and the commodification of public health as it relates to the free market enterprise Politics, Propaganda, and Public Health examines the profit-driven agendas, non-branded marketing strategies, and consumer influences that induce public trust toward commercial interests Specifically, we investigate the ways in which Merck Pharmaceuticals engineered public understanding of the human papillomavirus (HPV) and cervical cancer through social marketing and product advertising In examining Merck’s campaign as it relates to American capitalism, and more closely investigating the vested interests feeding public awareness efforts, we attend to the social, political, and commercial agendas driving today’s health care communication Big Pharma spends more money on advertising and lobbying than it does on researching medicine to improve public health (Kantar Media, 2017; The Pew Charitable Trusts, 2017; Grantham, Ahern, & Connolly-Ahern, 2010; Jaramillo, 2006) Yet, surprisingly, the commercialization of public health is an under-examined topic Politics, Propaganda, and Public Health investigates Merck’s promotional messaging for the Gardasil vaccination as it relates to the medicalization process; a practice in which health-related risks serve as marketing platforms for pharmaceutical companies At its most basic level, this work offers a multifaceted look at how one pharmaceutical company gradually entered and quickly controlled a vaccination market Concrete examples and case-specific findings showcase the bigger picture, pointing to the commoditization, politicization, and medicalization of public health Merck’s pioneering promotional strategies, combined with the unique nature of the vaccination (a preventative treatment for a sexually transmitted infection) and an unconventional target market (young girls), make this case an appropriate one to analyze as we examine the changing nature of pharmaceutical marketing in the United States By deconstructing Merck’s issue awareness efforts, the launch of the Gardasil vaccination, and the company’s ensuing lobbying strategies, we address commercial agents that go far beyond the face value of standard product advertising Politics, Propaganda, and Public Health attends to symbiotic agents that regulate public health messaging, and ultimately, issues a call for regulation realignment in the health care industry BOOK OUTLINE In light of the paradigm shifts taking place in both academia and industry, Hartley (2012) suggests that fields related to media and cultural studies re-direct focus toward the means and mechanisms of change; centering an analytical lens on the overall dynamics of systems This book pieces together the various ways in which Merck Pharmaceuticals engineered public understanding of HPV and cervical cancer, while drawing attention to the cultivated commercialization of public health Through blended methodologies, each chapter forges a globalized understanding of how corporatized health communication and capital interests shape consumer perceptions, public trust, citizen efficacy, and legislative policies In the early chapters of this work, we orient the reader with key terms, principal concepts, regulation development, and company history We then more fully introduce the campaign under investigation following Hall’s (1977) method of textual analysis By stripping campaign messages down to fundamental elements of marketing semantics, we provide the groundwork for a basic, but imperative, understanding of Merck’s health messages Subsequent focus groups consider current trends in health care communication and the implications of mixed-marketing models guiding public awareness efforts Eye tracking analysis later documents ways in which brand fixations correlate with attitudes toward awareness messages Through within-subject investigative design, we compare physiological indicators of attention with self-reported measurements of awareness We conclude this body of work with in-depth interviews that more closely examine the role corporate funding plays in legislation, regulation, and voter/consumer behavior This final phase of research brings our investigation full circle, showcasing the underlying nuances of product industry, government agency, and consumer capitalism In sum, this book takes on multiple forms of research methods, data analysis, and writing styles; all of which contribute to the crystallization of our broader argument (Richardson, 2000) As author and researcher Laura Ellingson (2005) explains, holistic approaches to extensive, in-depth research involve “collecting the data, making sense of them, and then writing about them; these processes not occur in a linear fashion, but are interwoven” (p.155) Indeed, each chapter of our text embraces its own style and format, and through the