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Journal of Risk Research
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Swine flu and hype: a systematic
review of media dramatization of the
H1N1 influenza pandemic
Celine Klemma, Enny Dasb & Tilo Hartmanna
a Department of Communication Science, VU University
Amsterdam, Amsterdam, Netherlands
b Department of Communication and Information Science,
Radboud University Nijmegen, Nijmegen, Netherlands
Published online: 20 Jun 2014.
To cite this article: Celine Klemm, Enny Das & Tilo Hartmann (2014): Swine flu and hype: a
systematic review of media dramatization of the H1N1 influenza pandemic, Journal of Risk
Research, DOI: 10.1080/13669877.2014.923029
To link to this article: http://dx.doi.org/10.1080/13669877.2014.923029
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Swine flu and hype: a systematic review of media dramatization of
the H1N1 influenza pandemic
Celine Klemm
a
*, Enny Das
b
and Tilo Hartmann
a
a
Department of Communication Science, VU University Amsterdam, Amsterdam, Netherlands;
b
Department of Communication and Information Science, Radboud University Nijmegen,
Nijmegen, Netherlands
(Received 28 January 2014; final version received 15 April 2014)
Highly disconcerting at the time, in retrospective, the 2009 H1N1 influenza pan-
demic looks like much ado about nothing. As a consequence, many accused the
media of having created an artificial hype or hysteria around the new virus, thus
contributing to unwarranted public fear. The current paper set out to examine the
validity of such accusations. We integrated empirical findings on whether the
media dramatized H1N1 on a global scale through systematically reviewing prior
content-analytic studies. We developed a coding scheme specifying three indica-
tors of dramatized media coverage that –together –inform about how mass
media coverage about H1N1 may amplify risk perceptions in the public: (a) the
volume of media coverage, (b) the media content presented, particularly an over-
emphasis of threat while neglecting measures of self-protection and (c) the tone
of coverage. Results show that media attention was immense, that news content
stressed threat over precautionary measures, while the pattern of coverage tonal-
ity remained nebulous due to conflicting findings. The present review also
revealed a critical gap in existing knowledge about the tone of media coverage
on H1N1, and discusses implications for future research on dramatization of
public health risks by the media.
Keywords: H1N1; swine flu; pandemic; mass media; news coverage;
sensationalism; dramatization; content analysis; health communication; risk
communication
Spring 2009 brought the emergence of the first influenza pandemic since 1968, and
with it, the world verged on a swine flu panic. First discovered in Mexico, the new
flu virus was sprawling around the globe, with two alarming characteristics: it was
affecting the young and healthy, rather than the usual risk groups of the elderly and
chronically ill, and it resembled the strain that had caused the fatal Spanish fluin
1918. Scary at the time, the 2009 pandemic retrospectively looks like much ado
about nothing. The toll was far from matching early apprehensions about the scale it
could reach. According to the World Health Organization (WHO), H1N1 influenza –
as swine flu was later termed –caused approximately 18,000 deaths, compared to
around 250,000–500,000 deaths seasonal influenza causes each year, and 40–100
million people that died of the Spanish flu (Taubenberger and Morens 2006; WHO
2010,2012).
*Corresponding author. Email: c.klemm@vu.nl
© 2014 Taylor & Francis
Journal of Risk Research, 2014
http://dx.doi.org/10.1080/13669877.2014.923029
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When the initially announced risk of a fatal pandemic did not materialize, many
began to blame the media of having created an artificial H1N1 hype or hysteria,
blowing up the threat to bait for a bigger audience (e.g. Keil, Schönhöfer, and
Spelsberg 2011). ‘Now I and my colleagues in the media are the ones accused of
crying wolf’, Independent’s health editor Jeremy Laurance moaned (The Indepen-
dent, 2009, May 2). Epidemiologists and public health scholars Bonneux and Van
Damme (2010) called the H1N1 pandemic an ‘iatrogenic pandemic of panic’
(1308), an artefact caused by the treatment of the problem that is created by the way
health officials and the media handled the health crisis. Wagner-Egger and
colleagues (2011, 461) found that many laypeople viewed the media as villain, as
‘fear mongering or as a puppet serving powerful interests’. Also, WHO Director-
General Margaret Chan, and her Assistant Director-General, Keiji Fukuda implicated
that the media was a contributing cause of heightened risk perceptions among the
public (Durodié 2011).
Are such accusations valid? It is important to answer this question because the
media serves as a key communication platform in a public health crisis (Glik 2007;
Yu et al. 2011). Whether they can fulfil this important role, however, depends on the
media’s untainted reputation as a trusted information source just as much as on the
actual information they broadcast. Like in Aesop’s classic fable of the boy who cried
wolf, journalists –if perceived as scaremongers –might lose their credibility and
their warnings may be overheard when a future risk emerges.
Therefore, the current paper set out to examine the validity of such accusations.
Although previous studies have examined media coverage of H1N1, very few stud-
ies have explicitly examined whether the media dramatized H1N1, suggesting either
that they did or that they did not (Vasterman and Ruigrok 2013; Yu et al. 2011).
These different conclusions may be due to different operationalization of what con-
stitutes dramatization. Media coverage has been defined as dramatizing if it exagger-
ates existing risks, if it awards it with a disproportionate amount of attention
considering the actual relevance of the threat (e.g. a media hype; Vasterman 2005)
or if coverage portrays the (health) threat primarily based on arousing or emotional
language as well as based on emotion-evoking formal features rather than factual
ones (Aust and Zillmann 1996; Dudo, Dahlstrom, and Brossard 2007; Yu et al.
