The Blame Frame: Media Attribution of Culpability About the MMR–Autism Vaccination Scare more

This article was downloaded by: [Avery Holton] On: 11 January 2012, At: 09:07 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Health Communication Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hhth20 The Blame Frame: Media Attribution of Culpability About the MMR–Autism Vaccination Scare Avery Holton , Brooke Weberling , Christopher E. Clarke & Michael J. Smith a b c d a b c d School of Journalism, University of Texas at Austin School of Journalism and Mass Communication, University of South Carolina Department of Communication, Cornell University School of Medicine, University of Louisville Available online: 11 Jan 2012 To cite this article: Avery Holton, Brooke Weberling, Christopher E. Clarke & Michael J. Smith (2012): The Blame Frame: Media Attribution of Culpability About the MMR–Autism Vaccination Scare, Health Communication, DOI:10.1080/10410236.2011.633158 To link to this article: http://dx.doi.org/10.1080/10410236.2011.633158 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Health Communication, 1–12, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1041-0236 print / 1532-7027 online DOI: 10.1080/10410236.2011.633158 The Blame Frame: Media Attribution of Culpability About the MMR–Autism Vaccination Scare Avery Holton School of Journalism University of Texas at Austin Brooke Weberling Downloaded by [Avery Holton] at 09:07 11 January 2012 School of Journalism and Mass Communication University of South Carolina Christopher E. Clarke Department of Communication Cornell University Michael J. Smith School of Medicine University of Louisville Scholars have examined how news media frame events, including responsibility for causing and fixing problems, and how these frames inform public judgment. This study analyzed 281 newspaper articles about a controversial medical study linking the measles, mumps, and rubella (MMR) vaccination with autism. Given criticism of the study and its potential negative impact on vaccination rates across multiple countries, the current study examined actors to whom news media attributed blame for the MMR–vaccine association, sources used to support those attributions, and what solutions (e.g., mobilizing information), if any, were offered. This study provides unique insight by examining the evolution of these attributions over the lifetime of the controversy. Findings emphasize how news media may attribute blame in health risk communication and how that ascription plays a potentially vital role in shaping public behavior. Theoretical and practical implications are discussed. In February 1998, an article suggesting a potential association between autism and the measles, mumps, and rubella (MMR) vaccine appeared in the British medical journal The Lancet (Wakefield et al., 1998). From the onset, this suggestion was met with significant criticism from the scientific and medical communities—criticism that strengthened over the years as other research refuted a connection (Gerber & Offit, 2009). The study attracted considerable interest among the public, policymakers, and news media around the world (Clarke, 2008) and, argued health officials, cast Correspondence should be addressed to Avery Holton, School of Journalism, University of Texas at Austin, 1 University Station A1000, Austin, TX 78712-0113. E-mail: averyholton@gmail.com doubt on vaccine safety (Petts & Niemeyer, 2004) and led to decreased rates of MMR uptake and a resurgence of measles in the United Kingdom and elsewhere. The MMR–autism controversy raises questions about news media coverage of important public health issues and how health officials can effectively communicate vaccine safety and risk in this context (Clarke, 2008, 2010). Of particular relevance is the question of blame: Who or what was viewed as responsible for the potential public health impacts of this study? To whom was responsibility attributed? What does this attribution say about journalism practice and risk communication? Scholars have examined how news media help direct attention to issues (see McCombs & Shaw, 1972; Rogers, 2 HOLTON ET AL. Downloaded by [Avery Holton] at 09:07 11 January 2012 Dearing & Chang, 1991) as well as frame aspects of these issues (see Entman, 1993, 2007; Matthes, 2009). News media can also explicitly or implicitly assign responsibility for causing and fixing social problems, which in turn can inform judgment and action on the part of citizens and policymakers (Iyengar, 1996; Kim & Willis, 2007; Weiner, 2006). While a few studies have examined news media framing of autism (Boyce, 2006; Clarke, 2008; Weberling, 2010a) and the MMR vaccination (Leask & Chapman, 2002), the current study is the first to explore the evolution of media attribution of blame for the MMR–autism controversy over its lifetime—a broad span of time that has included several contentious revelations. Indeed, multiple actors were involved in the publication and dissemination of the Wakefield et al. (1998) study, including Andrew Wakefield and his research partners, The Lancet, the news media, and other conduits of information. All could arguably bear some blame for the direct or indirect promotion of the findings and subsequent impacts. Defining key points in the controversy and uncovering how the attribution of blame may have changed over those periods may reveal patterns in news media framing of culpability, which likely affected public understanding of and reactions to this issue. The present study sought to (1) analyze actors to which the news media attributed blame for the controversy along with sources used to do so; (2) explore coverage over time, taking into account potential changes in attribution; and (3) assess attributions of responsibility for addressing this issue and its effects, focusing on mobilizing information provided to readers. Results elucidate theoretical and practical implications related to attribution, journalism practice, and risk communication. BACKGROUND The Wakefield et al. (1998) study described 12 children with enterocolitis—inflammation of the colon or