The H1N1 pandemic: media frames, stigmatization and coping

BMC Public Health

Kasisomayajula Viswanath²  Sara Minsky²  Michael McCauley¹ 

[1] Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;Department of Social and Behavioral Sciences, Harvard School of Public Health and Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA

关键词: Stress and coping;    Stigmatization;    Latinos;    Media frames;    Communication;    H1N1;   

Others  :  1161515
DOI  :  10.1186/1471-2458-13-1116

 received in 2013-09-06, accepted in 2013-11-25,  发布年份 2013

【 摘 要 】

Background

Throughout history, people have soothed their fear of disease outbreaks by searching for someone to blame. Such was the case with the April 2009 H1N1 flu outbreak. Mexicans and other Latinos living in the US were quickly stigmatized by non-Latinos as carriers of the virus, partly because of news reports on the outbreak’s alleged origin in Mexican pig farms.

Methods

In this exploratory study we examined the psychological processes of cue convergence and associative priming, through which many people likely conflated news of the H1N1 outbreak with pre-existing cognitive scripts that blamed Latino immigrants for a variety of social problems. We also used a transactional model of stress and coping to analyze the transcripts from five focus groups, in order to examine the ways in which a diverse collection of New England residents appraised the threat of H1N1, processed information about stereotypes and stigmas, and devised personal strategies to cope with these stressors.

Results

Twelve themes emerged in the final wave of coding, with most of them appearing at distinctive points in the stress and coping trajectories of focus group participants. Primary and secondary appraisals were mostly stressful or negative, with participants born in the USA reporting more stressful responses than those who were not. Latino participants reported no stressful primary appraisals, but spoke much more often than Whites or Non-Hispanic Blacks about negative secondary appraisals. When interactions between participants dealt with stigmas regarding Latinos and H1N1, Latinos in our focus groups reported using far more negative coping strategies than Whites or Non-Hispanic Blacks. When discussions did not focus on stereotypes or stigmas, Latino participants spoke much more often about positive coping strategies compared to members of these same groups.

Conclusions

Participants in all five focus groups went through a similar process of stress and coping in response to the threat of H1N1, though individual responses varied by race and ethnicity. Stigmatization has often been common during pandemics, and public health and emergency preparedness practitioners can help to mitigate its impacts by developing interventions to address the social stressors that occur during outbreaks in highly-localized geographic regions.