2011; Zillmann 2006; Zillmann and Gan 1996; Zillmann, Gibson, and Sargent
1999). Although these definitions have clear merits, they also have a downside: they
need an objective reference point as to what constitutes ‘too much’,or‘exagger-
ated’,or‘too emotional’media coverage. As Kitzinger (1999) points out, answering
the question of whether the media dramatize risks often also entails two underlying
assumptions, which are rarely explicated. The first is normative. It proposes that
there is something like ideal risk reporting, such as an objective representation of
risks. The second is that the official providers of risk information, namely health
officials and journalists, act on a purely ‘scientific’basis. We ought to be aware of
those assumptions when speaking about dramatization of mass media coverage.
Both assumptions suggest that research on dramatization seeks to contrast media
coverage, either with an explicated definition of ‘ideal journalism’or objective quan-
tifications of the ‘actual real risk’.
In the present research, we introduce a non-normative, quantified approach to
dramatization of risk based on scientific theories on risk perception, health commu-
nication and media sensationalism. We developed a coding scheme specifying three
indicators of dramatized media coverage that –together –may inform about how
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mass media coverage about H1N1 may amplify risk perceptions in the public: (a)
the volume of media coverage, (b) the media content presented, particularly an over-
emphasis of threat while neglecting measures of self-protection and (c) the tone of
coverage.
The goal of this study is thus to provide an answer to the question whether the
media dramatized H1N1 by means of a systematic review of prior content-analytical
studies on news coverage of H1N1. We include all prior content analyses of media
coverage of H1N1 –also those that did not explicitly examine the question of media
dramatization –if they include valuable information that may help answer the ques-
tion of dramatization. In the next section, we elaborate on our quantitative operation-
alization of dramatization and the theoretical and empirical basis for our key
constructs.
Quantitative indicators of dramatized media coverage of health risks
Communicating risk in an effective manner often entails ‘finding comprehensible
ways of presenting complex material that is clouded by uncertainty and is inherently
difficult to understand’(Berry 2004, 26). Risk communication scholars have pro-
vided a rich empirical fact base about the way individuals understand and evaluate
risk and risk information, and evidence abounds that perception of risk by laypeople
and by ‘risk assessors’barely overlap (e.g. Slovic 1987; Slovic and Weber 2002).
Applied to the current context of media coverage on the H1N1 pandemic, these find-
ings from risk research indicate that the media can serve as ‘amplifier’of risk
(Kasperson, Kasperson, and Pidgeon 2003), however, overly negative perceptions of
health risks among the public or even public scares need not necessarily be triggered
by gross exaggerations in the media. They can result from flawed or biased informa-
tion processing, due to the way the audience assigns meaning to the information pre-
sented (Loewenstein et al. 2001; Slovic et al. 2007), and from media external factors
such as the general ‘Zeitgeist’of perceiving the world as a risky place, as well as
from the interpretation of the new, emerging risk against the backdrop of a collective
memory of similar risk such as past pandemics (Durodié 2011; Wahlberg and
Sjoberg 2000).
As news reporting on a public health crisis such as an emerging pandemic,
relates to various academic disciplines, ranging from health communication to jour-
nalism studies, the current review chose an interdisciplinary approach, integrating
findings from the various disciplines when developing the following three indicators
of dramatization.
Volume of media coverage
Research in the field of risk communication found that ‘giving too much or too
prominent space or time’to a certain risk may lead to sensationalism and dramatize
risks (Dunwoody and Peters 1992, 203). Studies on the social amplification of risk
framework found that extensive coverage may serve as risk amplifier, regardless of
whether the risk portrayal is actually accurate (Kasperson et al. 1988). Similarly,
quantity of coverage theory found that increased media coverage often ‘turns public
opinion in a negative direction’–regardless of the tone of coverage itself –and can
thus produce heightened opposition and fear (Mazur and Lee 1993, 683). Based on
these findings, we define the sheer volume of news coverage on H1N1 as a first
Journal of Risk Research 3
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indicator for how much the mass media (implicitly) suggested H1N1 to be an
alarming health risk, i.e. media dramatization.
Media content
Studies in the field of health communication and psychology have provided ample
evidence that specific types of information presented –or the lack thereof –can
influence individuals’perceptions and health behaviours (Witte 1994; Witte and
Allen 2000). One of the most prominent models in this context is Witte’s Extended
Parallel Process Model (EPPM). The model distinguishes between information on
the severity of and individual susceptibility to a threat from information on preven-
tive measures, their effectiveness (response efficacy) and the efficacy beliefs of the
individual to perform these measures (self-efficacy). Witte’s EPPM model has been
extensively researched, as well as been applied to health messages in news media
(Love 2011). While risk information and an understanding of the threat is an essen-
tial foundation for individuals to develop a motivation to protect themselves, empiri-
cal evidence demonstrates that it can also result in fear and maladaptive responses to
risk if it comes without information on protective measures to avert the threat
(efficacy information) (Floyd, Prenctice-Dunn, and Rogers 2000; Rogers 1983).
Furthermore, effects of health messages differ, depending on whether they purely
include a mention of protective measures or also explicit statements about the
effectiveness of measures (response efficacy). In order to motivate individuals to
take preventive measures, news reports should ideally include both, mentions of pre-
ventive measures and statements about their effectiveness (Witte and Allen 2000).
Based on these findings, we propose that media content –specifically, a one-sided
focus on the risk of H1N1 with neglect of available intervention possibilities such as
hand washing or vaccination, is a second indicator for how much the mass media
(implicitly) suggested H1N1 to be an alarming health risk, i.e. media dramatization.