inclusion of varied accounts and sociopolitical issues, we present the reader with a triangulated, or interwoven, interpretation of Politics, Propaganda, and Public Health Our journey begins in chapter 1, in which we establish the foundation, direction, and context for the case at hand Chapter One The Doctor, the Baker, and the Medicine Maker A dominant force in American culture, media act as both an economic and cultural institution; creating marketable enterprises and social meaning through mass messaging systems (Cook, 2005) Guided by the “invisible hand,” U.S media nourishes consumer capitalism through advertiser-supported content, and as a powerful social educator, advertising defines cultural norms and constructs social realities (Buchanan, 2001) Therefore, as a profit-making business and a producer of meaning, the influences of the U.S media system go far beyond commercial interests, penetrating the core layer of societal operations and human functioning America’s free market enterprise and dual-product marketplace provide fertile ground for the commercialized exploitation of public health For example, pharmaceutical advertising, also known as direct-to-consumer advertising (DTCA), serves as both a major source of funding for the American media system and a major source of health information for the U.S public As one of only two Western countries to allow pharmaceutical advertising (New Zealand being the other), the United States spends more on marketing prescription drugs than most countries spend on administering medicine, with expenditures totaling $5.4 billion in 2015 alone Notably, Americans also spent a record $457 billion on prescription drug medications that same year (Llamas, 2016) Health communication in the United States is largely a commercial enterprise, with many Americans learning about important health issues through paid pharmaceutical advertisements (Donohue, 2006) The system encourages intense competition among pharmaceutical companies to bring drugs to market quickly with the most effective marketing communication plans The question is, successful paid media campaigns bring about effective health communication? Public opinion is divided Proponents of DTCA claim pharmaceutical messages help publicize available treatments for underreported conditions, such as depression (Sorofman, 1992) Others point out that prescription drug advertising predominantly relies on emotional claims rather than quantitative data; presenting consumers with vague and misleading information (Frosch, Krueger, Hornik, Cronholm, & Barg, 2007; Woloshin, Schwartz, Tremmel, & Welch, 2001) Indeed, direct-toconsumer advertising is a topic ripe for discourse, as it unites matters of public health, consumer culture, and a dual-product marketplace While supporters suggest DTCA promotes a more educated, healthier society, increasing overall consumer welfare (Mukherji, Raman, Dutta, & Rajiv, 2017), critics argue such commercialized health communication drives consumer demand and ultimately shifts the physician-patient relationship to a physician-consumer relationship (Bradley & Zito, 1997) Though the controversy surrounding direct-to-consumer advertising is complex, it is certainly not new Debates over prescription drug advertising date back to the 1970s, when a trajectory of U.S Supreme Court cases drew attention to issues related to commercial canvassing, regulatory intervention, and First Amendment violations (Beales & Muris, 1993; Perri, Shinde, & Banavali, 1999; Bates v State Bar of Ariz., 433 US 350—Supreme Court 1977; Bigelow v Virginia, 421 U S 809, 421 U.S 817–818l; Virginia Pharmacy Board v Virginia Consumer Council, 425 U.S 748) Appendix D Moderator Guide for Co-Ed Marketing Focus Groups The following questions will be asked prior to playing the commercials: What is your current understanding of HPV? What you know about the Gardasil vaccination? What benefits/deterrents come to mind when considering vaccination? The following questions will be asked after viewing each of the three commercials: Overall, what did you take away from this message? Do you think this message successfully communicated the HPV health issue? What specific elements helped you understand the issue? Was there a certain visual image that stood out in your mind? Do you think the actors/actresses were appropriate for this commercial? Why/why not? If you were to improve one aspect of the message, what would it be? The following questions will be asked after all three ads have been played: Read prior to questions: For the most part, discussions related to HPV and the Gardasil vaccination have remained gendercentric, with regulations and marketing efforts largely focused on the female demographic Recently, the Advisory Committee on Immunization Practices (ACIP) recommended