“Angelina Effect”: a Longitudinal Analysis of Celebrity Breast Cancer
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Beyond the “Angelina Effect”: A Longitudinal Analysis of Celebrity Breast Cancer Disclosures’ Impact on News Media and Public Online Breast Cancer Information Seeking Outcomes, 2005-2016 A Dissertation SUBMITTED TO THE FACULTY OF THE UNIVERSITY OF MINNESOTA BY Susan M. LoRusso IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Rebekah H. Nagler, Marco Yzer July 2017 © Susan M. LoRusso 2017 i Acknowledgements My name graces the title page of this dissertation, but this work is the product of a large group of advisers, faculty, colleagues, friends, and family. I want to take the opportunity to thank all of those who have helped make this accomplishment possible. First, I want thank my advising team, Dr. Rebekah Nagler and Dr. Marco Yzer. Dr. Nagler, as a busy assistant professor you chose to invest part of your time advising me, and for this I am grateful. Not only did you provide me with thoughtful feedback, guidance, and support, but you also helped me to see the value in my work and build my confidence as a researcher. As my first adviser, Dr. Yzer you taught me early on that integrity in research is more important than statistically significant results—one of the most important lessons I’ve learned in the last five years. I also want to thank my dissertation committee chair, Dr. Sarah Gollust, for your invaluable insight during the development of my dissertation project and support throughout the process. Lastly, I want to thank my dissertation committee member, Dr. Darin Erickson, who helped me to conceptualize my analytical approach for Study 2. Other faculty and staff of the SJMC deserve thanks for their help and support over the years. These individuals influenced my research and teaching, or simply helped me navigate the challenge that is graduate school: Mary Achartz, Dr. Colin Agur, Dr. Betsy Anderson, John Blair, Dr. Valerie Belair-Gagnon, Sue Couling, Dr. Ruth DeFoster, Julie Golias, Kathleen Hanson, Dr. Jisu Huh, Dr. Sherri Katz, Dr. Seth Lewis, Dr. Meghan Manning, Christine Mollen, Dr. Amy O’Connor, Nora Paul, Rebecca Rassier, Angie Rehn, Dr. Hyejoon Rim, Dr. Amy Sanders, Dr. Dan Sullivan, Dr. Chris Terry, Dr. Albert Tims, Dr. Dan Wackman, Dr. Brendan Watson, Jennifer Welsch, and Dr. Jennifer ii Williams. I would also like to acknowledge the funding support of the Joel and Laurie Kramer School of Journalism Fund, Hubbard Graduate Fellowship, Kriss Research Support Grants, and the Ralph D. Casey Dissertation Research Award. In addition, I would like to thank my coders for Study 1: Dylan Beckwith; Haley Johnson; and Sarah Smokrovich. I have been honored to be surrounded by an amazing group of peers over the last five years. Sarah Cavanah, Jennifer Lueck, Ben Miller, Casey Carmody, Taemin Kim, Kriste Patrow, and Chelsea Reynolds—you have been among my greatest friends, sources of support, and encouragement during my graduate studies. Without you, I’m not sure how I would have gotten through this process. In addition, I would like to acknowledge all the help and support from my fellow graduate students: Cassie Batchelder Merrick, Michelle Chen, Chuqing Dong, Meghan Erkkinen, Xiaofei He, Liz Housholder, Debra Kelly, Hyejin Kim, Eunah Kim, Jisu Kim, Soojung Kim, Soyoon Kim, Brett Johnson, Jiyoon Lee, Magdalene Lee, Xinyu Lu, Anna Popkova, Jared Martin-Rogers, Michaele Myers, Chris Nettleton, Alex Pfeuffer, Missi Rossi, Weijia Shi, Wooyeol Shin, Konstantin Toropin, Sarah Wiley, Rodrigo Zamith, and Xuan Zhu. Thanks also to my friend of nearly 30 years, Meghan Snegosky. Meghan, you have been a constant source of encouragement, support, and laughter throughout my reentry into higher education. I must also thank the University of Wisconsin-Stout community who supported my graduate school aspirations, particularly the faculty and staff of the Food and Nutrition department. In addition, I offer my thanks to Dr. Amanda Brown for taking a risk and mentoring a complete research novice. Lastly, without the mentoring and support iii I received from Dr. Richard Tafalla and colleagues in the Ronald E. McNair Scholar’s Program, a Ph.D. would have never been a consideration. As described above, faculty, staff, friends, and colleagues have played a critical role in my graduate studies and this dissertation, but my family’s role cannot be overstated. My entire family has been immensely supportive as I’ve trudged through higher ed over the last eight years, but their greatest influence was during my formative years. To my mother, Mary LoRusso, thank you for all of the love and support you have given me over a lifetime. Thank you for putting up with my endless questions about everything, and allowing me to stay up way too late reading with a flashlight under the covers. To my brothers, Matthew LoRusso and Carl LoRusso, thank you for being my first students, even though you had little choice in the matter. To my aunts, Vicki Bowler and Loretta Sondrall, thank