intestines—and developmental disorders. Nine of the children were diagnosed with autism, a pervasive developmental disorder (PDD) typically diagnosed in children between 18 and 36 months (American Psychiatric Association, 2000; Caronna, Milunsky, & Tager-Flusberg, 2008). More prevalent symptoms include delayed or regressive cognitive functioning, impaired social interaction, and repetitive behavior (Centers for Disease Control and Prevention [CDC], 2011a). Parents of eight of the children recalled onset of symptoms shortly after their children received the MMR vaccination. Wakefield postulated that the measles virus used in the vaccine damaged the intestinal lining, caused the enterocolitis, and permitted the entrance of gut-derived peptides that subsequently led to abnormal brain development and autism (Offit & Coffin, 2006). At best, these findings can generate hypotheses that can be tested in larger, more epidemiologically rigorous analyses. They cannot, as the authors noted, prove a causal association (Wakefield et al., 1998). However, Wakefield subsequently recommended at a press conference that single vaccines—one each for measles, mumps, and rubella—be offered in place of MMR until a potential link with the entercolitis and autism could be further studied (Offit, 2008). Numerous epidemiologic studies subsequently failed to support an MMR–autism link (Gerber & Offit, 2009; Miller & Reynolds, 2009; see also Institute of Medicine, 2004), and criticisms of the study’s methods, ethics, and conclusions remained prevalent. Notably, 10 of the study’s 13 authors issued a retraction of the MMR–autism interpretation in 2004 (Murch et al., 2004). At the same time, allegations of Wakefield’s professional misconduct were publicized by Sunday Times investigative reporter Brian Deer (2011a; 2001b). In June 2006, the UK General Medical Council (GMC) formally accused Wakefield of failing to attain ethical review board approval for the study and of failing to disclose that he had received compensation from a lawyer representing several children in the study whose families were involved in autism-related litigation against MMR manufacturers (Offit, 2008). In January 2010, the GMC found him guilty of these charges and revoked his British medical license (Whalen, 2010). One month later, The Lancet retracted the original 1998 article in its entirety. Finally, in January 2011, the British Medical Journal published a series of articles that summarized many of the prior accusations and demonstrated how Wakefield falsified data to strengthen the apparent MMR–autism link (Deer, 2011a, 2011b; Godlee, Smith, & Marcovitch, 2011). Despite scientific and ethical flaws with the Wakefield (1998) study, concern about a link continued to attract considerable interest among the public, policymakers, and the news media (Clarke, 2008). Health officials argued that the study helped cast doubt on vaccine (especially MMR) safety (Petts & Niemeyer, 2004). After the study’s release, national rates of MMR vaccinations in the United Kingdom fell, resulting in measles outbreaks throughout the country (Godlee, Smith, & Marcovitch, 2011). The first measles death in the United Kingdom in more than a decade was reported, and in the United States, there was a smaller but detectable decrease in MMR immunization rates (Smith, Ellenberg, Bell, & Rubin, 2008). Nonetheless, the United States experienced the largest measles outbreak in more than a decade in 2008 (Centers for Disease Control and Prevention, 2008) and is on track for even more cases in 2011 (Centers for Disease Control and Prevention, 2011b). LITERATURE REVIEW The current study examines media framing of the MMR– autism controversy—in particular, attribution of responsibility or blame for the aforementioned public health impacts. The following sections provide a review of relevant literature on vaccine risk communication (including the role of mass media) as well as framing and attribution. THE BLAME FRAME, MEDIA ATTRIBUTION, AND MMR 3 Vaccine Risk Communication and the Role of Mass Media The news media remain an important source of health information (Vasterman, Yzermans, & Dirkzwager, 2005) and can promote vaccine importance as well as raise awareness of safety issues (Davis, Chapman, & Leask, 2002; Leask & Chapman, 2002). A number of criticisms have been leveled against news media coverage of the autism-vaccine issue, including (1) inaccurately balancing claims of a link versus overwhelming evidence to the contrary (Clarke, 2008; Lewis & Speers, 2003; Offit & Coffin, 2006) and (2) failing to recommend how individuals, especially parents, could address vaccine-related concerns (Clarke, 2010). In a larger sense, the controversy raised questions about effective vaccine risk communication. Some scholars and health officials have emphasized the need to “correct” misinterpretations of risk, such as the nonexistent threat of autism, by providing clear evidence of vaccine benefit (such as studies that refute an autism link) (Bellaby, 2003; Dittmann, 2001; Miller & Reynolds, 2009). Other recommendations center on engagement, in which officials work to understand and proactively address concerns (Blume, 2006; Francois et al., 2007). been tied to agenda setting—the concept that the news media guide public awareness and opinion by emphasizing certain issues or issue attributes (Kim, Scheufele, & Shanahan, 2002; Weaver, 2007). Agenda setting and framing converge in the mental pictures people formulate about issues, which can affect public response to those issues (McCombs & Ghanem, 2001). Research often emphasizes the most obvious or dominant frames, typically determined by the headline, lead paragraph, and/or main idea of a story (Connolly-Ahern & Brodway, 2008; Smith & Wakefield, 2006; Weaver, Lively, & Bimber, 2009). However, Entman (2003) noted that focusing on dominant frames may produce results that aren’t necessarily illustrative of all frames. For this reason, the current study considers both dominant and less prominent, peripheral frames. Downloaded by [Avery Holton] at 09:07 11 January 2012 Attributing Blame One particularly insightful area