This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
HEALTH NEWS AGENDA BUILDING: JOURNALISTS' PERCEPTIONS OF THE ROLE OF PUBLIC RELATIONS
This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
HEALTH NEWS AGENDA BUILDING: JOURNALISTS' PERCEPTIONS OF THE ROLE OF PUBLIC RELATIONS
This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
HEALTH NEWS AGENDA BUILDING: JOURNALISTS' PERCEPTIONS OF THE ROLE OF PUBLIC RELATIONS
This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
HEALTH NEWS AGENDA BUILDING: JOURNALISTS' PERCEPTIONS OF THE ROLE OF PUBLIC RELATIONS
This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
HEALTH NEWS AGENDA BUILDING: JOURNALISTS' PERCEPTIONS OF THE ROLE OF PUBLIC RELATIONS
This study uses a nationwide survey of health journalists (N = 774) to explore the agenda-building process in health news, examining how journalists develop story ideas, value expert source characteristics, and perceive the acceptability of using public relations materials. Results indicate that intermedia agenda setting may be a stronger influence on agenda building than are information subsidies, and that journalists rate characteristics associated with public relations training as important in expert sources. Also, journalists who take an audience advocate role are more accepting of news releases than those who take a skeptic role.
When developing health news reports, journalists often use information that comes in the form of "information subsidies." An information subsidy is news information packaged free for journalists by those seeking publicity.1 Public relations materials are examples of information subsidies. In the area of science and health, the literature suggests that general assignment reporters depend on subsidies because they, themselves, may know less about the story subject, and that beat or specialty reporters may use them as a means to meet deadline pressures. While there is nothing inherently wrong with using information subsidies from public relations professionals, some critics2 have raised concern about the credibility and framing power this process can confer on groups that already are perceived to have extensive societal power (e.g., corporations).
One way that journalists try to maintain ownership of health stories is to rely less on information subsidies for the generation of story ideas, even though it may take more time and effort. Nevertheless, the process of producing news is complicated and influenced by many factors, not the least of which are money and time. The realities of a twenty-four-hour news cycle do not always make it practical or possible to avoid using information subsidies. The purpose of this study is to examine how health journalists make decisions about using information subsidies in reporting on health stories by analyzing how they (1) develop story ideas using public relations and non-public relations resources, (2) value expert sources and source characteristics, and (3) perceive the acceptability of using public relations materials in their stories. Additionally, the study looks at how journalists' views of their professional roles are associated with using public relations resources. The study's findings should contribute to our understanding of agenda building and offer insight for public relations professionals and journalists alike.
Literature Review
Health News Consumption and Agenda Setting. According to the Pew Research Center for the People and the Press, attention to health news is ranked sixth in popularity among news topics.3 It is outranked only by news about weather, crime, community, the environment, and politics. Nearly one-fifth of Americans say that they follow health news very closely.4 Studies show that younger and less-educated Americans get their health news from television, while older and more-educated Americans get health news from newspapers and magazines.5 Other research shows that people's top sources for general health information are the Internet and their doctors.6 Because health news is a top news category, there are ample opportunities for a variety of organizations that supply health information subsidies to reach the American public through news channels.
In addition to informing the public, health news can set the agendas for policy advocates and medical professionals. The concept of agenda setting explains news media influence on how the public perceives the salience and importance of issues in the news.7 Agenda setting concerns how the audience responds to the news media, not to how the media agenda itself is created. Media outlets define the importance of health issues by bringing potential health risks to light, giving them deeper meaning, shaping public perceptions about possible solutions, and, hence, shaping policy decisions.8
Because the mass media play a key role in transmitting knowledge and raising public awareness of public health issues, the scientific community, such as scientists and physicians, also pays attention to health news.9 As a result, there is a reciprocal relationship between the scientific community and the press. For instance, Phillips, Kanter, Bednarczyk, and Tastad10 found that medical journal articles appearing in the New York Times were cited more in the medical literature. In sum, the mass media influence policymakers, health professionals, and consumers' thinking about health.