【 授权许可】

   
2013 McCauley et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Pappas G, Kiriaze II, Giannakis P, Falagas ME: Psychosocial consequences of infectious diseases. Gin Microbiol Infect 2009, 15:743-747.
• [2]Wagner-Egger P, Bangerter A, Gilles I, Green E, Rigaud D, Krings F, Staerkle C, Clemence A: Lay perceptions of collectives at the outbreak of the H1N1 epidemic: heroes, villains and victims. Public Underst Sci 2011, 20:461-476.
• [3]Alexander B: Amid Swine Flu Outbreak, Racism Goes Viral: Anti-immigrant Hatred Spreads on Talk Radio, Websites. http://www.nbcnews.com/id/30467300/ns/health-cold_and_flu/t/amid-swine-flu-outbreak-racism-goes-viral/ webcite
• [4]Barrett R, Brown PJ: Stigma in the time of influenza: social and institutional responses to pandemic emergencies. J Infect Dis 2008, 197(Suppl 1):S34-S37.
• [5]Schoch-Spana M, Bouri N, Rambhia K, Norwood A: Stigma, health disparities, and the 2009 H1N1 influenza pandemic: how to protect Latino farmworkers in future health emergencies. Biosecur Bioterror 2010, 8:243254.
• [6]Washington J: Immigration Foes Link Flu to Mexican Threat Claims. http://seattletimes.com/html/health/2009163038_apusswinefluimmigrationdebate.html webcite
• [7]DeBruin D, Liaschenko J, Marshall MF: Social Justice in pandemic preparedness. Am J Public Health 2012, 102:586-591.
• [8]Blumenshine P, Reingold A, Egerter S, Mockenhaupt R, Braveman P, Marks J: Pandemic influenza planning in the United States from a health disparities perspective. Emerg Infect Dis 2008, 14:709-715.
• [9]U.S. Centers for Disease Control and Prevention: 2009 H1N1 and Seasonal Influenza and Hispanic Communities: Questions and Answers. http://www.cdc.gov/h1n1flu/qa_hispanic.htm webcite
• [10]Hennessy-Fiske M: H1N1 Death Rates Higher For Some Ethnic and Racial Groups in California: Latinos, Blacks and Native Americans in the State have been More Likely to Die from Swine Flu than Whites, Data Show. http://articles.latimes.com/2010/jan/15/local/la-me-h1n1-stats15-2010jan15 webcite
• [11]Blake KD, Blendon RJ, Viswanath K: Employment and compliance with pandemic influenza mitigation recommendations. Emerg Infect Dis 2010, 16:212-218.
• [12]Kumar S, Quinn SC, Kim KH, Daniel LH, Freimuth VS: The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the, H1N1 pandemic. Am J Public Health 2009, 2012(102):134-140.
• [13]Dovidio JF, Gluszek A, John MS, Diltman R, Lagunes P: Understanding bias toward Latinos: discrimination, dimensions of difference, and experience of exclusion. J Soc Issues 2010, 66:59-78.
• [14]Guyll M, Madon S, Prieto L, Schen KC: The potential roles of self-fulfilling prophecies, stigma consciousness, and stereotype threat in linking Latino/a ethnicity and educational outcomes. J Soc Issues 2010, 66:113-130.
• [15]Reynolds B: Crisis and emergency risk communications: countering stigmatization. CDC Podcast Transcripthttp://www2c.cdc.gov/podcasts/media/pdf/H1N1_CERC_Stigma.pdf webcite
• [16]Scheufele DA: Framing as a theory of media effects. J Commun 1999, 49:103-122.
• [17]McCauley MP, Blake KD, Meissner HI, Viswanath K: The social group influences of US health journalists and their impact on the newsmaking process. Health Educ Res 2013, 28:339-351.
• [18]World Health Organization: Global Alert and Response (GAR): Global Outbreak Alert & Response Network. http://www.who.int/csr/outbreaknetwork/en/ webcite
• [19]Abraham T: The price of poor pandemic communication. BMJ 2010, 340:c2952.
• [20]Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO: Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognit Ther Res 2011, 36:210-218.
• [21]Goodall C, Sabo J, Cline R, Egbert N: Threat, efficacy, and uncertainty in the first 5 months of national print and electronic news coverage of the H1N1 virus. J Health Commun 2012, 17:338-355.
• [22]Savoia E, Testa MA, Viswanath K: Predictors of knowledge of H1N1 infection and transmission in the U.S. population. BMC Public Health 2012, 12:328. BioMed Central Full Text
• [23]World Health Organization: Implementation of the International Health Regulations (2005): report of the review committee on the functioning of the International Health Regulations (2005) in relation to pandemic (H1N1) 2009. In Sixty-Fourth World Health Assembly. Geneva: World Health Organization; 2011. http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf webcite