of framing research is the attribution of blame—designation of responsibility for causing and fixing social problems. Iyengar (1991) argued that news framing of responsibility can influence individuals’ decisions about whether and how to act to solve social problems, such as poverty and unemployment. Similarly, Hallahan (1999) suggested that attribution of responsibility is one of the most important frames for communicating health issues. He referred to the medicalization of news, or the practice of blaming individuals for health problems, which is common among American media. Episodic framing (e.g., using examples of individuals affected by a health or social issue) tends to invoke individual blame and weakens support for broader political, economic, or environmental solutions. However, thematic framing (e.g., citing incidence levels and population statistics) can increase support for these solutions (Iyengar, 1989, 1990, 1996; Weiner, 2006). Research on news coverage of health issues illustrates these frames and discusses possible audience effects (see Brown & Basil, 1995, Slater & Jain, 2011). For example, Weeks et al. (2011) found when the news media framed mammography guidelines as controversial in 2009, people sought more information online than previously. Similarly, Chang (2011) noted news media coverage of the H1N1 outbreak in Taiwan evoked public fear without improving prevention or treatment efforts. In a content analysis of newspaper and television coverage of obesity from 1995 to 2004, Kim and Willis (2007) found that personal causes and solutions were included more frequently than societal-level causes and solutions, especially in television news. However, this pattern changed in more recent years, with mentions of societal-level causes increasing and personal solutions decreasing. The latter study emphasizes how medical developments can affect news coverage of health issues over time, demonstrating the importance of longitudinal examination of issues such as the MMR–autism controversy. News Framing From a mass communication perspective, framing refers to the texts, images, and news platforms used to describe an issue (Goffman, 1974; Reese, 2007). Journalists and other sources frame an issue by providing news and information to the public that explain problems, provide context, and offer solutions or recommendations (Boykoff, 2007; Entman, 1993). The framing process occurs among the news media, communication professionals, and their audiences and can include the selection, emphasis, or omission of certain aspects of an issue (Reese, 2001, 2007). The news media decide which sources to use when framing an issue, quoting sources such as communication practitioners, organizations, or individuals attempting to demonstrate expertise or advance a specific angle or aspect of a story (Zoch & Molleda, 2006). Health reporters in particular often rely on information from “expert” sources when crafting stories because of the complex nature of many health issues (Len-Ríos et al., 2009). However, this information may not always be factual (Greenberg & Knight, 2004). Rather, opinions tend to be used more by sources in news media coverage when attempting to indicate blame (Guo, Hsu, Holton, & Jeong, 2011). Scholars consider framing a multifaceted process consisting of (1) inputs constructed by the news media and communication professionals; (2) processes—ways in which frames become embedded in news stories and in people’s minds; and (3) outcomes—audience responses to these frames (Scheufele, 1999; Scheufele & Tewksbury, 2007). In communication research and other fields, framing has 4 HOLTON ET AL. Framing of the Autism–MMR Controversy This study also drew on previous research of news media coverage of the autism–MMR vaccine issue. Clarke (2008) conducted a content analysis of 279 articles in U.S. and UK newspapers from 1998 to 2006, examining the extent of balanced reporting surrounding the MMR–autism link (e.g., presence of claims that support and refute a connection). Given that the bulk of scientific evidence favors a rejection of the autism–vaccine connection, such balance can create a media discourse at odds with this consensus. Clarke also acknowledged that while news media framing of the MMR–autism link could have audience implications, including decreased vaccine uptake, he focused on the structural or descriptive element: the way frames appeared in news coverage. Similarly, Boyce (2006) conducted a content analysis of the autism–vaccine controversy in British newspapers, television, and radio coverage in 2002 and found that journalists balanced “expert” sources, such as scientists, with the “ordinary voices” of parents and politicians. While scientific experts accounted for one-third of all sources, the majority were nonmedical experts, including parents and politicians. However, neither Clarke (2008) nor Boyce (2006) focused on news media framing of responsibility or blame regarding the Wakefield et al. (1998) study. Only one study on attribution in a vaccine context had been conducted as of September 2011, and it focused on vaccine-preventable diseases such as measles and pertussis. Leask and Chapman (2002) explored Australian newspaper coverage of low rates of childhood vaccinations from 1993 to 1998. They focused on who was to blame for these rates and actors who assigned blame. Politicians focused on society at large (a “national shame” resulting from inadequate government policies), while doctors focused on parents (not immunizing was akin to child neglect). While Leask and Chapman’s (2002) coding categories informed this study’s approach, they broadly examined immunization and responsibility for low uptake rather than focusing on a single illness or disease. Additionally, the aforementioned studies focused on news coverage in the United States, United Kingdom, and Australia only, whereas the current study examined samples of coverage from other nations as well to provide a wider, more international approach. The present analysis also describes coverage over time, as the Wakefield study gained prominence (and criticism) and potential