Evaluating Women's Health Messages: A Resource Book

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Edited by: Roxanne Louiselle Parrot & Celeste Michelle Condit

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  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: Political Agendas and Women's Reproductive Health Messages

    Part II: Historical Issues in Communicating about Women's Reproductive Health

    Part III: A Fetal and Maternal Health Approach to Communicating about Women's Reproductive Health

    Part IV: A Campaign Perspective for Communicating about Women's Reproductive Health

    Part V: A Social Support Framework for Communicating about Women's Reproductive Health

    Part VI: Contemporary Priorities in Communicating about Women's Reproductive Health

  • Copyright

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    Dedication

    We dedicate this book to Betty Jean Simmons Louiselle and Beatrice May Spencer Condit, our Moms

    Preface

    Because now is the only time there ever is to do a thing in,” said Miss Ophelia. “Come, now, here's paper, pen, and ink; just write a paper.“

    Harriet Beecher Stowe, Uncle Tom's Cabin1

    Because medical research has not kept pace with technology and drug therapy in assessing outcomes for women, women's health demands our attention. Moreover, the messages communicated to women and men about women's health obscure this simple fact. This book provides the only existing collection that overviews the pattern of gaps among media, campaigns, and medical and social scientific information about women's reproductive health. For scholars, this volume offers the first systematic attempt to examine the medical, social scientific, and public messages about women's health care—juxtaposing them with one another to identify consistencies and inconsistencies, and highlighting gaps in the research and our understanding.

    Two chapters have been devoted to each topic in this volume. The first chapter of each pair provides a critical summary of medical and/or social scientific research on the topic. These chapters describe the state of the research and reveal some of the problems with it. Social scientific research is included because of our commitment to a wholistic health care model, instead of a narrower medical care model. The second chapter in each pair provides a description and critical analysis of mass mediated messages women have been receiving in recent years about this medical research. Messages that are mediated by journalists receive most of the attention in these chapters, but messages that are part of popular books, television shows, and/or movies are described and analyzed where the authors thought them important.

    This volume has been divided into six parts in relation to agendas and women's reproductive health: political, historical, campaign, fetal and maternal health, social support, and contemporary priorities. Within each of these arenas a number of specific topics are addressed, each with the presentation of two chapters. Discussions under the section that examines a political agenda include abortion and illicit drug use by pregnant women. The part of the book devoted to a historical agenda reviews birth control and childbirth. The section of the book devoted to a campaign agenda reviews prenatal care and cervical, ovarian, and uterine cancers. The fetal and maternal health agenda analyzes women and smoking, and women and alcohol use. The social support section of this volume considers research and messages associated with breast cancer and with menstruation and menopause. The closing part of the book evaluates reproductive health in terms of women and reproductive technologies, hysterectomy, and HIV/AIDS.

    The authors of chapters that provide summaries and analyses of the “Medical and Social Scientific” discourse employed searches of indexes such as Medline and Psychlit to review both the available information and the key contentious issues over the past decade. These are followed by chapters that provide summaries and analyses of the public discourse, offering a far more systematic set of studies of such messages than is common in this area. Typically, critical descriptions of messages are done on an impressionistic basis. Those critical insights are, of course, valuable, but most of the chapters in this book ground the critical analyses in carefully designed surveys of texts. Authors have selected texts using random samples or full text sets from public indexes for the 3 to 5 years (approximately 1989–1993) surrounding the women's health initiative at the national policy level (this is discussed in more detail in Chapter 1). This helps the surveys to be more comprehensive and less prone to idiosyncratic selection biases than are other critical descriptions in the area.

    The latter should not be taken to mean, however, that there is a rote-like uniformity to the studies presented in this volume. Different topics require somewhat different treatments, and the authors have brought their own perspectives and methodological strengths to these chapters—and sometimes they disagree with each other. Some of the authors who examine public messages have highlighted newspapers; others have focused on magazines. Some chapters concentrate on the medical literature; others spend more time on the social scientific studies. Each topic area itself deserves an entire book, and in many cases numerous books have been written about the topic. It is the differences and similarities among the chapters, however, that usefully reveal the broad range of needs that remain both in women's health care research and in the presentation of the messages that allow women to use the medical knowledge and technologies with informed decisions.