Tone of coverage
Scholars in the field of journalism or media studies, in particular those researching
sensationalism, have demonstrated that coverage tonality impacts audiences’risk per-
ceptions. Certain attention grabbing production features such as video manoeuvres
(e.g. slow motion and eyewitness camera) and decorative effects (e.g. sound effects
and fast-pace cutting) are commonly suspected to exaggerate factual content (Grabe,
Kamhawi, and Yegiyan 2009; Grabe, Zhou, and Barnett 2001). Further, Zillmann and
colleagues found that exemplars of victims in news, particularly when emotionally
intense, can strongly and lastingly increase (health) risk perceptions (Aust and
Zillmann 1996; Zillmann 2006). Based on Zillmann’sfindings, Hendriks Vettehen
and colleagues propose to define vivid storytelling through concrete personal narra-
tives or interviews with laypeople as a sensationalist or dramatic feature (Hendriks
Vettehen, Nuijten, and Beentjes 2005). Studies from health communication demon-
strate that these findings are likewise applicable to media coverage on health risks.
Biener and colleagues report that the emotional tone of messages about health risks
impacts message perception, and that negative affect can increase risk perceptions
(Biener et al. 2004; Loewenstein et al. 2001). Dudo and colleagues suggest that emo-
tion-laden language and the use of worst-case scenarios can be defined as sensational-
ist or dramatic (Dudo, Dahlstrom, and Brossard 2007). Based on these findings, we
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propose the tone of H1N1-related media coverage (tonality as well as formal features)
as a third indicator of media dramatization that may have (implicitly) contributed to
heightened public risk perceptions.
Methods
Search protocol
For the purpose of the present literature review, we identified relevant prior publica-
tions through a search in two computerized scientific databases (EBSCO Host, Web
of Science) on 1 August 2012. We combined the search term Media or Newspaper
or Radio or TV or Online or Twitter or Facebook or YouTube or Blog* or ‘Content
Analysis’or Framing with each of the search terms H1N1, ‘Swine Flu’or ‘Pan-
demic Influenza’,including only articles published after the H1N1 outbreak. Since
Web of Science is a multidisciplinary database, we filtered out articles from unre-
lated disciplines. Our search resulted in a total of 235 articles (EBSCO Host data-
base: 42, Web of Science: 193).
Inclusion and exclusion criteria
The 235 articles identified were sorted using a number of inclusion and exclusion
criteria (Figure 1). In the first step, we excluded 15 duplicates. We then screened the
remaining 220 articles and excluded 19 articles that were not peer-reviewed journal
articles, and 12 articles not English-language. We further checked for relevance, con-
sidering two inclusion criteria: articles had to refer to the H1N1 pandemic (no other
pandemic), and studies needed to analyse media content. We excluded 26 articles
that addressed other influenza pandemics and 153 articles for not employing content
analyses.
Ten relevant articles remained. We searched in the reference lists of the obtained
articles and contacted several researchers to identify further relevant articles. A closer
inspection revealed three articles (Pandey et al. 2010; Vasterman and Ruigrok 2013
1
;
Yu et al. 2011) that were not identified in the initial search, which we added to our
systematic review. In sum, 13 articles containing content analyses of the mass media
coverage of H1N1 were retrieved for the present literature review.
Main findings
A summary of the identified 13 articles that analysed news coverage on the H1N1
influenza pandemic worldwide is presented in Tables 1–4. All studies consisted of
quantitative analyses. Eight articles investigated the content of H1N1-related news
in traditional media outlets. Most studies analysed print newspapers like The New
York Times, Washington Post or China Times, some tabloids such as The Sun, while
few examined TV news. Six articles examined new media such as Twitter, YouTube,
Wikipedia and blogs. Altogether, the studies cover the media reporting in 32 Euro-
pean countries, Canada, the US, Taiwan and Australia (Table 1). However, except
for the UK (Hilton and Hunt 2011) and The Netherlands (Vasterman and Ruigrok
2013), news coverage in European countries was only analysed for the first week of
the H1N1 pandemic (Duncan 2009).
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Dramatization indicator 1: volume of media coverage
Ten out of thirteen studies (Table 2) analysed the volume of H1N1-related coverage
over the course of the pandemic. All studies demonstrate that overall the H1N1
Records identified through database search
(n = 235)
Screening
Eligibility Identification
Records screened for relevance
(n = 220)
210 records excluded:
19 for type of publication (e.g., editorials,
conference papers)
12 no English language
26 other influenza pandemics: avian
influenza (17), 1918 Spanish flu (3), 1968
Hong Kong Flu (1), general pandemic
influenza (3), seasonal flu (2)
153 no content analysis, but instead focus
for instance on managerial/policy issues,
pandemic preparedness, etc.
Full-text articles assessed for eligibility
(n = 10)
Included
Studies included in qualitative synthesis
(n = 13)
Removal of 15 duplicate records
3 additional records
identified through other sources
Figure 1. Selection process of sampled articles.
Table 1. Summary of countries and media analysed in the reviewed studies.
Country Media sample
Australia Five Sydney TV stations
Canada Globeandmail.com, Vancouversun.com, Cbc.ca
Republic of China
(Taiwan) The Liberty Times, Apple Daily, United Daily News, China Times
The Netherlands NRC Handelsblad, de Volkskrant, De Telegraaf, Trouw, Algemeen
Dagblad, De Pers, Metro, Spits; TV: NOS Journaal, RTL Nieuws,
Hart van Nederland
UK Guardian, The Independent, The Daily Telegraph, The Daily Mail,
The Express, The Sun, The Mirror, The News of the World (&
Sunday issues)
US The New York Times, USA Today, Los Angeles Times, Washington
Post, CNN.com, MSNBC.com
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Table 2. Summary of reviewed studies –volume of media coverage (dramatization
indicator 1).