impacts on vaccination confidence and uptake rates unfolded. However, like the aforementioned research, the present study concentrated on the structural angle (what frames were presented by the news media), as opposed to the functional angle (audience effects). This approach provides a necessary first step for describing existing message characteristics, setting a foundation for future research, and informing the following research questions that guided the present study: • RQ1. How have the news media framed attribution of the MMR–autism link and its effects? • RQ2a. What sources were used to attribute blame? • RQ2b. Did these sources present factual information or opinion that may have been offered by individuals or organizations? • RQ3. Have the news media attributions of blame changed over time? Have key moments in the autismvaccine issue affected those representations? Mobilizing Information As a final area of interest in news media attribution of responsibility, this study focused on media-provided solutions or calls to action (Iyengar, 1989; Kensicki, 2004). Research on framing of social problems suggests that while the news media may identify who is responsible, they do not typically provide solutions that the public can use to help alleviate concern (Hoffman, 2006; Kensicki, 2004; Lemert, 1984; Nicodemus, 2004). Lemert (1984) argued that such mobilizing information is fundamental in enabling and empowering the public to act. Media framing of the MMR– autism link may suggest blame and/or resolutions that may influence people to take or avoid certain actions, such as seeking information on MMR vaccination or allowing their children to be immunized. Mobilizing information (MI) is similar to Kensicki’s (2004) “calls to action” concept and has been widely cited in mass communication research (Hoffman, 2006; Lemert et al., 1977; Lemert, 1984; Nicodemus, 2004). In short, MI enables people to act on existing ideas and motivations. Lemert (1981) distinguished three types of MI: identificational, which includes names and contact information for people or groups; locational, which includes the time and place of an activity; and tactical, which includes explicit and implicit instructions for certain behaviors. MI is often cited in research exploring the media’s role in empowering citizens to act on salient issues, including vaccination (Hoffman, 2006; Nicodemus, 2004; Weberling, 2010b), and remains an important concept for the study of autism, MMR vaccination, and health communication in general. Thus, this study also asked the following question: • RQ4. Have the news media presented any mobilizing information/calls to action in coverage of the MMR– autism link and its effects? Downloaded by [Avery Holton] at 09:07 11 January 2012 METHODS This study used content analysis of global media coverage of the MMR–autism controversy over a 13-year time span (1998 to 2011). The first newspaper article to discuss the Wakefield et al. (1998) findings appeared on February 27, 1998 (“Child jabs feared to trigger autism,” 1998). This date served as the starting point for a content search. As the issue remains salient, an endpoint was selected based solely on THE BLAME FRAME, MEDIA ATTRIBUTION, AND MMR 5 the timing of the present study. Therefore, dates included for analysis were February 27, 1998–March 1, 2011. Selection of Sample A LexisNexis Academic database search of that time frame for all newspaper coverage containing the words “autism,” “autis∗ ,” “MMR,” and “vaccination” revealed a population of 1,347 news items. The database included U.S. and international newspapers, all of which were included in the initial search. Letters to the editor, entertainment articles, book reviews, news briefs (150 words or less), and other similar articles were removed, in addition to duplicate articles. The latter included those that contained content matching that of an article already in the sample; wire articles that appeared in multiple newspapers; and articles where only a slight portion of the content had been altered (e.g., the headline changed but the content and author/source remained the same). After removing these articles, 1,011 remained. This population was stratified by year, and approximately 30% of each year’s articles was sampled to ensure a sampling error of approximately 5% at the 95% confidence interval. Systematic sampling yielded a sample of 286 articles. After a final review, five more were excluded for containing duplicate information, resulting in a final sample of 281 articles. These articles were the units of analysis. Blame frames. Coders first identified the presence of actors to whom blame was attributed in each news article. These included: (1) the media, (2) elected officials (e.g., state senators, government officials, etc.), (3) The Lancet, (4) Andrew Wakefield, (5) other individual actors (e.g., other health or similar researchers), (6) society (e.g., parents, family, etc.), (7) science/medicine (e.g., in broad terms), (8) other journals, and (9) other. Given that multiple actors may have been linked to the MMR–autism controversy within a single article, any mention of blame established peripheral attribution. Within each article, dominant attribution was then assessed based on the actor who received the majority of attention. This was determined by calculating the number of sentences that either included or referred to the actor. When counts were identical—as happened in less than 3% of the articles—the dominant attribution was chosen at the discretion of the coder. Source attribution. Coders also determined the presence of sources used within each news article to attribute blame. These included: (1) elected officials, (2) nonprofit organizations (e.g., Autism Speaks, the Autism Society, etc.), (3) individuals with autism, (4) family members, (5) other personal sources (e.g., friends, co-workers), (6) science/medical sources (e.g., health practitioners, medical researchers, etc.), (7) celebrities, and (8) other experts. Coders also noted whether or not the sources offered (1) facts such as statistics, organization names, and medical definitions