    Many of you reading this volume will be wrestling with questions and decisions about your own reproduction. Many readers of this volume will have their own children and be wondering how to discuss human reproduction with them, especially at this time when nearly every day brings to light another moral or ethical question about such matters. In relation to the transmission of HIV, for example, information about condom use as a barrier may be viewed as unwarranted and even broaching immorality if individuals’ religious principles promote sexual relations only between a married man and woman. Issues of reproductive technology include debate about the use of the eggs of an aborted fetus, the implantation of the egg from a woman of one race into the womb of a woman of another race, and whether or not menopausal women should be eligible to receive fertilized embryos. And for some, prenatal care programs, like access to health care generally, are deemed a benefit to be earned rather than a right that should be afforded.

    Debate about human reproduction, we believe, is good and demonstrates fundamental principles upon which this nation is founded. To be actively involved in the debate, however, most of us turn to sources, both interpersonal and mediated, to help bridge our knowledge gaps. Physicians, themselves under significant time constraints and deluged with new medical and technological information published in their scientific journals, may sometimes be a source of information. Often, they provide pamphlets and other reading materials to patients who seek health information. National organizations such as the American Cancer Society and the March of Dimes also disseminate thousands of pieces of printed material to help us understand human reproduction. Newspapers, magazines, radio, and television provide additional grist for the mill. And, whatever we read, hear, or experience we are likely to share with the people closest to us, our family and friends, and vice versa. In the process of moving from scientific research to daily life, health messages change, sometimes without great deliberation and forethought. Significant details are lost, distorted, or added. Patterns in these shifts are the focus of this book.

    The contents of this volume are aimed at nonacademicians and academicians alike. For individuals who are interested in reviewing what is presently known about matters relating to women's reproductive health alongside the public messages available in this area, the book's division into chapters addressing particular topics allows the reader to select the ones of most interest and supplement those with others at leisure. We hope that this book is well suited as a primary text in advanced courses in public health campaigns, health communication, and health or media message design or theory, as well as women's studies classes that address reproductive health issues. The book would also provide a supplementary text in similar courses or in a persuasive campaigns class. For health practitioners, the book provides a tool to use in understanding health-seeking behavior and patients’ need for more personalized information, including specific guidelines about how to do and to attain behavioral recommendations. Most of the chapters that review bodies of research were reviewed by one or more physicians and/or epidemiologists to ensure that our own “translation” process is valid.

    We appreciate the help of some very talented and dedicated doctoral students at the University of Georgia. Sally Caudill, Adrienne Fry, Michele Kilgore, Kim Kline, Raka Shome, Stuart A. Ainsworth, Darci Slayten, Donald R. Turk, Tricia D. Stuart, and Melanie Williams provided many hours of time and effort to ensure that the countless references and citations used by the authors in this volume were complete and to proofread the galleys. We also thank Kris Bergstad for her excellent work copyediting a difficult manuscript. The contributors exceeded our expectations in providing the materials for this collection. In nearly every case, we have had to make editing choices to cut material from chapters to conform to our page limits. So, if a particular chapter warrants it, please contact the primary author, who may very well have an earlier, more extensive version of the work and/or an expanded reference list. Finally, we wish to thank Renée Piernot for her editorial assistance and Sophy Craze for the superior editorial work that allowed this book to move forward with alacrity after it had been stalled too long in the bureaucratic swamps of academic publishing. She deserves extraordinary thanks.

    We enjoyed editing this volume and have learned a great deal from its contents. We hope that you will learn something as well and that the materials will generate debate.