• [24]Dawood FS, Iuliano AD, Reed C, Meltzer MI, Shay DK, Cheng PY, Bandaranayake D, Breiman RF, Brooks WA, Buchy P, Feikin DR, Fowler KB, Gordon A, Hien NT, Horby P, Huang QS, Katz MA, Krishnan A, Lal R, Montgomery JM, Molbak K, Pebody R, Presanis AM, Razuri H, Steens A, Tinoco YO, Wallinga J, Yu H, Vong S, Bresee J, Widdowson MA: Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis 2012, 12:687-695.
• [25]Viboud C, Simonsen L: Global mortality of 2009 pandemic influenza A H1N1. Lancet Infect Dis 2012, 12:651-653.
• [26]Richt JA, Webby RJ, Kahn RE: The Pandemic H1N1 Influenza Experience. Curr Top Microbiol Immunol 2013, 365:269-279.
• [27]Harvard School of Public Health: Survey Finds nearly Half of Americans Concerned They Or Their Family May Get Sick From Swine Flu. HSPH News Press Release; 2009. http://www.hsph.harvard.edu/news/press-releases/survey-americans-concerned-swine-flu/ webcite
• [28]Phelan JC, Link BG, Dovidio JF: Stigma and prejudice: one animal or two? Soc Sci Med 2008, 67:358-367.
• [29]Cho J, de Zuniga HG, Shah DV, McLeod DM: Cue convergence: associative effects on social intolerance. Commun Res 2006, 33:136-154.
• [30]MediaMatters for America: Paranoia Pandemic: Conservative Media Baselessly Blame Swine Flu Outbreak on Immigrants. http://mediamatters.org/research/2009/04/27/paranoia-pandemic-conservative-media-baselessly/149558 webcite
• [31]Pescosolido BA, Martin JK, Lang A, Olafsdottir S: Rethinking theoretical approaches to stigma: a framework integrating normative influences on stigma (FINIS). Soc Sci Med 2008, 67:431-440.
• [32]Wilder DA: The role of anxiety in facilitating stereotypic judgments of outgroup behavior. In Affect, Cognition, and Stereotyping: Interactive Processes in Group Perception. Edited by Mackie DM, Hamilton DL. Buffalo: Academic Press; 1993:87-109.
• [33]Son Hing LS: Responses to stigmatization: the moderating roles of primary and secondary appraisals. Du Bois Rev 2012, 9:149-168.
• [34]Alonso-Zaldivar A: Obama Reassures Latinos on Swine Flu Efforts. http://www.nydailynews.com/latino/obama-reassures-latinos-swine-flu-efforts-article-1.410325 webcite
• [35]National Association of Hispanic Journalists: NAHJ Calls for Truth and Fairness in Swine Flu Coverage. http://www.marketwired.com/press-release/nahj-calls-for-truth-and-fairness-in-swine-flu-coverage-1229270.htm webcite
• [36]Scott KA, Tamashiro KL, Randall R, Sakai RR: Chronic social stress: effects on neuroendocrine function. In Handbook of Neuroendocrinology. Edited by Fink J, Pfaff DW, Levine J. London: Academic; 2011:521-534.
• [37]Bos AE, Pryor JB, Reeder GD, Stutterheim SE: Stigma: advances in theory and research. Basic Appl Soc Psych 2013, 35:1-9.
• [38]Krendl AC, Macrae CN, Kelley WM, Fugelsang JA, Heatherton TF: The good, the bad, and the ugly: an fMRI investigation of the functional anatomic correlates of stigma. Soc Neurosci 2006, 1:5-15.
• [39]Friedman EM, Williams DR, Singer BH, Ryff CD: Chronic discrimination predicts higher circulating levels of E-selectin in a national sample: the MIDUS study. Brain Behav Immun 2009, 23:684-692.
• [40]Masuda A, Price M, Anderson PL, Schmertz SK, Calamaras MR: The role of psychological flexibility in mental health stigma and psychological distress for the stigmatizer. J Soc Gin Psychol 2009, 28:1244-1262.
• [41]Lazarus RS, Follunan S: Stress, Appraisal, and Coping. New York: Springer; 1984.
• [42]Beck AT, Clark DA: An information processing model of anxiety: automatic and strategic processes. Behav Res Ther 1997, 35:49-58.
• [43]Staal MA: Stress, Cognition, and Human performance: a literature review and conceptual framework. National Aeronautics and Space Administration (NASA) technical memorandum; 2004. http://naca.larc.nasa.gov/search.jsp?R=20060017835&qs=N%3D4294966753%2B4294724089 webcite
• [44]Berinsky AJ, Mendelberg T: The indirect effects of discredited stereotypes in judgments of Jewish leaders. Am J Pol Sci 2005, 49:845-864.
• [45]Trawalter S, Richeson JA, Shelton JN: Predicting behavior during interracial interactions: a stress and coping approach. Pers Soc Psychol Rev 2009, 13:243-268.
• [46]McCubbin HI, McCubbin MA: Typologies of resilient families: emerging roles of social class and ethnicity. Fam Relat 1988, 37:247-254.