Country Media Main findings Study
31 European
countries 3 top newspapers
of each country
Immense volume during
first pandemic week
(3979 articles)
UK by far the highest
No. of articles, while
Eastern European
countries have in general
far lower volume of
coverage
Duncan (2009)
The Netherlands 8 newspapers
(broadsheet and
tabloid), 3 main
TV news
Immense volume (2270
articles), average of 1.4
articles per newspaper/day
Highest volume of news
reports: first two pandemic
weeks
Media attention comes in
6 waves, 3 more intense
peaks
Vasterman and
Ruigrok (2013)
UK 8 newspapers
(broadsheet and
tabloid)
Highest volume: July/
Aug (550 articles), 2
smaller waves in April/
May, and October
Media attention across
the pandemic in the UK
differed from other
countries
Hilton and Hunt
(2011)
US 4 newspapers
(broadsheet), 2
online news
sources
Highest volume: late
April/May, with a
sudden drop in volume
by June
Goodall et al.
(2012), Yu et al.
(2011)
Australia 5 Sydney TV
stations
H1N1 was leading
health story for 8 weeks
and for 20 weeks
remained in the top five
most frequently reported
health stories
Fogarty et al.
(2011)
Worldwide Blogosphere Media attention shows a
rapid increase, peak, and
decline April 24–May 7
2009
Tausczik et al.
(2012)
Worldwide called
the H1N1
pandemic an
Wikipedia At the pandemic start the
number of visits to
Wikipedia pages
increased rapidly but
returned to baseline
within a few weeks
Tausczik et al.
(2012)
(Continued)
Journal of Risk Research 7
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pandemic presented a major theme on the media agenda; the amount of coverage
was remarkably large. In the first four days of the pandemic (27–30 April 2009), the
three top newspapers of each of 31 European countries published around 650–800
articles on H1N1 per day. In the first week (27 April–3 May), this summed up to a
total of 3463 articles, an enormous number considering the same media together had
only published 2824 articles on all other health-topics in a period of one month
(Duncan 2009). Media attention was similarly huge in the online sphere. A great
deal of information was available on the video platform YouTube. In the first two
months of the pandemic (April/May), a total of 142 videos contained relevant infor-
mation about H1N1 influenza. In the early pandemic days, Twitter had over 50,000
tweets per day that mentioned H1N1 or swine flu (Chew and Eysenbach 2010).
Development of volume of media coverage over pandemic course
The fact that the reviewed studies all analysed different time frames (ranging
between seven days and eight months) complicated finding overall patterns across
studies. Still, when integrating findings, three peaks in news coverage on H1N1
emerged, all of which coincided with important real-world events.
First peak end of April/start of May 09 –pandemic outbreak. All studies demon-
strated that H1N1-related coverage was by far the highest at the very start of the
pandemic, followed by a rapid fade-away within the first month. The outbreak of
H1N1 in Mexico, the spread of the virus and the WHO’s issue of a first outbreak
notice in late April 2009 together prompted the first and largest peak (Duncan 2009;
Goodall et al. 2012; Hilton and Hunt 2011; Tausczik et al. 2012; Vasterman and
Ruigrok 2013; Yu et al. 2011). Online media such as Twitter, blogs and Wikipedia
visits showed an equivalent pattern, yet the surge in media coverage at the start of
the H1N1 outbreak was even more immediate (Signorini, Segre, and Polgreen 2011;
Chew and Eysenbach 2010).
Table 2. (Continued).
Country Media Main findings Study
Worldwide Twitter Trend in tweet volume is
comparable to print
media
Highest volume of
H1N1-related tweets:
late April/May (>1% of
sample tweet volume),
then rapidly decline
within the 1st week of
May to ≈0.3%
Chew and
Eysenbach
(2010), Signorini
et al. (2011)
Worldwide YouTube 142 H1N1-related videos
with a total duration of
569 min
Pandey et al.
(2010)
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Table 3. Summary of reviewed studies –media content (dramatization indicator 2).
Country Media Main findings Study
Australia 5 Sydney TV
stations Threat information
Severity: 63% of statements
Susceptibility: n.a.
Efficacy information
Preventive measures: 37% of
statements
Response efficacy: n.a.
Fogarty et al.
(2011)
US 4 newspapers
(broadsheet), 2
online news sources
Threat information: 67.1% of news
reports (Study 2
1
)
Severity: 86% of news reports
(Study 1)
Susceptibility: 30% of news
reports (Study 1)
Efficacy information
Preventive measures
Study 1: 56% | Study 2: 74%
of news reports
Response efficacy: 15% of
reports that addressed
preventive measures clearly
suggested effectiveness, 8%
questioned effectiveness
Both (threat and efficacy) in one
news item: 47% of news reports
Goodall et al.
(2012), Yu
et al. (2011)
UK 4 newspapers
(broadsheet), 2
online news sources
Study looked at threat and efficacy
information in much detail, below
just a main summary of the trend in
themes, please refer to original
article.Threat information:
Severity: predominant theme
Susceptibility: 2nd most
prominent
Efficacy information
Preventive measures: 3rd most
prominent
Response efficacy: n.a.
Both (threat and efficacy) in one
news item: n.a.