    RoxanneLouiselleParrott
    CelesteMichelleCondit

    Note

    1. H. B. Stowe, Uncle Tom's Cabin or Life Among the Lowly (Garden City, NY: Nelson Doubleday, n.d.), p. 328. (Original work published 1852)

  • About the Contributors

    Karen H. Bonnell (Ph.D., University of Kentucky) is Assistant Professor of Communications at the University of Southern Indiana at Evansville, Indiana. A former TV news producer, she now manages the University of Southern Indiana Television Center and teaches broadcast production and management at the university.

    Sally A. Caudill is a doctoral candidate in speech communication at the University of Georgia. Her areas of interest include feminist theory, rhetoric, communication education, and multicultural education. Her work in these areas has been presented at several national and regional Speech and Women's Studies conferences. She is currently beginning work on her dissertation, which will focus on rhetoric in multicultural education. She received her M.A. in Speech Communication from the University of South Florida. She has received teaching awards during her tenure at both universities.

    Rebecca J. Welch Cline is Associate Professor of Communication Studies in the

    Department of Communication Processes and Disorders at University of Florida. She received her Ph.D. from The Pennsylvania State University. Her general research interests are interpersonal communication and health communication. Her recent research focuses on interpersonal communication issues and HIV/AIDS, including interpersonal communication for the prevention of HIV infection, interpersonal communication with people with HIV disease, and gender issues associated with communicating about HIV/AIDS. She has published research in the Journal of Applied Communication Research, Human Communication Research, Communication Monographs, Communication Research, and the Communication Yearbook.

    Celeste Michelle Condit is Professor of Speech Communication at the University of Georgia in Athens. She is the author of Decoding Abortion Rhetoric: The Communication of Social Change (1990) and coauthor of Crafting Equality: America's Anglo-African Word (1993; winner of the Marie Hocmuth Nichols Award). She has served as a Visiting Investigator at the National Institutes of Health in the National Center for Human Genome Research. She has authored several essays on abortion, reproductive technologies, and the discourse of genetics in academic journals, as well as methodological and theoretical essays on the processes of public and technical discourses and social change processes. She has served as chair of the Women's Caucus of the Speech Communication Association and published essays on the meaning of feminism.

    Deirdre M. Condit (Ph.D., Rutgers University, 1996) is Assistant Professor of Political Science and Women's Studies at Virginia Commonwealth University. Her research interests include reproductive rights and technology, the social construction of the reproductive body, and theoretical issues concerning the sex/gender distinction in feminist theory. At present, she is working on a manuscript-length piece on the conflict between fetal rights and the political identity of the pregnant woman.

    Margaret J. Daniels (M.A., Speech Communication, University of Georgia, 1993) is an instructor at Trident Technical College in Charleston, South Carolina. Her research interests include women and health, and health campaigns.

    Lisa A. Flores (Ph.D., University of Georgia, 1994) is Assistant Professor at Arizona State University. She specializes in critical rhetorical studies, feminist criticism, communication and culture, and Chicano/Chicana discourse. She is currently working on a book on Mexican American women in mass media.

    C. Jay Frasier (A.B.D., Southern Illinois University at Carbondale) is Assistant Professor at Lane Community College in Eugene, Oregon. His research interests include general semantics, dramatic forms of educational discourse, the use of magic as an educational tool, and interpersonal conflict. His research has appeared in ERIC and The Looking Glass.

    Theresa D. Frasier (M.A., Southern Illinois University at Carbondale) is Adjunct Professor at Linn-Benton Community College in Lebanon, Oregon. Her research interests include family communication, health communication, and communication satisfaction.

    Kathryn J. French (Ph.D., University of Southern California, 1989) is Assistant Professor at Southern Illinois University at Carbondale. Her primary research interests include the study of resistance to persuasion, giving bad news, and health communication. Her research has appeared in Psychology of Tactical Communication and American Communication Administrators Bulletin.

    Tina M. Harris (Ph.D., University of Kentucky, 1995) is Assistant Professor in the Department of Communication at Bowling Green State University. Her areas of interest include intercultural and interpersonal communication.