Gardasil as a routine vaccination for boys aged 11–12 What are your opinions regarding this issue? Of the three commercials you just viewed, which you feel most strongly communicated the HPV health threat? Please explain the reasoning behind your choice Did the co-ed marketing approach effectively appeal to both men and women? Before viewing these ads, did you consider the vaccination to be appropriate for both boys and girls? How would you rate the overall effectiveness of the HPV/Gardasil campaign? What would you suggest changing to improve viewer’s understanding of the health risk? Does health care advertising influence your communication with your health care professional? Is so, to what degree? Does Gardasil’s association with Merck Pharmaceuticals influence your confidence in the vaccination’s ability to prevent HPV? Why or why not? If so, in what ways? Is there anything else anyone would like to add to the discussion? Appendix E Demographic Survey for all Focus Groups DEMOGRAPHIC SURVEY (Distribute Upon Conclusion of Focus Group Discussion) Your Age: Your Gender: Your Race: □ Asia-Pacific Islander □ African-American □ Hispanic □ White, non-Hispanic □ Native-American □ Other _ Prior to your participation in this study, had you heard of the Gardasil vaccine? □ Yes □ No □ Not sure If you answered yes to the above question, from which sources have you learned about the Gardasil vaccine? (Please check all that apply) □ Television ad □ Website □ Physician □ Friends/Family □ Other _ Have you received at least one of the three recommended Gardasil vaccination shots included in Merck’s HPV inoculation series? Yes No Not sure Prefer not to answer Have you received all three shots included in Gardasil’s vaccination series? Yes No Not sure Prefer not to answer If you received only part of the three-shot series, please indicate your reason for not completing the vaccination schedule (only provide a response if you feel comfortable answering the question) Which of the following best characterizes your sexual activity? □ Have never been sexually active □ Have been sexually active in the past, but not currently □ Currently sexually active □ I prefer not to answer this question Appendix F Eye Tracking Materials PRE-EXPOSURE SURVEY Participant Number Are you a smoker? □ Yes □ No During a typical week, you have more than three alcoholic beverages a week? □ Yes □ No □ Not Sure Have you heard about any foods that might help prevent heart disease or heart attacks? □ Yes □ No □ Not Sure Have you heard about any foods that might help prevent cancer? □ Yes □ No Have you heard of the Gardasil vaccine? □ Yes □ No □ Not Sure If No is selected, then skip to: Have you heard anything about cancer From which sources have you learned about the Gardasil vaccine? (Please check all that apply) □ Television ad □ Website □ Physician □ Friends/Family □ Other Have you heard anything about cancer being related to things people eat or drink? □ Yes □ No In the past 12 months, have you experienced any health problems that you thought might be related to any dietary supplements you took? □ Yes □ No □ Not Sure On a scale of to 10, how familiar are you with (Please click and drag the marker to indicate level of familiarity—10 being the most familiar) The Human Papillomavirus Rotavirus Virus Influenza Virus Herpes simplex Virus Please rank the following terms from highest to lowest (1 being the highest, being the lowest) based on how often you hear them used in casual conversations (click and drag to rank) Cervical Cancer Colon Cancer Lung Cancer Skin Cancer Please rank the following illnesses from highest to lowest (1 being the highest, being the lowest) based on how heavily you believe they are covered in the media (click and drag to rank) Cervical Cancer Colon Cancer Lung Cancer Skin Cancer Please rank the following cancers from highest to lowest (1 being the highest, being the lowest) based on how often they seem to appear in social awareness/preventative marketing campaigns (click and drag to rank) Cervical Cancer Colon Cancer Lung Cancer Skin Cancer Please rank the following cancers from highest to lowest (1 being the highest, being the lowest) based on how prevalent you believe them to be (click and drag to rank) Cervical Cancer Colon Cancer Lung Cancer Skin Cancer On a scale of to 10 (1 being the lowest, 10 being the highest), how concerned are you with contracting the following (please click and drag the marker to indicate level of concern): The Human Papillomavirus Rotavirus Virus Influenza Virus Herpes simplex Virus Cervical Cancer Colon Cancer Lung Cancer Skin Cancer Your Age: Gender □ Male □ Female Ethnicity (Check all that Apply): □ Asia-Pacific Islander □ African-American □ Hispanic □ White, non-Hispanic □ Native-American □ Other Which of the following