Agenda-Building Theory and Information Subsidies. The concept of agenda building has been traced by Scheufele" to Cobb and Elder's 1971 study of politics and the news. Temporally, agenda building occurs prior to agenda setting.12 Whereas agenda setting relates to how the media agenda affects the public's perception of issue salience and how the public processes news information,13 the central point of agenda-building research is how some news items get on the media agenda while others do not. The process of agenda building includes journalists identifying, selecting, and developing story ideas, and weighing the importance of using facts, sources, and background research in the story. While the agenda-building process is of primary interest to public relations practitioners in media relations, many individuals and groups (advocacy groups, citizens, etc.) shape the "building" of the story. It is the job of media relations specialists to beat out other groups and get their organization into the news. Information subsidies, in the form of media relations tactics, are one tool used by public relations practitioners to achieve this goal.
Zoch and Molleda14 have argued that power in the agenda-building process is allocated, in part, by who initiated the story and the nature of the story. This means that how the story idea is generated substantially affects the agenda-building process and is the critical "first" step in the news production process. From the standpoint of public relations practitioners, it would be in their best interests to generate and frame the story ideas. Previous research by Curtin15 found that more than one-quarter of newspaper managing editors said they frequently "used public relations materials as the basis for a news story even just to spark an idea." It is not merely this first step where public relations professionals are involved in the agenda-building process, although they may get fewer chances to shape the story in its later stages. Following idea generation, ensuing work on the story, even in cases where journalists do enterprise reporting, may include a public relations source. Public relations offices may also provide referrals to experts or arrange interview logistics.16
It is an acknowledged practice that journalists often use public relations sources.17 Researchers have presented empirical and qualitative evidence of a relationship between public relations materials and events and the news media agenda.18 Sigal's early research revealed that press conferences and government press office materials were indispensible sources of news, particularly for the Washington daily press.19 Some have questioned whether these press materials affect the substance of news. One such study found that mentions of organizations in PR Newswire messages were related positively to mentions of the organizations in the news content of both the New York Times and Wall Street Journal.20 Also, the authors found positive correlations between the tone of the PR messages and the media coverage. Nonetheless, in a review of the literature on journalist-public relations practitioner relationships and the ability of practitioners to "frame" the news, Grunig pointed out that journalists tend to balance PR frames with those of other sources and, overall, journalists tend to maintain a neutral story frame.21
In the area of health, it has been argued that journalists rely more heavily on sources and experts because of a focus on novel health findings and the technical nature of the information. Tanner22 found that television health news journalists reported relying most heavily on a public relations person for their story ideas. Dunwoody found that deadline pressure and the need to accommodate a lot of equipment in the reporting process led science writers to depend more on press conferences than on original reporting.23 Another study24 of science journalists at elite newspapers revealed that they work through public relations departments and also rely on scientific journals for news of medical discoveries. The role of information subsidies, in the form of media relations tactics, and their importance to news development and agenda building is tied into the demands of the journalistic profession.
Factors Affecting Acceptance of Information Subsidies. Two factors associated with acceptance of information subsidies are the size of the news market and perceptions of the news sources' motives. It is common wisdom that weekly community newspapers do not have the same staff resources as do larger news organizations. They are therefore more restricted in the number of original stories that reporters can tackle and thus rely more on information subsidies. Another factor is perceived source motives. For instance, part of the journalist's role is to be a watchdog of powerful institutions like business and government,25 but journalists are less distrustful of universities and nonprofit organizations that are thought to serve society.
Data provide mixed support for these two factors. Curtin26 found that newspaper journalists were less willing to use press materials from companies versus nonprofits. Similarly, Berkowitz and Adams27 found that a local TV station was least likely to use information subsidies from business and government sources and most likely to use news releases from nonprofit organizations. Curtin28 also found that newspaper weeklies were more likely to employ public relations material as news filler. Additionally, a study of TV and newspaper use of press releases by market size29 showed that small TV stations and newspapers were more likely to save news releases for future use than were large TV stations (42% vs. 58% of news releases) and newspapers (23% vs. 33% of news releases). However, another study30 found that television market size and staff size were not significantly related to the use of VNRs (video news releases) distributed by the Centers for Disease Control.