• [47]Taylor SE, Stanton AL: Coping resources, coping processes, and mental health. Annu Rev Clin Psychol 2007, 3:377-401.
• [48]Miller CT, Kaiser CR: A theoretical perspective on coping with stigma. J Soc Issues 2001, 57:73-92.
• [49]Compas BE, Connor-Smith JK, Saltzman H, Thomsen AB, Wadsworth ME: Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull 2001, 127:87127.
• [50]Sim J: Collecting and analyzing qualitative data: issues raised by the focus group. J Adv Nurs 1998, 28:345-352.
• [51]Borkan J: Immersion/Crystallization. In Doing Qualitative Research. Edited by Crabtree BF, Miller WL. Thousand Oaks: Sage Publishing; 1999:179-194.
• [52]McLeod JD: Social stratification and inequality. In Handbook of the Sociology of Mental Health. Edited by Aneshensel CS, Phelan JC, Bierman A. Dordrecht: Springer; 2013:229-253.
• [53]McCauley EH: Economic issues in the eradication of African Swine Fever in the Dominican Republic. Proceedings of the 3rd International Symposium on Veterinary Epidemiology and Economics; Edwardsville, Kansashttp://www.sciquest.org.nz/node/61226 webcite
• [54]Gaertner P: Whether pigs have Wings: African Swine Fever eradication and pig repopulation in Haiti. http://www2.webster.edu/~corbetre/haiti/misctopic/pigs/gaertner.htm webcite
• [55]Florez K, Aguirre A, Viladrich A, Cespedes A, De La Cruz A, Abraido-Lanza A: Fatalism or destiny? a qualitative study and interpretative framework on Dominican women’s breast cancer beliefs. J Immigr Minor Health 2009, 11:291-301.
• [56]U.S. Department of Health and Human Services: H1N1 Flu: A Guide for Community and Faith-Based Organizations. Washington, DC; 2009. http://www.flu.gov/planning-preparedness/community/cfboguidance.pdf webcite
• [57]Pescosolido BA, Medina TR, Martin JK, Long JS: The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. Am J Public Health 2013, 103:853-860.
• [58]Corrigan PW, Kosyluk KA: Erasing the stigma: where science meets advocacy. Basic Appl Soc Psych 2013, 35:131-140.
• [59]Masuda A, Hayes SC, Fletcher LB, Seignourel PJ, Bunting K, Herbst SA, Twohig MP, Lillis J: Impact of acceptance and commitment therapy versus education on stigma toward people with psychological disorders. Behav Res Ther 2007, 45:2764-2772.
• [60]Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J: Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 2006, 44:1-25.
• [61]Masuda A, Latzman RD: Examining associations among factor-analytically derived components of mental health stigma, distress, and psychological flexibility. Pers Individ Dif 2011, 51:435-438.
• [62]Bond FW, Bunce D: The role of acceptance and job control in mental health, job satisfaction, and work performance. J Appl Psychol 2003, 88:1057-1067.
• [63]Vezzali L, Capozza D, Stathi S, Giovannini D: Increasing outgroup trust, reducing infrahumanization, and enhancing future contact intentions via imagined intergroup contact. J Exp Soc Psychol 2012, 48:437-440.
• [64]Sue DW, Bernier JE, Durran A, Feinberg L, Pedersen P, Smith EJ, Vasquez-Nuttall E: Position paper: cross-cultural counseling competencies. Couns Psychol 1982, 10:45-52.
• [65]Powell ND, Allen RG, Hufnagle AR, Sheridan JF, Bailey MT: Stressor-induced alterations of adaptive immunity to vaccination and viral pathogens. Immunol Allergy Clin North Am 2011, 31:69-79.
• [66]Barbour RS: Making sense of focus groups. Med Educ 2005, 39:742-750.
• [67]Morgan DL: The Focus Group Guidebook. Thousand Oaks: Sage; 1998.
• [68]Robert Wood Johnson Foundation: Qualitative Research Guidelines Project: Focus Groups. http://www.qualres.org/HomeFocu-3647.html webcite
• [69]Schoch-Spana M: Community resilience for catastrophic health events. Biosecur Bioterror 2008, 6:129-130.
• [70]Viswanath K: Public communications and its role in reducing and eliminating health disparities. In Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business. Edited by Thomson GE, Mitchell F, Williams MB. Washington, DC: Institute of Medicine; 2006:215-253.
• [71]Markel H, Stern A: The foreignness of germs: the persistent association of immigrants and disease in American society. Milbank Q 2002, 80:757-788.
• [72]Taylor-Clark KA, Viswanath K, Blendon RJ: Communication inequalities during public health disasters: Katrina’s wake. Health Commun 2010, 25:221-229.