or (2) opinions (e.g., “Science really needs to offer better solutions through research,” “Wakefield clearly damaged parent confidence in the vaccination”). Because this study also sought to identify changes in attribution over time, the specific date and year of each article were noted. Articles were grouped based on three key events surrounding the Wakefield et al. study: (1) the time period between the publication of the study and the initial allegations of Wakefield’s unethical practices (February 27, 1998–February 21, 2004); (2) the time period between the initial allegations and Wakefield’s conviction of ethical violations by the GMC (February 22, 2004–January 27, 2010); and (3) the time period since that conviction (January 28, 2010–March 1, 2011). Mobilizing information (MI). Using Lemert’s (1981, 1984) definitions, coders determined the presence of three types of MI: (1) identifying information (names of individuals or organizations); (2) locations (physical and web addresses, telephone numbers); and (3) tactics (instructions on how to get involved or what to do beyond reading a news article). For example, identifying information might have included the name of an autism advocacy group such as Autism Speaks; a location could be a website (e.g., autismspeaks.org); and a tactic might have directed the reader to the donation link on the website. Downloaded by [Avery Holton] at 09:07 11 January 2012 Coding Variables A codebook1 was developed by the first author in consultation with the other authors and based on a review of relevant literature on framing, attribution, and media coverage of the MMR–vaccine controversy (Boyce, 2006, 2007; Clarke, 2008; Weberling, 2010a), as well as findings from two pretests.2 In particular, this study used Leask and Chapman’s (2002) approach as a guide for developing categories, which included attributions of blame for the controversy and its impacts on vaccination rates; sources that made these attributions; and solutions to address this issue (i.e., mobilizing information). complete coding scheme is available upon request. graduate students were recruited to analyze the sample. In order to improve intercoder reliability as well as variable measures, both coders underwent two training sessions in which they received variable definitions and coding instructions. Using articles discarded during the sampling procedure, the coders pretested the initial codebook. To determine intercoder reliability, Krippendorff’s alpha was used. It is a robust measure of reliability that can be used regardless of the number of coders, levels of measurement, sample size, and presence of missing data (Hayes & Krippendorff, 2007). Scores above .8 represent strong reliability. Intercoder reliability scores on the initial pretest ranged from .59 to 1.0. After minor revisions to the codebook to improve reliability, the coders pretested another sample of discarded articles, resulting in more appropriate intercoder reliability scores ranging from .84 to 1.0. 2 Two 1 The 6 HOLTON ET AL. TABLE 1 Dominant Attribution of Blame for the MMR-Vaccination Scare Attribution Andrew Wakefield Science/medical Society Other actor The Lancet The media Other Other journal Frequency 108 (39.7%) 76 (27.9%) 43 (15.8%) 29 (10.7%) 7 (2.6%) 5 (1.8%) 3 (1.1%) 1 (0.4%) Cumulative Percent 39.7 67.6 83.4 94.1 96.7 98.5 99.6 100.0 Coding Process and Reliability Both coders were given a final copy of the codebook from which to work and entered all data into separate Excel files. Those data were then combined and imported into SPSS for processing. All cells with missing data were revisited by the coders before the final computations. To determine final intercoder reliability, Krippendorff’s alpha was calculated on a randomly selected subset of 20% of the stories (see Riffe, Lacy, & Fico, 2005). Scores above .8 represent strong reliability. Reliability scores for all variables were .84 or higher.3 Note. n = 272. Nine articles had no dominant attribution. Frequency presented numerically with percentage in parentheses. TABLE 2 Sources Used to Attribute Blame for the MMR-Vaccination Scare Attribution Science/medical Nonprofit Family Elected officials Media Other Individual Celebrity Personal Frequency 189 (67.3%) 55 (19.6%) 54 (19.2%) 32 (11.4%) 14 (5.0%) 11 (2.8%) 3 (1.1%) 2 (0.8%) 0 (0.0) M 1.14 0.23 0.24 0.13 0.05 0.03 0.01 0.00 0.00 SD 1.05 0.51 0.55 0.39 0.24 0.14 0.15 0.03 0.00 RESULTS Sample Snapshot Downloaded by [Avery Holton] at 09:07 11 January 2012 The 281 coded articles came from 32 different news outlets and 10 countries, with the majority funneling through the United Kingdom (63.7%) and the United States (16%). Other countries included Scotland (5.7%), Canada (4.6%), Ireland (4.3%), Australia (3.6%), South Africa (0.8%), New Zealand (0.8%), Sri Lanka (0.4%), and China (0.4%). The coverage peaked in 2001–2002, a time frame that included more than one-third (35.6%) of the overall sample. The time period between the publication of the Wakefield et al. (1998) article and the initial allegations of unethical conduct received the most coverage (Wave 1, 55.5%), followed by the time frame between those allegations and Wakefield’s conviction of ethical violations (Wave 2, 37.4%) and the period since (Wave 3, 7.1%). Attributing Blame Searching for actor(s) to whom the news media attributed blame for the MMR–autism link and subsequent effects, coders first identified peripheral blame and then determined the most dominant source of blame. For RQ1, results from both approaches indicated that Wakefield (e.g., “Vaccination rates have done nothing but stagger since Wakefield introduced his findings” etc.) and science/medical actors (e.g., “Science could be doing more to comfort our fears” etc.) were most often blamed. Considering peripheral attributions, Wakefield was at least marginally blamed in more than half of the articles (55.9%), followed by science/medical (51.0%), society (33.5%), The Lancet (23.1%), other individual actors (21.4%), the media (5.0%), elected officials (2.1%), other (1.4%), and other journal (0.4%). However, for dominant attributions, the news media