Hilton and
Hunt (2011)
China
(Taiwan) All 4 major
newspapers in
Taiwan
Threat information: 38% of headlines,
35% of articles Chang (2012)
Efficacy information: 18% of
headlines, 15% of articles
Both (threat and efficacy) in one
news item: 20% of news reports
(Continued)
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Second peak July–September 09 –declaration of pandemic and first summer wave.
A second peak in media attention was triggered by the WHO’s declaration of H1N1
as a ‘pandemic’on 11 June 2009 together with a first wave in H1N1 cases in June
and July. Five studies provide information on news volume in this period. All but
one study (Yu et al. 2011) found that the June events resulted in a second peak in
H1N1 news coverage in summer 2009. When comparing the amount of volume dur-
ing the second peak to the earlier April/May peak, country differences emerged, par-
ticularly between the UK and the other countries (Goodall et al. 2012; Hilton and
Hunt 2011; Vasterman and Ruigrok 2013; Yu et al. 2011). Such differences may be
explained by differences in epidemiology, as the H1N1 virus in the UK had a differ-
ent epidemiology from the other countries. Again, the online sphere revealed similar
patterns. Chew and Eysenbach (2010) found that Twitter activity increased during
summer 2009, and the study clearly documents that the surge in volume was trig-
gered by the WHO’s declaration.
Third peak October/November 09 –mass vaccinations and autumn wave. Lastly, the
start of mass vaccination programmes paired with a second wave of H1N1 cases
(CDC 2012; ECDC 2010) resulted in a third peak of media attention in October and
November 2009. Six studies investigated news coverage in this period. They all
indicate a last spark of media attention in autumn, yet the studies reveal country dif-
ferences in terms of the intensity of the peak compared to the previous spring and
summer peak (Goodall et al. 2012; Hilton and Hunt 2011; Rachul, Ries, and
Caulfield 2011; Vasterman and Ruigrok 2013; Yu et al. 2011). In a comparable fash-
ion to traditional media, Twitter showed an increase in activity end of October, as
well as immediate responses to the arrival of vaccines in the US on 6 October
(Chew and Eysenbach 2010).
Table 3. (Continued).
Country Media Main findings Study
Canada 3 online news
sources Threat information: n.a. Henrich and
Holmes (2011)
Efficacy information: 6% of
comments
Both (threat and efficacy): n.a.
Worldwide Twitter Threat information: 0.2–1.3% of
tweets Signorini,
Segre, and
Polgreen,
(2011)
Efficacy information: tweets relating
to hand-hygiene (2–3%), facial mask
(<7%), vaccination (1–3%) of all
H1N1 related tweets
Both (threat and efficacy) in one
news item: n.a.
Worldwide YouTube 61% (n= 87) of videos had threat
and/or efficacy information (not
analysed separately)
Pandey et al.
(2010)
1
Study 1 (Goodall et al. 2012) looked at severity and susceptibility information separately, while study 2
(Yu et al. 2011) looked at them together (i.e. they looked at risk information in general).
10 C. Klemm et al.
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Table 4. Summary of reviewed studies –tone of coverage (dramatization indicator 3).
Country Media Main findings Study
31 European
countries 3 top newspapers of
each country
In the first pandemic week,
the vast majority of articles
were factual (70%), the
second largest bulk was
supportive
Duncan
(2009)
The Netherlands 8 newspapers
(broadsheet and
tabloid), 3 main TV
news
News coverage was mainly
alarming (74% of messages)
Tone changed between
different stages (alarm
stage, preparatory stage and
crisis stage). As the
pandemic progressed,
alarming messages
decreased, while reassuring
and neutral messages
increased
Vasterman
and Ruigrok
(2013)
US 4 newspapers
(broadsheet), 2
online news sources
33% of news reports
referenced to fear, half
suggesting too much fear;
the other half not
commenting on whether
fear was justified
The amount of references to
fear decreased over the
pandemic course
Sensationalism: 5% of
articles used emotion-laden
language, 11% portrayed
H1N1 as a global
pandemic, 8% used worst-
case scenarios
Goodall et al.
(2012), Yu
et al. (2011)
Worldwide Blogosphere Blogs include twice as
much positive (2%) than
negative emotion words
(1%)
Tausczik
et al. (2012)
Wikipedia Over time expressions of
negative emotions
decreased significantly,
while positive emotions
increased
Canada 3 online news
sources
Tonality not directly
measured, but reference to
fear
Fear of H1N1 (19% of
comments posted), of
vaccine (8%)
Henrich and
Holmes
(2011)
(Continued)
Journal of Risk Research 11
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Dramatization indicator 2: media content
Eight studies that we identified explicitly analysed media content. Two out of the
thirteen studies chose a deductive approach in the development of content catego-
ries, both using as underlying framework the EPPM (Witte 1994; Witte and Allen
2000). The remaining studies applied an inductive approach, however in doing so,
found comparable content categories to those specified in the EPPM. Hence, it is
worthwhile to use the EPPM distinction between threat and efficacy information as
guideline for our analysis of the content-specific indicators of dramatization.
Threat information: severity of and susceptibility to H1N1
Across countries and studies information on the severity of and susceptibility to
H1N1, such as reference to the risk of hospitalization or death, the spread of the dis-
ease and mortality tallies, was by far the leading theme in H1N1 news coverage.
Goodall and colleagues (2012) reported that severity information was present in
86% of stories in US news. Since the individual reviewed studies differed in terms
of the countries and media analysed as well as in their specific research interests,
noteworthy dissimilarities could be observed. Studies found differences in whether
news focused on the severity of the threat vs. individual susceptibility to it. For
instance, US news showed a much stronger focus on severity information (Goodall
et al. 2012), while UK news showed a stronger focus on the individuals susceptibil-
ity, particularly on local infections (Hilton and Hunt 2011). Chang (2012), who
made an interesting addition by not only analysing the presence of threat informa-
tion but also noting whether messages sounded alarm or stressed the need for alert-
ness, found for Taiwanese news that the main message when tackling the threat of
the H1N1 virus, was the need for enhanced alertness rather than sounding an alarm.