    Mary L. Kahl (Ph.D., Indiana University, 1994) is Assistant Professor in the Department of Communication and Media and a member of the Women's Studies Faculty at the State University of New York at New Paltz. She holds a B.A. in Communication and in English from the University of Michigan, and earned her advanced degrees in speech communication from Indiana University. During her 15-year academic career she has taught at the University of California—Davis, Stonehill College, and Boston College. She has written and published in the areas of political communication, women and communication, health communication, and rhetorical theory. An officer in national and regional communication associations, she also volunteers as a communication consultant and speech writer for local and national political campaigns.

    Pamela J. Kalbfleisch (Ph.D., Michigan State University, 1985) is Associate Professor in the Department of Communication and Mass Media at the University of Wyoming in Laramie, Wyoming. Her research focuses on the elements of trust and distrust in interpersonal relationships. She is the editor of Interpersonal Communication: Evolving Interpersonal Relationships (1993); coeditor of Gender, Power and Communication in Human Relationships with Michael J. Cody (1995); and is the author of a persuasion text, The Persuasion Handbook (1989). She is on the board of directors for the IMPACT foundation in New York City, and works with this foundation and several groups in her local community to help foster the development of mentoring relationships. She is especially concerned with helping women and members of disadvantaged groups find mentors and other sources of social support.

    Maureen P. Keeley (Ph.D., University of Iowa, 1994) is Assistant Professor in Speech Communication at Southwest Texas State University. She has published research in national communication journals such as Human Communication Research on nonverbal communication and issues focusing on relational communication. The NVPS acknowledges and uses this expertise; it also provides a method with which to explore the communication process of second guessing as well as the consequences of the functions of nonverbal behaviors. Future research will continue to examine women, communication, and their relationships in a variety of situations.

    Michele Kilgore is a doctoral candidate in the Department of Speech Communication at the University of Georgia, with interests in intercultural communication in health care, critical discourse analysis, and teaching English for medical purposes. She received an M.S. in Applied Linguistics from Georgia State University, was an Apprentice Teacher in the Harvard Summer School ESL Program, and completed coursework in Teaching English for Specific Purposes at the Institute for Applied Language Studies at the University of Edinburgh. She has published contributions to TESOL's New Ways in Teaching series. Prior to graduate study, she spent 10 years working in hospitals in respiratory therapy.

    Cynthia P. King is a doctoral candidate in the Department of Speech Communication at the University of Maryland. With a B.A. and M.A. from Auburn University, she has focused her research on the rhetoric of African Americans. Her dissertation is a study of history texts about and written by African Americans in the 19th century.

    Kimberly N. Kline (doctoral candidate at the University of Georgia in Athens) is Assistant Professor in the Department of Communication at Purdue University. Her research incorporates rhetorical theory and method to explore the construction of illness and identity (especially in regard to women's health) as well as to discuss the persuasiveness of various health messages and/or campaigns. She received the top student paper award in the Health Communication Division for the 1995 Speech Communication Association convention.

    Joan Marie Kraft (Ph.D., Northwestern University, 1989) taught at Wittenberg University for 2 years before receiving a post-doctoral fellowship (funded by the National Institute on Alcohol Abuse and Alcoholism) at the Center for Research on Deviance and Behavioral Health, Institute for Behavioral Research at the University of Georgia. In general, her research investigates links between young women's experiences in the labor market and their premarital sexual behavior. She also analyzes connections between work roles, family roles, and alcohol consumption among women and men. Several papers and presentations based on this research concentrate on whether drinking practices (i.e., frequency of drinking, escapist reasons for drinking, and binge drinking) are associated with work-family conflict. She currently works at A&C Enercom where she conducts research for utility companies.

    Joan Lawrence-Bauer is the Interim Executive Director of the Kingston (New York) YWCA. She received her B.A. in Communication from the State University of New York at New Paltz in 1993. She has worked in the field of business administration and communication for more than 20 years, is a member of the Catskill Women's Network, and serves on the Board of Directors of the M-ARK Project and of the Belleayre Conservatory.