overwhelmingly 3 Intercoder reliability scores using Krippendorff’s alpha: Article source, 1.0; Date, 1.0; Wave, 1.0; Combined Peripheral Attribution, .95; Dominant Attribution, .84; Combined Sources (presence), .95; Combined Sources (count), .89; Fact/Opinion, .87; Mobilizing Information (presence), .98; Combined Mobilizing Information (presence), .97. Note. n = 281. Frequency presented numerically with percentage in parentheses. M denotes mean prevalence of sources in single articles. blamed Wakefield (more than one-third of the time—see Table 1), followed by science/medical actors. Society and other individual actors also received a notable amount of attribution. Interestingly, The Lancet—the portal of Wakefield’s study—was dominantly blamed by only 2.6% of the articles. Sources of Blame This study also explored sources used to attribute blame (RQ2a). The news media relied most heavily on science/medical sources, quoting them in more than twothirds (67.3%) of articles (Table 2). Other primary sources of blame included nonprofit advocacy groups (19.6%), family members (19.2%), and elected officials (11.4%). Notably, while media sources, celebrities, and other sources were quoted, no individuals with autism were used as sources attributing blame. Three statistically significant correlations were found between sources and dominant attributions of blame. Nonprofit sources were more likely to be used in stories that placed blame on other actors (χ 2 = 3.72, df = 1, p < .05). Science/medical sources were most likely to be used in stories that placed blame on other actors (χ 2 = 4.25, df = 1, p < .05) and on Wakefield (χ 2 = 5.79, df = 1, p < .05). In addition, this study explored whether THE BLAME FRAME, MEDIA ATTRIBUTION, AND MMR TABLE 3 Source Use of Fact Versus Point of View/Opinion Fact M Science/medical Nonprofit Family Elected Media Individual 0.47 0.04 0.02 0.03 0.03 0.01 SD 0.51 0.20 0.15 0.17 0.17 0.08 M 0.63 0.20 0.19 0.10 0.05 0.01 Point of View/Opinion SD 0.48 0.40 0.40 0.31 0.21 0.10 Significance ∗∗∗ ∗∗∗ ∗∗∗ ∗∗∗ ∗ 7 — Note. n = 281; df = 280. Significance based on between-pair mean differences. Variables with zero occurrences were excluded. Significance indicated by ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001. p < .001) before tapering off with a 6.9% rise between Wave 2 and Wave 3 (z > 1.64, p < .05). While dominant attribution of blame also dipped significantly over the waves for science/medical actors (Wave 1–2, z > 2.58, p < .001; Wave 2–3, z > 1.64 p < .05) and rose slightly for The Lancet (Wave 1–2, z > 1.64, p < .05; Wave 2–3, z > 1.64 p < .05), the most notable change occurred to dominant attribution for Wakefield (see Table 5). The prevalence for Wakefield leapt 28.9% between the first two waves (z > 2.58, p < .001) and 16.7% over Wave 2 and Wave 3 (z > 2.58, p < .001). Over the course of Wave 1 and Wave 3, the frequency of Wakefield receiving the majority of blame increased 45.6% (z > 2.58, p < .001). Mobilizing Information Finally, this study examined the prevalence of mobilizing information within the sample (RQ4). Approximately one-quarter (26.0%) of articles contained mobilizing information, including names of organizations (e.g., Autism Speaks, Generation Rescue, Defeat Autism Now, etc.), locations (e.g., www.immunisation.org.uk, www.jabs.org.uk, etc.), and tactics (e.g., joining anti-autism rallies, calling local government officials, etc.). Of those that did contain some form of mobilizing information, more than 8 out of 10 (82.2%) contained names. Far fewer contained tactics (30.1%) and locations (26.0%). Downloaded by [Avery Holton] at 09:07 11 January 2012 sources offered facts or opinions in making their attributions (RQ2b). Means reported in Table 3 show that sources overwhelmingly supplied opinions rather than facts. These differences are especially interesting, given that science/medical sources were more likely to attribute blame to Wakefield and other individual actors (e.g., other researchers involved with the Wakefield study, researchers producing follow-up studies) while nonprofits placed blame on other actors. Longitudinal Blame Change RQ3 explored possible changes in actors to whom blame was attributed over the lifetime of the autism-MMR controversy. Peripheral and dominant attributions were compared over three time periods that represented key points in the controversy. As Table 4 illustrates, peripheral attributions of blame to science/medical sources decreased significantly wave over wave, dropping 16.5% between Wave 1 and Wave 2 (z > 2.58, p < .001). In addition, peripheral attribution to society fell significantly between Wave 2 and Wave 3 (23.1%, z > 2.58, p < .001). In contrast, peripheral attribution rose significantly wave over wave for Wakefield and The Lancet, rising 12.1% for Wakefield between Wave 1 and Wave 2 (z > 2.58, p < .001) and 7.4% over Wave 2 and Wave 3 (z > 1.64, p < .05). Peripheral attribution of The Lancet increased 27.8% between the first two waves (z > 2.58, DISCUSSION This study explored how the news media attributed blame associated with the MMR–autism link and its potential public health effects (e.g., on rates of vaccination uptake). A sample of newspaper articles from a number of countries was analyzed to identify actors to whom the news media attributed blame, the sources that cast blame, whether those sources presented facts or opinions, and how attribution changed over the lifetime of the controversy (from 1998 to the present). The findings help fill gaps in current literature, which has considered news media framing of autism and vaccination separately but has not focused attention TABLE 4 Presence of Peripheral Attribution of Blame Over Time Media % (n) Wave 1 (n = 156) Wave 2 (n = 105) Wave 3 (n = 20) Total (N = 281) 5.1 (8) 4.8 (5) 7.1 (1) 4.9 (14) Elected % (n) 0.6 (1) 0.1a (1) 20.0a (4) 2.1 (6) Lancet % (n) 10.3b (16) 38.1b,c (40) 45.0c (9) 23.5 (66) Wakefield % (n) 55.5d (71) 67.6d,e (71) 75.0e (15) 55.9 (157) Individual Actor % (n) 23.1 (36) 19.0 (20) 20.0 (4) 21.6 (60) Society % (n) 32.7 (51) 38.1f (40) 15.0f (3) 33.5 (94) Science/Medical Other % % (n) (n) 60.3g (94) 43.8g,h (46) 20.0h (4) 51.2 (144) 8.3i (13) 2.0i,j (2) 0.0j (0) 5.3 (15) Note: “Other” includes other journals, others unidentified, and none. Total of cells surpasses 100.0% because multiple peripheral attributions could be coded from each article. Significance in difference of actor presence between waves indicated by shared superscripts and determined by z-test: c, e = p < .05; i, j = p < .01; a, b, c, d, f, g, h = p < .001. 