The Role of Sources in Agenda Building. Journalists use expert sources in health stories to provide perspective, contribute balance to the story, discuss research implications, and legitimize other research.31 Berkowitz32 has argued that "news sources exert a stronger influence over the news agenda than journalists." He explains that journalists give sources power because sources provide journalists a way to convey balance and objectivity. However, not all sources are deemed equally useful. For instance, Conrad33 found that journalists reporting on genetics viewed sources more favorably if they returned telephone calls promptly, provided dear responses, and managed not to "overqualify" their research findings. Similarly, in a case study of a corporate takeover, researchers concluded that factors such as providing journalists access to an executive for interviews, responding to the reporter speedily, and adopting an advocacy stance influenced the quality of coverage the company received.34 Likewise, it has been emphasized that personal contact with a reporter35 and respecting a reporter's deadline are important.36
Public relations textbooks provide advice to school public relations practitioners concerning source characteristics that journalists value. Guidelines for preparing experts for such interviews are (1) "be prepared," (2) "call the reporter back immediately," and (3) "do change your schedule to meet the reporter's deadlines."37 Among Seitel's38 tips for print media interviews are: "don't bluff," "state facts and back up generalities," "if the reporter is promised further information, provide it quickly," and "tell the truth." Cutlip, Center, and Broom's39 advice is to be truthful and to provide journalists with newsworthy and timely information.
Journalistic Norms and Roles. How journalists view their job roles is thought to influence their perceptions of information subsidies. Berkowitz40 has argued that journalists must balance their time to meet the demands of their news organizations, their profession, and their readers. To that end, journalists "find news items that can be gathered and reported predictably, that allow careful rationing of resources and that can be completed within organizationally accepted deadlines." In other words, journalists must balance spending more time on an indepth piece with using an information subsidy. Journalists, though, have conflicting views as to the use of information subsidies. In a survey of news editors, it was found that while 62% agreed that "PR practitioners provide useful information," 76% also agreed that "Editors do not trust PR practitioners."41
Scholars have argued that the most influential factor in the news process is journalists themselves. For instance, Donsbach42 has argued that journalists rely mostly on other journalists for deciding what is news. He cited the fact that journalists say that they count other journalists among their three closest friends, and that journalists report using news wires, colleagues, elite media, and competitive media in making news decisions. Early research supports these claims. Dunwoody43 studied science writers and found that their editors evaluated the writers based on whether they "got" the same story as the competition. The science writers, recognizing how they would be evaluated, blunted the criticism by making sure they covered the same stories as other media. Similarly, Sigal asserted that "The newsman's first impression of what the news is comes from what newspapers, especially the Times and Post, cover."44 Another study45 of local television news story selection shows that most story ideas originated from the news staff or other media.
While journalists have mixed reactions to interactions with public relations practitioners,46 Berkowitz pointed out that their relationship is part of a larger "shared culture."47 In fact, researchers have found their roles to be mutually reinforcing role enactments in a conflictual setting.48 Berkowitz49 argued that relationships are not necessarily adversarial or mutually beneficial, but are dynamic and dependent on many factors, including the power differential between the source and the news organization. This means that on some occasions, journalists will either choose public relations sources or be compelled to do so by necessity when the public relations person asserts power, even if the journalists are more prone to select non-public relations sources.50
Hypotheses and Research Questions
Based on our review of the literature, we offer the following hypotheses and research questions.
H1: Health journalists will report that they use public relations resources (i.e., U.S. government news releases, nonprofit news releases, etc.) less frequently than they use nonpublic relations resources (i.e., medical journals, personal interest, etc.) for story ideas.
H2: Health journalists will report relying more on nonprofit public relations resources (nonprofit, government, university) for story ideas than they do corporate public relations resources.
H3: Health journalists working for national and metropolitan media will use public relations sources as resources for story ideas less often than will journalists for community media.
H4: Reporter belief in the acceptability of using public relations materials correlates positively with use of such resources.
RQ1: Will health journalists rate as important the expert source characteristics associated with public relations source training (e.g., providing accurate information, getting back to reporters quickly, etc.)?
RQ2: Do reporter characteristics (years of experience, media market, health topics covered, training as a health journalist, and perception of journalistic roles) predict reliance on public relations resources for story ideas?