    Robert Lemieux (M.A., Michigan State University, 1988) is a doctoral candidate in speech communication at the University of Georgia. His research interests in health communication focus on the creation and dissemination of health campaigns—specifically, the use of fear appeals in the message, the emotions the message evokes, and cognitive channels to deliver the message. His other primary research interest is in relational communication, with a focus on the development and maintenance of romantic relationships. Current research is testing the triangular theory of love and exploring the use of routine behaviors as relational maintenance strategies. Aside from his chapter in this book, other research has appeared in Communication Research. He is also a past recipient of an Excellence in Teaching Award from the International Communication Association.

    Nelya J. McKenzie (Ph.D., University of Florida, 1994) is Assistant Professor in the Department of Communication, Auburn University at Montgomery. Her research interests include gender and communication and intergenerational communication.

    Diane Helene Miller (M.A., University of California—Berkeley, 1989) is a doctoral candidate in speech communication at the University of Georgia, where she has also completed a Graduate Certificate in women's studies. She is a recipient of the Berkeley Fellowship, the University of Georgia University-Wide Assistantship, and the AAUW Athenian Award for Outstanding Scholarship. Her research interests include feminist rhetorical theory and criticism, media criticism, lesbian studies, and queer theory. She is currently writing a dissertation that examines recent representations of lesbians and the discursive construction of “lesbianism” in public discourse.

    Mary Moster, Ph.D., is Assistant Professor of Psychology at Martin University, Indianapolis. Her overall research interest is in the area of health promotion and disease prevention, focusing especially on low-income, minority, and other underserved populations. Past research (unpublished) was on psychosocial factors influential in mediating the impact of stressful life events. She is currently planning a research project to investigate the availability of health information and evaluating the impact of increased health information on current health practices, especially in low-income or minority populations.

    Elizabeth Jean Nelson (Ph.D., University of Iowa) is Associate Professor in the Department of Communication at the University of Minnesota, Duluth, where since 1988 she has taught courses in rhetorical theory, public address, and popular culture. Her research interests include Western mass media and the presentation of woman's body, media and diet messages that target women, the language women use as they talk about their bodies, as well as a host of campaigns (health care and social campaigns) that pertain directly to women. Her published work includes “Living With the Fat of the Land: A Mythic Analysis” in Feminist Forum; “Who's Looking Out for the Boys? Public Reaction to ‘Take Our Daughters To Work Day’ “in Understanding Language and Gender; “The Lessons of History” in the Women's Review of Books; and “Public Purge, Private Excess: The Weight in Western Popular Culture,” under revision for publication in Women and Language.

    Margot L. Nelson, R.N., Ph.D., C.S., is Associate Professor of Nursing at Augustana College, Sioux Falls, South Dakota. Her research has primarily involved the lived experiences of individuals infected with the human immunodeficiency virus and psychoneuroimmune responses in life-threatening health conditions. She has published articles related to advocacy in nursing as well as collaborative nursing education and the lived experience of HIV infection in books and nursing journals, including Nursing Outlook, Nursing & Health Care, and Research in Nursing & Health.

    Susan A. Owen (Ph.D., University of Iowa, 1989) is Associate Professor in the Department of Speech Communication at the University of Puget Sound.

    Roxanne Louiselle Parrott, Ph.D., is Associate Professor in the Department of Speech Communication and a Fellow in the Institute of Behavioral Research at the University of Georgia. She also has an adjunct appointment in the Department of Medicine at the Medical College of Georgia. She is coauthor (with Michael Pfau) of Persuasive Communication Campaigns and coeditor of Designing Health Messages. Her research interests include an examination of how mediated and interpersonal communication interface, affecting individuals’ involvement with message content.