8 HOLTON ET AL. TABLE 5 Presence of Dominant Attribution of Blame Over Time Media % (n) Elected % (n) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) Lancet % (n) 1.3b (2) 3.8b,c (4) 5.0c (1) 2.5 (7) Wakefield % (n) 24.4d (38) 53.3d,e (56) 70.0e (14) 38.4 (108) Individual Actor % (n) 14.1f (22) 6.7f,g (7) 0.0g (0) 10.3 (29) Society % (n) 16.0 (25) 15.2h (16) 10.0h (2) 15.3 (43) Science/Medical Other % % (n) (n) 37.2i (58) 15.2i,j (16) 10.0 j (2) 27.0 (76) 5.1k (8) 3.8k (4) 0.0 (1) 4.6 (13) Wave 1 (n = 156) Wave 2 (n = 105) Wave 3 (n = 20) Total (N = 281) 1.9 (3) 1.9a (2) 0.0a (0) 1.8 (5) Note. “Other” includes other journals, others unidentified, and none. Significance in difference of actor presence between waves indicated by shared superscripts and determined by z-test: a, b, c, h, j, k = p < .05; d, e, f, g, i = p < .001. on blame attribution for an autism-vaccine link over time. Furthermore, the current study provides insight into how the news media convey health (vaccine) risk and what scholars and practitioners can learn about journalism practice and risk communication as a result. Source Bias In the present study, sources primarily came from four areas: science/medical, nonprofit, family, and elected officials. Given the science and medical element of the MMR– autism issue, the news media’s reliance on them was not surprising. However, they provided more opinions than facts in coverage. Boyce (2007) noted that scientists, as sources, can humanize coverage by considering how issues might relate to their personal lives. For example, when asked about the MMR–autism link, scientists may have considered their own children and thus offered opinions based on that experience. This strategy may potentially provide a more effective response to arguments of the anti-MMR sources than science-based facts alone, given that such arguments tend to rely heavily on emotional appeals. Additionally, by leveling more blame on Wakefield than any other actor, scientists and medical professionals reinforced the notion of Wakefield as the lone culprit in the MMR–autism controversy, thereby preserving the sanctity of medicine and the scientific process (Franzen, Rodder, & Weingart, 2007). Nonprofit sources placed blame on other actors and not specifically Wakefield. There is evidence (beyond the present study) that rather than blaming Wakefield for the controversy, nonprofit organizations instead embraced him as someone offering hope in an otherwise frustrating situation. For example, an anti-MMR vaccination advocate from Cure Autism Now supported Wakefield even in light of the criticisms against him, stating that “no one can tell me that the MMR vaccine did not contribute to my son’s autism” (Liddane, 2002, p. 1). The present study did not specifically code the presence of such statements, but this issue and the attribution finding discussed above raise several questions related to media ethics and norms. Specifically, they reflect the benefits and perils of taking a balanced approach to an unbalanced issue (Clarke, 2008). While offering competing views may be beneficial to public knowledge, such views may be at odds with an established consensus (e.g., no autism–vaccine link). In this context, refuting scientific evidence with comparatively unfounded commentary does not constitute a balanced approach to coverage. As noted by many scholars (Boyce, 2006; Len-Rios et al., 2009; Zoch & Molleda, 2006), reporters rely on multiple sources for various reasons, including time or resource constraints, Downloaded by [Avery Holton] at 09:07 11 January 2012 Cues for Attributing Blame In their role as “accountability journalists,” the news media are expected to suggest who is responsible for causing and solving social issues (Bennett et al., 2006; Donohue, Tichenor, & Olien, 1995). However, while controversial issues allow the news media to explore critical elements of those issues, journalists traditionally rely on cues from elite sources (such as government officials) to develop their frames (Bennett, Lawrence, & Livingston, 2006). Over the course of the MMR-link controversy, the news media placed an increasing amount of blame on one individual— Wakefield. This finding suggests the news media used certain cues, such as the allegations of unethical conduct and the full retraction of the Wakefield et al. (1998) study, to formulate blame. Certainly journalists cannot be faulted for increasing their blame in light of increasing evidence against the study and its findings. Indeed, the 2011 article in the British Medical Journal that labeled the Wakefield study a fraud directly accused Wakefield of causing unwarranted fear about MMR vaccination (Deer, 2011a). While the news media increased its peripheral attribution to Wakefield and The Lancet over time, Wakefield received a much greater portion of dominant attribution. In the case of the MMR–autism controversy, perhaps journalists individualized blame to provide the clearest possible source of fault. Although newspapers are arguably able to provide more complex information than other types of media for reasons including more available space for content (Riffe, Lacy, & Reimold, 2007), attributing blame to other actors—such as Wakefield’s fellow researchers, The Lancet (for publishing the 1998 article), health officials (perhaps for not doing enough to counter Wakefield’s arguments), elected officials, the news media, or other sources—might have been viewed by journalists as too complex. Attributing blame to one individual might have made for a simpler message (Kim & Willis, 2007; Lawrence, 2004). THE BLAME FRAME, MEDIA ATTRIBUTION, AND MMR 9 convenience, lack of knowledge on a subject, and/or