Table 4. (Continued).
Country Media Main findings Study
UK 4 newspapers
(broadsheet), 2
online
The majority of articles are
neutral (83%), 13% are
alarming, 4% are reassuring
Hilton and
Hunt (2011)
China (Taiwan) All 4 major
newspapers in
Taiwan
Most reports adopt high
alarm frames (38% of
headlines, 35% articles)
Chang (2012)
Worldwide YouTube 16% (23 videos) were
misleading mostly
portraying H1N1 as
overhyped, calling it a
manmade conspiracy or
government propaganda
Pandey et al.
(2010)
Worldwide Twitter Tweets commonly
expressed humour (13%),
concern (12%), questions
(10%)
Chew and
Eysenbach
(2010)
12 C. Klemm et al.
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Efficacy information: protective measures
Next to severity, the second most prominent theme in news coverage on H1N1 was
personal protection against the disease, i.e. efficacy information (Chang 2012;
Fogarty et al. 2011; Goodall et al. 2012; Yu et al. 2011). The majority of the
reviewed studies looked exclusively at the mention of preventive measures, only
few included response efficacy in their analysis. This complicates conclusions on the
prevalence of efficacy information because it is not entirely clear if a found lack of
response efficacy information is due to the fact that the news indeed did not report
on it, or whether they did, but researchers did not analyse and hence report it in their
findings. From those studies that analysed the presence of response efficacy, we can
conclude that although news reports frequently included information on protective
measures, they only rarely addressed the effectiveness of recommended actions.
Taken together, all but one study (Hilton and Hunt 2011) found that efficacy infor-
mation was the second most dominant information in news coverage on H1N1.
However, studies that analysed also the presence of response efficacy information in
news, find that it was only seldom mentioned.
In sum, all but one of the reviewed studies found that threat information
accounted for the largest share of information provided in H1N1-related news, while
efficacy information was the second most prominent theme. The only study that
found efficacy information to exceed threat information was Yu and colleagues’
(2011) study, possibly due to the fact that they measured only severity and no sus-
ceptibility information. Results indicating whether severity or susceptibility informa-
tion was presented more frequently were inconsistent; half the studies found
severity, the other half susceptibility to be the predominant information.
Dramatization indicator 3: tone of media coverage
The majority of studies that investigated tone of news coverage found little evidence
of the media ‘over-hyping’the H1N1 pandemic. Studies varied greatly in their oper-
ationalization of tone of coverage. While some studies coded an overall tone (e.g.
Duncan 2009; Hilton and Hunt 2011), or tone in form of frames (e.g. alarming, reas-
suring; Vasterman and Ruigrok 2013) others coded references to emotions, such as
fear (Goodall et al. 2012; Henrich and Holmes 2011), relief or anxiety (Chew and
Eysenbach 2010; Tausczik et al. 2012), and one single study explicitly analysed sen-
sationalism (Yu et al. 2011). Findings regarding the overall tone are mixed. Duncan
(2009) reported that in the first week of the pandemic 70% of articles in European
media portrayed factual information, and Hilton and Hunt (2011) found the same for
the further course of the pandemic (83% of articles were factual or neutral). How-
ever, Vasterman and Ruigrok (2013)find the opposite when analysing tonality of
frames; 74% of messages contain alarming frames. Likewise, Chang (2012)finds
that most reports adopt high alarm frames. The study differentiates these frames fur-
ther into alarming and alerting frames though, and finds that the majority of alarm-
ing frames have the tone of high alert, rather than sounding alarm. Regarding the
reference of media to certain emotions, Goodall and colleagues (2012) report that
around one third of news reports referenced to fear. Half of these suggested too
much fear, while the other half did not comment on whether fear response was justi-
fied. Tausczik and colleagues (2012) report more negative emotion words in swine
flu blogs than in other blogs, yet they find twice as many references to positive
Journal of Risk Research 13
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emotion words (2%) than to negative emotion words (death-related and anxiety-
related; 1%). Tausczik’s study reveals interesting inter-media effects also in terms of
tonality. For instance, anxiety measured in blogs preceded information seeking on
Wikipedia; both followed similar trajectories, peaking shortly after the announce-
ment of H1Nl and then declining rapidly. Further, there was a strong correlation
between the number of positive and negative emotion words in blogs and newspa-
pers on the same day. Yu and colleagues (2011), who explicitly analysed sensation-
alism, reported that around 5% of articles used loaded words such as ‘fatal’or
‘lethal’, and almost 20% described worst-case scenarios. All studies investigating
changes in sentiment over time found a decrease of negative sentiments over time
(Goodall et al. 2012; Tausczik et al. 2012; Vasterman and Ruigrok 2013).
Discussion
The present literature review set out to examine if the mass media dramatized H1N1,
as suggested by criticism of the media during and after the 2009 pandemic (Bonneux
and Van Damme 2010; Laurance 2009; Keil, Schönhöfer and Spelsberg 2011;
Wagner-Egger et al. 2011). We systematically reviewed existing content-analytical
studies of H1N1 coverage including also those that did not explicitly examine the
question of media dramatization. Drawing on findings from risk research, health com-
munication, journalism and media studies, we developed a coding scheme specifying
three features of H1N1-related media coverage that indicate dramatization: volume of
coverage, media content (specifically, focus on threat vs. efficacy information) and
emotional tone of coverage.