    Michael Pfau, Ph.D., is Professor in the School of Journalism and Mass Communication at the University of Wisconsin—Madison. His overarching research interest is social influence, particularly campaign influence. He has authored more than 50 articles and book chapters, many dealing with influence strategies in health campaigns, appearing in Communication Monographs, Communication Research, Human Communication Research, and elsewhere. He is a past recipient of the SCA Golden Anniversary Monographs Award. He has coauthored four books, the most recent being Persuasive Communication Campaigns (with Roxanne Parrott) published in 1993.

    Salome Raheim (Ph.D., University of Iowa, 1990) is Assistant Professor in the School of Social Work at the University of Iowa. Her research interests include the discourse of social movements and ideology and their relationship to the empowerment of oppressed social groups. Her work appears in a variety of journals such as Affilia: Journal of Women and Social Work, Journal of Gay and Lesbian Social Services, and the International Journal of Social Work.

    Cathey S. Ross is Assistant Professor in the Communication Department at the University of North Carolina at Greensboro. She received her doctorate in Speech Communication from the University of Georgia. Her main research interest is interpersonal influence. She has investigated influence in health, family, and educational contexts. She is currently working on a project investigating the communication behaviors of adult children and their still active, healthy parents. In addition to her research and teaching, she conducts seminars and workshops on family communication for local groups and organizations.

    E.M.I. Sefcovic (M.A., University of Georgia, 1991) is a doctoral candidate in the Department of Speech Communication, University of Georgia, Athens. Her current areas of research interest are rhetorical theory and criticism, qualitative methods, and labor discourse. She is a past winner of and runner-up for the Southern Speech Communication Association's Bostrom Award for competitive student papers. Her work has been published in the Journal of Communication Inquiry. Before becoming a member of the academic community, she was a reporter and editor for more than 20 years for Hearst and Cox newspapers. She has also served as community relations director for Glens Falls Hospital, a regional acute-care facility in New York State.

    Helen M. Sterk (Ph.D., University of Iowa, 1986) is Associate Professor at Marquette University, in Milwaukee, Wisconsin. She coauthored After Eden: Facing the Challenge of Gender Reconciliation (1993), a book analyzing feminist and religious resources for community. With Lynn Turner, she edited Differences That Make a Difference (1994), an anthology of essays devoted to discussion of the utility of “difference” as a concept in gender communication research. With Linda A. M. Perry and Lynn Turner, she edited Constructing and Reconstructing Gender (1992). In addition, she has authored numerous articles on the interactions among variables such as narrative, gender, religion, and popular culture. She won the Cheris Kramararae dissertation award in 1987 from the Organization for the Study of Communication and Gender. Her current work is a two-book project presenting women's narratives on birthing and a coauthored interpretation of those narratives from the points of view of anthropology, history, English, rhetoric, and midwifery.

    Mary Anne Trasciatti is a doctoral candidate in the Department of Speech Communication at the University of Maryland. She received her B.A. from Providence College and her M.A. from Emerson College. Her research interest focuses on women's rhetoric. Her dissertation is a study of the process of Americanization of Italian women immigrants in the early 20th century.

    Martha Solomon Watson (Ph.D., University of Texas at Austin) is Professor and Chair in the Department of Speech Communication at the University of Maryland, College Park. A former editor of the Southern States Communication Journal and the Quarterly Journal of Speech, she has also served as Chair of the Publications Board for the Speech Communication Association. Her research interests include women's rhetoric, social movements, and autobiography. She is the author of critical biographies of Emma Goldman and Anna Howard Shaw (with Wil Linkugel), the editor of A Voice of Their Own: The Woman Suffrage Press, 1848–1915, and a forthcoming book on the autobiographies of women activists: Lives of Their Own: The Rhetorical Dimensions of the Autobiographies of Women Activists.

    Melanie Ayn Williams is a doctoral candidate in the Department of Speech Communication at the University of Georgia. She received her M.A. from the University of North Texas in 1993. Her primary research interests are in the areas of social influence and health campaigns, research methods, interpersonal theory, and women's and Mexican American's health communication. She has presented her scholarship at both national and regional conferences. While at the University of Georgia, she has twice been honored with a competitive university-wide research appointment.


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