you for unconditional kindness and for enabling me to see the world beyond Luck, WI. To the loved ones I have lost: Grandma and Grandpa—Ardyce and Reuben “Swede” Haglund—thank you for inviting us into your home, playing along with my imaginary friends, driving me to the library every week, and your love; Uncle Garry, each book, chemistry set, and fossil, that you gave me, invited me to think critically and question assumptions; Uncle Bill, thank you for always encouraging me and accepting me for the just the way that I am. My family has expanded since childhood. I must thank my sister-in-law, Jennifer LoRusso, for your constant support over the last eight years, and my sister-in-law, Stephanie LoRusso, for helping me navigate reentry into higher ed. Additionally, I would like to thank you both (and your husbands, Matthew and Carl, respectively) for creating the five cutest nieces and nephews a person could have. Your children have provided a iv much needed distraction from the stresses of graduate school, contributing to the thread of sanity that I have left. To Ben Blanchette, thank you for helping me to get through the day-to-day, see hope in the future, believing in me, and for your love. I wouldn’t have finished this dissertation without you. Finally, I would like to acknowledge and thank the 95 women and men who served as celebrities-of-interest for this dissertation. This dissertation is not a criticism of your decision to come forward. At one time, there was stigma surrounding even the discussion of breast cancer. Notable persons willing to publicly discuss their own experiences with breast cancer have helped to push that stigma aside. v Dedication This work is dedicated to my grandmother, Ardyce Haglund. Grandma, you are responsible for my lifelong obsession for the news, and your influence is seen in these pages. Your public display of pride for my Ph.D. pursuits was often embarrassing, but appreciated nonetheless. You wanted to be here to see me earn my Ph.D.—and I wish you were—but, regardless, you played a significant role in the conclusion of this dissertation. I’ve often thought of throwing in the towel on this Ph.D. thing. When those thoughts crept in, I could hear your voice—full of disappointment, shaming me into completing this dissertation. I would rather make you proud, so I kept going. vi Abstract A long research tradition exists investigating the content of news coverage of celebrity breast cancer disclosures and, to a greater extent, the impact these personal health narratives have on public cancer-related outcomes. However, the bulk of this research focuses on specific, large-scale media events, such as Angelina Jolie’s 2013 BRCA disclosure. The attention to individual disclosures provide insight about the specific media event, but does not further knowledge about the larger phenomenon of celebrity cancer disclosures. To go beyond the Angelina effect, this dissertation addresses three overarching research questions: 1) What breast cancer-related messages are present in media coverage of celebrity breast cancer disclosures; 2) do these messages impact public cancer-related behavioral outcomes (i.e., online breast cancer information seeking); and 3) are there attributes of the celebrity that predict media and public outcomes? To address these questions, first, 110 individual celebrity breast cancer disclosures between 2005 and 2016 were systematically identified. Then, two longitudinal studies were conducted. To address the first question, Study 1 used computer assisted and hand coded procedures to assess the presence of episodic frames (defined as containing information specific to the celebrity and her experience with breast cancer) and thematic frames (defined as including population and subpopulation breast cancer information [e.g., prevalance, risk, survial rates]). In addition, the presence of seven content categories classified as misinformation (defined as information which is innaccurate, misleading, or oversimplified) in news coverage was assessed. Results demonstrated that 80% of the news articles were written with an episodic frame, and 20% vii were written with a thematic frame, indicating very little information beyond the celebrity’s own experience with breast cancer was conveyed to the public. However, misinformation was largely absent in the news coverage—only misinformation pertaining to early breast cancer detection and mastectomy decisions was present in 10% or more of the news coverage. Study 2 attempts to determine if news content impacts information seeking by using the framing outcomes from Study 1 to predict Google Trends search query outcomes. Due to the disparate rates in the presence of episodic and thematic frames this dissertation is unable to provide support linking content and online breast cancer information seeking outcomes. However, time series models suggest that media coverage of celebrity breast cancer disclosures in the aggregate have a distal impact on the public’s breast cancer information seeking outcomes.