Method
Sample. A professional survey research center at a Midwestern university collected the data between January and February 2008. The Association of Health Care Journalists, in a partnership, developed the sampling frame from the online Bacon's Media Directory. There were 2,805 valid names of health journalists.31 A total of 774 surveys were completed for a 61.9% response rate.52
Variables. Use of Resources for Story Ideas. Reporters were asked about "the resources you use for health story ideas... please tell me how often you use each of the following resources." Non-public relations resources included: medical journals; personal interest or that of someone on staff; readerslviewers/listeners' e-mails or phone calls; and reading newspapers or other publications. Public relations resources included: a public relations person who pitches a story; U.S. government news releases; news releases from nonprofit organizations; corporate news releases; university news releases; and other sources. Responses were recorded on a scale of 1 (not at all) to 7 (very often). Results for "other sources" were coded qualitatively from openended responses.
Use of Sources. Reporters were asked about "the importance of various characteristics of an expert when you decide whether or not to use an expert in a health story." Journalists were asked to rate the importance of: provides accurate information; ability to explain complicated information; is easy to reach/gets back to me; (inotability; and has been quoted in other media. The response scale ranged from 1 (not at all important) to 7 (very important).
Acceptability of Using Public Relations Materials. A set of five questions measured journalist perceptions of the acceptability of using public relations materials. These questions were used previously by LenRios, Hinnant, and Park:53 (1) using a news release "as is" from a federal government agency about a new government health initiative; (2) running a story about death rates taken from a news release provided by a nonprofit organization; (3) developing a story about local in-store pharmacies from a news release sent by a public relations agency representing the pharmacies; (4) using a news release from a local university to create a story about the results of a faculty member's scientific studies; and (5) writing a story pitched by a public information officer from a local state health department. The scale was anchored with 1 (highly inappropriate) and 7 (highly appropriate).
Journalistic Experience. Respondents were asked their years of journalistic experience.
Media Market Size. Media markets were identified by asking: "Does your news organization serve a national audience, metropolitan audience, or community audience?"
Journalistic Training. Respondents answered yes, no, or don't know to whether they had had "specialized training in health reporting."54
Health Topics. These questions asked "Do you ever cover ___ ?" [insert health topic]: (1) cancer or cancer prevention; (2) heart disease or cardiovascular health; (3) nutrition, fitness, obesity or diabetes prevention; (4) mental illness or depression; (5) healthcare policy; and (6) strokes or stroke prevention. Dichotomous answer options were: (1) Yes, (0) No.
Journalistic Perception of Roles. A series of questions was used to determine whether journalists' professional role orientations affected their responses. The response scale ranged from 7 (extremely important) to 1 (not at all important). The questions were taken from Plaisance and Skewes55 and Weaver, Beam, Brownlee, Voakes, and Wilhoit.56 Principal components factor analysis showed that the questions loaded on two factors representing two roles: the skeptic (r = .76 between the two items) and the audience advocate (Cronbach's alpha = .57, r = .08 to .36). While the principal components analysis identified two distinct factors, the second factor's alpha is low or at best modest, and should be interpreted with some caution.
The skeptic role comprised "Journalists should be constantly skeptical of business" and "Journalists should be constantly skeptical of public officials." The audience advocate role included "Journalists should provide analysis and interpretation of complex problems," "Journalists should get information to the public quickly," "Journalists should advocate for their readers to improve their health and well-being," and "Journalists should concentrate on news that's of interest to the widest possible audience."
Findings
Our first hypothesis addressed whether journalists use public relations resources for story ideas less frequently than they report using nonpublic relations resources. Descriptive statistics (see Table 1) show that journalists rated the use of non-public relations resources for story ideas most highly, saying they used them more frequently than they used public relations resources. The one exception was the use of story ideas from medical journals, which was the only non-public relations source that rated lower than the public relations sources. The highest rated resources for story ideas were other news media, personal interest/someone on staff, and the news audience. Public relations resources that were used most frequently were university news releases and nonprofit news releases. To assess any statistical differences among non-public relations resources and public relations resources used for story ideas, twenty paired f-tests with Bonferroni adjustments for multiple comparisons, p < .0025 (see Table 2) were run. Results show that for all combinations, except for the case of using information from a medical journal, the non-public relations sources were rated significantly higher as story idea resources compared to public relations resources. All public relations resources were rated significantly higher than relying on a medical journal except for the cases of a public relations pitch or a corporate news release. When comparing a medical journal (M = 3.29, sd = 2.00) to a public relations pitch (M = 3.49, sd = 1.68), t(768) = -2.17, p = .03, the difference was nonsignificant. When comparing a medical journal (M = 3.29, sd = 2.00) to a corporate news release (M = 2.84, sd = 1.60), the medical journal was rated as used more frequently, t(768) = 5.04, p < .0025.