Was the volume of coverage expedient –or excessive?
The 2009 H1N1 pandemic received huge media attention, as all of the 13 studies
we reviewed found. Our review revealed that attention was not parallel to the trajec-
tory of the epidemic, i.e. reflecting the number of infections, but was instead rather
event-oriented. Precisely, we identified three peaks in media attention triggered by
real-world events. Judging whether the amount of attention the media gives to cer-
tain risks is justified or excessive, is a difficult, generally value-laden issue
(Kitzinger 1999). Yet, some of the reviewed studies conclude that the enduring
media attention, government vigilance and the daily fuelling of news with reports on
new infections and deaths might have made recipients believe that the threat is big-
ger than it was (Fogarty et al. 2011; Goodall et al. 2012). Their conclusions are in
line with prior research that found that the pure volume of information may lead to
risk overestimation and increase feelings of fear (Kasperson et al. 1988; Mazur and
Lee 1993). Based on the present findings, the extensive coverage on H1N1-related
risk provides an indication that mass media coverage was –perhaps inadvertently –
dramatized.
Did content emphasize threat while neglecting means of protection?
As regards content-related causes of dramatization, our review showed that most sto-
ries focused on H1N1 as a threat and featured the seriousness of and susceptibility
to the new H1N1 virus. We further found that efficacy information, despite being
the second most prevalent information in news on H1N1, was far less prevalent than
14 C. Klemm et al.
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threat information. Interestingly, the reviewed studies draw divergent conclusions
from these findings. Goodall et al. (2012, 14) concluded that stories ‘overreported
H1N1-related death and hospitalization’. They argued that death and hospitalization
were mentioned too frequently considering the likelihood of these consequences
according to the Center for Disease Control and Prevention (CDC). Although
Fogarty et al. (2011, 5) also found that the majority of newspaper statements referred
to the seriousness of and susceptibility to H1N1, they concluded that ‘statements
[…] were generally non-alarmist and reassuring’. Their conclusion suggests that
while media content may fuel risk perceptions by stressing the seriousness of health
threats, the tone of coverage may still remain sober and reassuring. These conclu-
sions illustrate that dramatization cannot be defined by a single indicator but
emerges in an interplay of several factors, as proposed in the current paper. In sum,
we found that content of H1N1-related news coverage may have contributed to dra-
matization in two ways: First through a disproportionate mention of risk compared
to the actual risk as specified by health institutions, which may heighten public per-
ceptions of risk (Goodall et al. 2012). Second, through an emphasis on H1N1-
related threat while neglecting efficacy information, which may increase public fear
and maladaptive responses in the public (Rogers 1983; Singer and Endreny 1987 as
cited by Kitzinger 1999).
Was the tone of coverage dramatic?
Concerning the tone of news coverage, the majority of studies found no evidence
for media dramatization but rather concluded that news reporting was factual and
non-alarmist (Duncan 2009; Hilton and Hunt 2011). However, in stark contrast the
two studies analysing frames (Chang 2012; Vasterman and Ruigrok 2013) found
alarming messages to be predominant; Vasterman and Ruigrok found a remarkably
high number of alarming frames (74% messages). Such sharply conflicting findings
could be rooted in country differences, such as differences in the actual risk H1N1
posed (epidemiology), media systems or local news cultures. They could also be
rooted in the complexity and subjectivity of what constitutes ‘alarm’, though, and be
a consequence of differences in operationalization. Vasterman and Ruigrok (2013)
define frames as alarmist when an event is described in terms of risk, including
updates on the number of infections, hospitalizations or deaths, as well as when a
threat is described as ‘extremely contagious’or ‘deadly’. Similarly, Chang defines
alarming frames when the article emphasizes the severity of an issue, people’s
vulnerability to its threats and the need for enhanced alertness. Whereas these stud-
ies on framing include information, namely severity and susceptibility, in their defi-
nition of ‘alarmist’, the other studies distinguish more strictly between information
and the tone in which information is presented (Duncan 2009; Hilton and Hunt
2011). In part, these studies are also narrower in their definition. For instance, Hilton
and Hunt (2011, 942) use the same three categories (alarmist, neutral and reassuring)
as the other studies, however, employ a more restricted definition of ‘alarmist’head-
lines, namely as “those that were judged as potentially able to cause the reader anxi-
ety”. Yu and colleagues (2011) draw on sensationalism literature and define media
coverage dramatic or sensationalist when swine flu is depicted as a global pandemic
(i.e. the extreme negative outcomes or the worst-case scenario); or a deadly disease
(i.e. emotionally loaded words such as ‘deadly’and ‘lethal’). The described varia-
tions in the conceptualizations combined with the apparent disparities in findings,
Journal of Risk Research 15
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illustrate the importance to find shared definitions of dramatized, alarmist or
exaggerated media portrayal of risk.
The present review also revealed a critical gap in existing knowledge about the
tone of media coverage on H1N1. Formal features have been identified as a crucial
component of dramatization (Hendriks Vettehen, Nuijten, and Beentjes 2005) and
have also been researched in the context of other epidemics (e.g. Dudo, Dahlstrom,
and Brossard 2007). However, almost none of the reviewed studies examined formal
features commonly linked to the tone of coverage such as images, language, person-
alized narratives or camera effects. An exception was the study by Yu and col-
leagues (2011) that analysed emotion-laden language and worst-case scenarios, and
found that 5.3% of articles used emotional-laden words such as ‘deadly’,‘lethal’,
‘fatal’and ‘huge death toll’, and around 11% portrayed H1N1 as a global pandemic
(worst-case scenario). Such a distinction between textual information and formal fea-
tures is paramount, as these two factors have been found to impact risk perceptions
in different manners, both in terms of information processing and in the eventual
evaluation of risk (Visschers et al. 2008; Zillmann 2006). Therefore, in the current
review, conclusions on the tone of media coverage of H1N1 can only be limited as
the sampled studies have only very limitedly investigated formal features that signal
dramatization.