because an organization or “expert” put forth the information. However, with a controversial and still somewhat mysterious health issue like autism for which parents are seeking reliable, fact-based information, misinformation perpetuated by the news media can lead to additional, perhaps needless uncertainty (such as a link with vaccines) (see Corbett & Durfree, 2004). In such instances, it is the news media’s responsibility to filter such information to include only scientific facts, rather than providing balanced opinions that may contribute to issue misperceptions (Petts & Niemeyer, 2004). process of educating people to perceive risk as “experts” do (Gurabardhi, Gutteling, & Kuttschreuter, 2004). Other recommendations include engagement, in which officials work to understand concerns and use media to proactively address emerging safety issues. One potential strategy is the use of exemplars or personal narratives—a strategy already used by some advocates of an autism–vaccine connection (e.g., stories of children allegedly “damaged” by vaccines who developed autism soon after; see Davies, Chapman, & Leask, 2002). Wakefield himself emerged as a persecuted figure (for proponents of a link) or dangerous maverick (for opponents, including public health officials), but he nonetheless served as an identifiable figure tied to a larger narrative about vaccine policy. Lack of Mobilization The difficult decisions the news media face when reporting a controversial issue also extend to mobilizing information (MI). Previous research indicates a general lack of MI in health news and, in the case of the autism-vaccine issue, a tendency to extend more MI to proponents of a connection (Lewis & Spears, 2003). In the current study, even when MI was present, it appeared primarily as names of nonprofits such as Justice Awareness and Basic Support, Cure Autism Now, and Defeat Autism Now!, all of which were proponents of the autism–vaccine link. In other words, news coverage explored causes of this issue without offering solutions, such as where to find more information on a connection from medical and public health sources (e.g., the CDC). Thus, the question of balance is again revisited: Should journalists, who have limited space to provide content and context, focus on mobilizing information? If so, how can they provide fair, balanced, and factual information for audiences? Downloaded by [Avery Holton] at 09:07 11 January 2012 CONCLUSIONS AND FUTURE RESEARCH This study found that attributions from the news media for the MMR–autism controversy pointed toward one individual—Andrew Wakefield—and away from other actors. This direction increased over time, indicating efforts to clarify attribution of blame for the public. Findings also indicated the news media took a more episodic approach to framing responsibility, emphasizing one guilty individual rather than multiple possible actors. Future research should move beyond the structural examination of news content to consider audience effects. In particular, research should assess the effects of these messages on perceived certainty and blame regarding the autism–vaccine issue and, by extension, vaccine-related attitudes and behaviors. Qualitative approaches such as personal interviews, panels, and other methods that often help connect quantitative health research with societal implications (Pope & Mays, 2006; 1995; Simpson & Freeman, 2004) should be considered. While newspaper articles included in this study did not represent all available media coverage of the autism–vaccine issue, they represented a well-established media platform that often guides content across other platforms (Pew Research Center, 2010). Newspapers also remain an important source of health information (Vasterman, Yzermans, & Dirkzwager, 2005). Nonetheless, future research should include a more holistic approach, such as additional types of media. Relatively newer information outlets such as blogs and social networking sites might offer alternative and influential approaches. Moreover, the majority of research on media coverage of the autism–vaccine controversy has occurred in the United Kingdom and the United States. This fact is not surprising, given that Wakefield rose to prominence as a British physician and published his work in The Lancet (a prestigious British medical journal). The issue also emerged amid the mad cow disease scare in the United Kingdom and a public increasingly skeptical of government reassurances of safety (Hargreaves et al., 2003). Other facets Risk Communication Implications The MMR–autism controversy also raises questions about effectively communicating vaccine benefits, safety, and risk. Does the autism–vaccine controversy signal a broader decline in public confidence in vaccination (Clarke, 2008)? How does one balance individual agency to choose a medical intervention against the public good immunization provides? The news media can both promote vaccine importance and raise awareness of safety issues (Leask & Chapman, 2002), and many scholars have put forth recommendations for effective risk communication using mass media (see Cho et al., 2010; Paek et al., 2010; Petts et al., 2010). Some have emphasized the need to “correct” misinterpretations of risk, such as the nonexistent threat of autism compared to the much greater risk of vaccine-preventable diseases, by providing clear evidence of vaccine benefit (such as studies that refute an autism link) (Bellaby, 2003; Dittmann, 2001; Miller & Reynolds, 2009). This strategy mirrors the traditional view of risk communication as a 10 HOLTON ET AL. of the controversy, including whether the vaccine preservative thimerosal could cause autism, first gained prominence in the United States (Offit, 2008). Both countries are also home to relatively prominent organizations skeptical of vaccination (Blume, 2006). At the same time, there is a need to conduct research in other international settings, as vaccine safety issues can make headlines worldwide with potentially negative consequences on vaccine uptake (Larson et al., 2011). 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