best characterizes your sexual activity? □ Have never been sexually active □ Have been sexually active in the past, but not currently □ Currently sexually active □ I prefer not to answer this question POST-EXPOSURE SURVEY Participant Number How carefully did you pay attention to the messages you just watched? When you were watching the messages, what were you thinking of? Circle one number on each line below that best describes how you feel about the messages you just watched Numbers “1” and “5” indicate strong feelings; boxes “2” and “4” indicate weaker feelings; and box “3” indicates that you are undecided Bad: Good ○ ○ ○ ○ ○ Low Quality: High Quality Not Credible: Credible Truthful: Deceptive Unethical: Ethical Effective: Ineffective ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ The “Make the Connection” message was the first video played, and featured Kimberly Elise talking to young women about the connection between HPV and cervical cancer On a scale of 1–5, I felt that the “Make the Connection” message was To what extent did you find the message easy to follow? □ Not at all easy to follow □ Moderately easy to follow □ Very easy to follow Are you aware of any organizations/companies sponsoring the awareness message? If yes, please indicate the name(s) of organizations/companies you recognized □ Yes □ No Please list the visual images you most clearly remember from the “Make the Connection” message The “Tell Someone” message was the second video you viewed, and featured many different women encouraging viewers to tell someone about the connection between HPV and cervical cancer I felt that the “Tell Someone” message was Bad: Good Low Quality: High Quality Not Credible: Credible Truthful: Deceptive Unethical: Ethical Effective: Ineffective ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ To what extent did you find the message easy to follow? □ Not at all easy to follow □ Moderately easy to follow □ Very easy to follow The advertisement caused me to think carefully about the Gardasil vaccine □ Strongly Agree □ Agree □ Neutral □ Disagree □ Strongly Disagree Are you aware of any organizations/companies sponsoring the awareness message? If yes, please indicate the name(s) of organizations/companies your recognized □ Yes □ No Please list the visual images you most clearly remember from the “Tell Someone” message The third message you viewed, “One Less,” was a commercial for the cervical cancer vaccination, Gardasil The video featured many differed women and girls encouraging women to become one less cervical cancer statistic by getting the vaccination I felt that the “One Less” advertisement was Bad: Good Low Quality: High Quality Not Credible: Credible Truthful: Deceptive Unethical: Ethical Effective: Ineffective ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ To what extent did you find the message easy to follow? □ Not at all easy to follow □ Moderately easy to follow □ Very easy to follow The advertisement caused me to think carefully about the Gardasil vaccine □ Strongly Agree □ Agree □ Neutral □ Disagree □ Strongly Disagree Are you aware of the company promoting the vaccination advertisement? If yes, please indicate the name of the company you recognized □ Yes □ No Please list the visual images you most clearly remember from the “One Less” advertisement The final message you viewed, “I Chose,” was also a commercial promoting the cervical cancer vaccination, Gardasil The video featured many differed women and girls explaining why they chose to get vaccinated I felt that the “I Chose” advertisement was Bad: Good Low Quality: High Quality Not Credible: Credible Truthful: Deceptive Unethical: Ethical Effective: Ineffective ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ To what extent did you find the message easy to follow? □ Not at all easy to follow □ Moderately easy to follow □ Very easy to follow The advertisement caused me to think carefully about the Gardasil vaccine □ Strongly Agree □ Agree □ Neutral □ Disagree □ Strongly Disagree Are you aware of the company promoting the vaccination advertisement? If yes, please indicate the name of the company you recognized □ Yes □ No Please list the visual images you most clearly remember from the “One Less” advertisement Now, think back to the first advertisement you watched (“Make the Connection”) Do you recall seeing any of the sponsorships listed below? Please check all that apply □ Pfizer □ GlaxoSmithKline □ Merck & Co □ Johnson & Johnson □ Women’s Step Up Network □ American Cancer Society □ Susan G Komen Breast Cancer Foundation □ Cervical Cancer Foundation Again, think back to the second advertisement you watched (“Tell Someone”) Do you recall seeing any of the sponsorships listed below? Please check all that apply □ Pfizer □ GlaxoSmithKline □ Merck & Co □ Johnson & Johnson □ Women’s Step Up Network □ American Cancer Society □ Susan G Komen Breast Cancer Foundation □ Cervical Cancer Foundation Finally, think back to the last advertisement you watched (“One Less”) Do you recall seeing any of the sponsorships listed below? Please check all that apply □ Pfizer □ GlaxoSmithKline □ Merck & Co □ Johnson & Johnson □ Women’s Step Up Network □ American Cancer Society □ Susan G Komen Breast Cancer Foundation □ Cervical Cancer Foundation On a scale of one to five, I feel that the Gardasil vaccine is Bad: Good Effective: Ineffective Worthwhile: Worthless Unwise: Wise Harmful: Beneficial ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ After seeing these advertisements, please indicate how likely you are to the following: Search for more information about the Gardasil vaccine Talk to my friends about the Gardasil vaccine Talk to my physician about the Gardasil vaccine Talk to my significant other about the Gardasil vaccine Get the Gardasil Vaccine for myself Recommend the Gardasil vaccine to others Very Unlikely ○ Somewhat Unlikely ○ Unsure ○ Somewhat Likely ○ Very Likely ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Please answer the flowing questions to complete this survey Your Age: _ Gender □ Male □ Female Your Race: □ Asia-Pacific Islander □ African-American □ Hispanic □ White, non-Hispanic □ Native-American □ Other Which of the following best characterizes your sexual activity? □ Have never been sexually active □ Have been sexually active in the past, but not currently □ Currently sexually active □ I prefer not to answer this question Prior to your participation in this study, had you heard of the Gardasil vaccine? □ Yes □ No □ Not Sure If you answered yes to the above question, from which sources have you learned about the Gardasil vaccine? (Please check all that apply) □ Television ad □ Website □ Physician □ Friends/Family □ Other Have you received the Gardasil vaccine? □ Yes □ No □ Received one or two of the scheduled vaccinations, but have not completed the vaccination cycle □ Prefer not to answer If you did receive a part of the injection cycle, but never completed the full vaccination, please indicate reasons for not completing the entire round of inoculations On a scale of one to five, I feel that the Gardasil vaccine is Bad: Good Effective: Ineffective Worthwhile: Worthless Unwise: Wise Harmful: Beneficial ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Screen shots of scenes and AOIs for With-in Subject Eye Tracking Design Heatmap (left) and Cluster (right) Fixation Visualizations About the Authors Laura Crosswell is an assistant professor of health communication at the University of Nevada, Reno She holds a joint appointment between the Reynolds School of Journalism and the University of Nevada, Reno School of Medicine, and also serves as the assistant director for the Center for Advanced Media Studies at the Reynolds School Laura’s research focuses on the physiological, psychosocial, and cultural influences of media content She specifically concentrates on politicized and commercialized public health communication, and the implications of message framing on citizenry, society, and human behavior Laura currently resides in Reno, Nevada, with her husband and their two adorable dogs Lance Porter is the F Walter Lockett Distinguished Professor of Mass Communication at Louisiana State University and the founding director of the Social Media Analysis and Creation (SMAC) Lab With more than 25 years of marketing experience, Lance has focused on digital media since 1995, when he built his first commercial website Before coming to LSU, Lance spent four years as executive director of digital marketing for Disney There he oversaw the creative and media strategies for more than 80 films He currently teaches courses in emerging and social media His research focuses on the cultural effects of social media He holds a joint appointment with the interdisciplinary Center for Computation and Technology (CCT) where he is the focus area lead in cultural computing Lance currently lives in Baton Rouge, Louisiana, with his wife and their two daughters He plays lead guitar for the Rakers ... Politics, Propaganda, and Public Health: A Case Study in Health Communication and Public Trust By Laura Crosswell and Lance Porter Communication Studies and Feminist Perspectives on Ovarian Cancer... rhetorical approaches to health communication; organizational approaches to health communication; health campaigns, media effects, and health communication; multicultural approaches to health communication; ... Politics, propaganda, and public health : a case study in health communication and public trust / Laura Crosswell and Lance Porter Description: Lanham : Lexington Books, [2018] | Series: Lexington