Limitations and suggestions for future research
As with any study, the present findings have to be interpreted considering several
limitations. First, as only one study explicitly but marginally analysed dramatization
of news coverage on H1N1, we were limited to the material at hand. Consequently,
we cannot report empirical evidence for all factors that we consider relevant for dra-
matization but were limited to an analysis of the information on the three indicators
that could be distilled from the existing content-analytic studies. Particularly, evi-
dence on formal features is lacking. We suggest that future studies explicitly investi-
gate news dramatization in the context of H1N1.
Second, we propose that dramatization emerges in a complex interaction of vari-
ous factors, as has been suggested by risk scholars (Kitzinger 1999). Yet, none of
the reviewed studies illuminates this interplay. As our review looked at three factors
and whether they were simultaneously present, we may conclude that the combina-
tion of an immense amount of news on H1N1 with an emphasis on H1N1-related
threat possibly contributed to dramatization. Yet, our conclusion is limited by the
fact that none of the sampled studies jointly examined all three indicators of drama-
tization. As to avoid making too simplistic judgements of whether the media drama-
tized risks, future studies should examine the co-occurrence of various
characteristics of dramatization.
Third, due to the small number of existing studies that could be identified and
included in the present review and the lack of standard or shared definitions for what
constitutes ‘sensational’or ‘alarmist’reporting among the general scientific commu-
nity as well as across the reviewed studies, any conclusions reached by the present
review can only be tentative.
The majority of studies reviewed here analysed traditional news reporting, there-
fore, only limited comparison between media forms was possible. It is important to
note, however, that media forms differ in terms of the journalistic standards they
adhere to. While we might expect professional journalists to be detached,
16 C. Klemm et al.
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unemotional reporters, we hold no such expectations towards users of social media.
Consequently, we might evaluate the presence of dramatic characteristics, such as
emotive language or tragic stories, differently, depending on whether they appear in
more traditional or in user-generated media forms. Additionally, social media audi-
ences tend to be more segmented, reaching only certain subpopulations, for instance
special interest groups. Therefore, we can expect different effects of dramatization
of traditional compared to social media content, as they might reach broader or nar-
rower audiences. Future studies should further look into specific media differences
in times of epidemic outbreaks.
Further, as stated earlier, the question of whether the media dramatize risks
entails underlying normative assumptions, which are rarely explicated. These sug-
gest that research on dramatization often aims to contrast media coverage, either
with an explicated definition of ‘ideal journalism’or with an objective quantification
of the ‘actual real risk’(Kitzinger 1999). However, risk research has illustrated that
rather than being quantified objectively, risk perceptions are highly subjective. Duro-
dié (2011) stresses that risk perceptions are socially mediated. They are a ‘function
of the times’(Durodié 2011, 512), i.e. impacted by our general perception of the
world as a dangerous, risky place, as well as interpreted in the context of our experi-
ences with similar past risks. Further, often the presentation of risk in the media is
the outcome of a power struggle behind the scenes, a struggle between several
claims-makers who seek to impose their preferred vision of the objective risk (Allan,
Anderson, and Petersen 2010). The fact that some of studies examined in the present
literature review reached different conclusions about the level of dramatization, even
if they obtained comparable empirical results, illustrates that the explication of
benchmarks should help to advance research on the dramatization of mass media
coverage.
Lastly, another important benchmark for determining whether news coverage
was dramatized is the original sources of news. News reporting, especially in the
early pandemic days, heavily relies on expert sources, such as press conferences,
press releases and interviews of health authorities such as the WHO, and of medical
or scientific experts. Future research should further address the sources of dramatiza-
tion: did journalists add dramatizing elements or were these introduced by the news
sources quoted by journalists?
Conclusion
Was mass media coverage of H1N1 dramatic? Dramatization builds on various fac-
tors, three of which we developed based on theory and empirical evidence in the
realm of risk research, health communication and journalism studies: excessive
media attention, content-related features such as an overemphasis on threat, and the
tone of coverage. For the case of H1N1-related news coverage, we found that two
out of three indicators were prevalent, yet the role of coverage tonality remained
nebulous, as findings were sharply conflicting. From this, we can conclude that
media may have –inadvertently –contributed to heightened risk perceptions
through a high volume of coverage and an unbalanced emphasis on the threat of
H1N1, however, tonality or formal features as a key factor in determining whether
media portrayal was dramatized, needs further empirical investigation. To provide
deeper insight into what constitutes ‘drama-laden’vs. ‘drama-free’news reporting
Journal of Risk Research 17
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on health risks, future studies should jointly analyse different indicators of
dramatization and explicate ‘benchmarks’of an ideal or non-dramatic coverage.
Acknowledgements
We would like to thank an anonymous reviewer for providing valuable comments, which
helped us to further improve the quality of this paper.
Funding
This study is part of the E-com@eu project. The research leading to these results has received
funding from the Commission of the European Communities Seventh Framework Programme
under grant agreement no. 278763. The study does not necessarily reflect the Commission’s
views and in no way anticipates the Commission’s future policy in this area.
Note
1. This article was under review at the time of the database search but has been published
in the meantime.
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