To address H2, one-tailed paired t-tests were run to determine if corporate news releases were rated significantly lower than were use of university, nonprofit, and government news releases. In all cases, corporate news releases ranked significantly lower (M = 2.84, sd = 1.60) than university news releases (M =3.83, sd = 1.66), t(771) = -14.79, p < .001, nonprofit news releases (M = 3.82, sd = 1.51), t(771) = -16.42, p < .001, and U.S. government news releases (M = 3.61, sd = 1.71), t(771) = -11.58, p < .001.
H3 addresses differences in news resource use among health journalists who worked in larger media markets compared to smaller ones. To analyze this hypothesis, a mean index was created of the use of PR resources and then a median split was used to group journalists as high or low users of PR resources. Cross-tabulations were calculated and there was no significant difference among journalists' high use of public relations resources for story ideas comparing national (16.6%), metropolitan (14.9%), and community (13.3%) media markets, χ^sup 2^(2, 526) = .72, p = .70.57
H4 predicted that journalists who felt it was acceptable to use public relations materials would be more likely to use such materials when developing story ideas. To assess this association, Pearson correlations were used. The results show that if journalists viewed it as acceptable to use a government news release, they also reported that they gathered story ideas from government news releases, r = .19, p < .01.58 Similarly, if journalists felt it acceptable to use figures from a nonprofit news release, they also said that they got story ideas from nonprofit news releases, r = .21, p < .01; if they found it acceptable to use corporate news releases, they used corporate news releases for story ideas, r = .28, p < .01; and when they found it acceptable to use university news \releases, they thought it was acceptable to use university news releases for story ideas, r = .26, p < .01.
Results for RQ1 (see Table 3) show that journalists do rate characteristics associated with public relations training - providing accurate information (M = 6.91, sd = 0.44), the ability to explain complicated information (M = 5.91, sd = 1.39), getting back to reporters quickly (M = 5.76, sd = 1.27), and quotability (M = 5.08, sd = 1.54) - as important characteristics of expert sources. However, reporters did not seem to rate a source's previous experience with the media as important (M = 3.41, sd = 1.64).
RQ2 was answered using a standard multiple regression equation (see Table 4). The criterion variable, use of PR resources for story ideas, was regressed on the combination of variables representing years of experience, media market size, health topics, training as a health journalist, and perception of journalistic roles. The equation using these 13 variables accounted for just 5.5% of the variance in the use of PR resources for story ideas, F(13, 710) = 3.18, p < .001. Standardized beta weights were examined to determine the importance of the predictors. Only journalist role orientation and reporting on health care policy were significant predictors. The largest beta weight was .15 (p < .001), representing an audience advocacy orientation. Journalist audience advocates were more likely to say they used PR sources for story ideas. Journalists who wrote stories about health care policy were less likely to use PR resources for story ideas (B = - .13, p < .01), as were journalist skeptics (B = - .08, p < .05).
DISCUSSION
As predicted, these data reveal that journalists rated non-public relations resources (other news media, self-interest/news staff, news audiences) as more important in generating story ideas. This finding is worth examining from an agenda-building perspective. Although citizens have a place on the list of possible influencers, they are not thought to powerfully shape media agendas. Moreover, it is possible to argue that when journalists look to their own interests for story ideas, they are actu- ally trying to predict their audiences' needs. Several studies have shown that journalists are self-referential concerning the audience.59 It could be that health journalists, concerned with the desires of their audience, look to other news media, which are also prioritizing audience-resonance with their story ideas. This indicates that agenda building in health journalism may be dissimilar to that of traditional news reporting. Unlike general news, the value of health information relies on whether people can use it. "Health information is, after all, an 'experience good/ That is, evaluations of its quality cannot be made until after the information has been acted upon."60 Perhaps the heightened value of the audience experience explains why health journalists use audience members and themselves for story ideas.
An additional explanation could be that intermedia agenda setting indicates a competitive media environment and a respect for one's peers. As noted, agenda building begins with story idea generation, and the group or person who conceives of the idea holds more power.61 If journalists turn to other journalists to build the media agenda, as suggested by our data and literature,62 journalists are recycling the same ideas and also providing confirmation of each others' information. This raises the question about whether the diversity and quality of ideas in the news marketplace is limited. On the other hand, this may mean that practitioners who get stories about their organizations in the news will see their story get picked up by numerous other news outlets. Future studies should examine whether there is an important role for public relations in the building of widespread and, perhaps, long-lasting media agendas shared across distance, channels, and time. It could be that intermedia agenda setting amplifies the voices of those organizations that successfully place their information subsidies.
Results from the standard regression analysis reveal that journalists who are greater audience advocates are more likely to lean toward public relations resources while skeptics are not. This difference likely signifies that skeptics are skeptical of all resources, while audience advocates are open to a greater variety of resources, even those that have vested interests, if they are perceived to serve the audience. Similarly, the finding that the use of PR resources for story ideas did not correlate with personal interests or the interests of someone on staff (except for nonprofit news release), but did correlate with use of news audience for story ideas, casts doubt on whether journalists are self-referential when considering their audiences. A more nuanced approach would be to consider whether journalists who rely on personal /staff interest and not on PR resources could be more insular while fulfilling the skeptic role, while journalists who look to news audience and PR resources could be fulfilling the advocate role. An additional result, that health care policy journalists are also less likely to rely on public relations resources, seems to confirm the idea that in the arena of politics, journalists are more leery of public relations.
Findings confirm the recommendations that public relations textbooks are giving public relations students. One consideration that stems from examining these ratings is that the source characteristics that journalists seek are made manifest in both public relations and non-public relations sources. As to whether journalists value these characteristics in public relations sources enough to dismiss their mistrust of some of these sources is unknown and likely depends on other variables.
Contrary to much conventional wisdom, no significant differences were found among journalists in different sized media markets. It was predicted that community newspapers would use a greater number of news releases because they have fewer staff and resources. Possibly journalists become quite adept at making do with limited resources without becoming overly reliant on information subsidies. It is also possible that self-reported use is understated by smaller outlets to maintain the appearance of journalistic integrity, More particularly, the results may be explained by the fact that localization is an important factor in accepting news releases. It is possible that while community newspapers do have fewer resources, they also have less news space and receive a larger number of irrelevant, non-localized information subsidies.
This study has its limitations because it only measured journalists' perceptions of their news behaviors. We cannot validate these self-reports against actual behavior in a cross-sectional survey. We did not track editors' decisions about information subsidies as they went through the process of generating story ideas and selecting news stories. Those types of studies, however, are typically focused on individual newsrooms or a limited number of them. The strength of our results is that they are based on a national sample of health journalists, which provide us with a more representative picture of their attitudes, opinions, and practices.
Media agenda building is a multifaceted process that deserves further study. Future research should link reporter characteristics and attitudes to actual gatekeeping behavior or to a content analysis of reporters' stories. Given the finding that intermedia agenda building's influence may be strong, this force should be added to agenda-building models. And, given journalism's reliance on AP stories to fill newspaper news holes and the putative use of print as a basis for broadcast and Web stories, this compounding effect deserves further study. Finally, the shift from newspaper to television or Web news is much vaunted, but how, if at all, has the media agenda-building process been impacted by new technologies and this "changing of the guard"? Will the media agenda be formed through an altered process or to a greater or more limited extent than in the past?
[Author Affiliation]
Mar�a E. Len-R�os is an assistant professor; Amanda Hinnant is an assistant professor; Sun-A Park is a doctoral student; Glen T. Cameron is a professor; Cynthia M. Frisby is an associate professor; and Youngah Lee is a doctoral student. All are at the University of Missouri. Funding for this research was provided through a grant from the Missouri Foundation for Health, Agreement 07-0242-HL-07.
