Picturing the populations who could benefit from health insurance access expansions: An analysis of US health insurance television ads airing in 2018.

Efforts to expand access to health insurance in the United States are key to addressing health inequities and ensuring that all individuals have access to health care during the coronavirus disease 2019 pandemic. Yet, attempts to expand public insurance programs, including Medicaid, continue to face opposition in state and federal policymaking. Limited policy success raises questions about the health insurance information environment and the extent that available information signals both available resources and the need for policy reform. In this study, we explore one way that consumers and policymakers learn about health insurance-television advertisements-and analyze content in ads that could contribute to an understanding of who needs health insurance or who deserves to benefit from policies to expand insurance access. Specifically, we implement a content analysis of health insurance ads airing throughout 2018 on broadcast television or national cable, focusing on the depictions of people in those ads. Our findings indicate that individuals depicted in ads for Medicaid plans differ from those in ads for non-Medicaid plans. Groups that comprise large populations of current Medicaid enrollees, children and pregnant people, were more likely to appear in ads for non-Medicaid plans than in ads for Medicaid plans. This has implications for potential enrollees' understanding of who is eligible as well as the general public's and policymakers' perspectives on who should be targeted for current or future policies.

Polarized Perspectives on Health Equity: Results from a Nationally Representative Survey on U.S. Public Perceptions of COVID-19 Disparities in 2023.

Republicans and Democrats responded in starkly different ways to the COVID-19 pandemic, from their attitudes in 2020 about whether the virus posed a threat to whether the pandemic ended in 2023. The consequences of COVID-19 for health equity has been a central concern in public health, and the concept of health equity has also been beset by partisan polarization. In this essay, we present and discuss nationally-representative survey data from 2023 on U.S. public perceptions of disparities in COVID-19 mortality (building on a multi-wave previous survey effort), as well as causal attributions for racial disparities, the contribution of structural racism, and broader attitudes about public health authority. We find anticipated gulfs in perspectives between Democrats on the one hand, and Independents and Republicans on the other. The results offer a somewhat pessimistic view on the likelihood of finding common ground in how the general public understands health inequities or the role of structural racism in perpetuating them. However, we show that those who acknowledge racial disparities in COVID-19 are more likely to support state public health authority to act for other infectious disease threats. We explore the implications of these public opinion data for advocacy, communication, and future needed research.

Invoking Identity? Partisan Polarization in Discussions of Race, Racism, and Gender in 2022 Midterm Advertising in the U.S.

CONTEXT: Media messaging matters for public opinion and policy, and analyzing patterns of campaign strategy can provide important windows into policy priorities. METHODS: We used content analysis supplemented with keyword-based text analysis to assess the volume, proportion and distribution of attention to race-related issues in comparison to gender-related issues during the general election period of the 2022 midterm campaigns for federal office. FINDINGS: Race-related mentions were overwhelmingly focused on crime and law and order with very little attention to racism, racial injustice, and the structural barriers that lead to widespread inequities. In stark contrast to mentions of gender, racial appeals were less identity focused and were competitively contested between the parties in their messaging, but much more likely to be led by Republicans. CONCLUSIONS: Our results suggest that discussion of race and gender were highly polarized with consequences for public understanding of and belief in disparities and policies important to population health.

Effects of exposure to media messages about limiting breast cancer screening: A qualitative experimental study.

OBJECTIVE: Examine how women aged 35-50 respond to messages about limiting cancer screening. METHODS: A national sample of women aged 35-50 (n = 983) were randomly assigned to read one of four media vignettes: three provided information about potential harms of mammograms using evidence, norms, or an anecdote strategy, and one provided no such information. Participants listed thoughts they had about the message, and after coding these themes, we tested for associations between the themes evoked, message exposure, and mammogram history. RESULTS: Thematic categories included emotions (8 %); behavioral intentions (14 %); and cognitions, attitudes, and beliefs (67 %). Pro-screening attitudes, questioning, and cues to get screened were most prevalent. The anecdote message often elicited pro-screening attitudes, while the evidence message often elicited negative emotions and anger, as well as questioning or skeptical responses. Those with a history of mammograms expressed more pro-screening attitudes and disagreed with the message more often. CONCLUSIONS: Media messaging about guideline-supported care, especially when it involves reducing a clinical service that is routine and valued by patients, may evoke counterarguing, skepticism, and other negative responses. PRACTICE IMPLICATIONS: Clinicians should recognize the role of the media in potentially shaping women's attitudes, beliefs, and intentions when it comes to breast cancer screening.

"Those Who Need It the Most": Equity Framing in 2021 U.S. Print News About Food Assistance.

Objective: To understand how equity appeared in news about food assistance from 2021. Methods: We assessed a national sample of news articles (N=298) for equity arguments and language about racial and health equity. Results: Only 28% of coverage argued that food assistance programs promote equity. Just 6% mentioned people of color or named racial disparities in food access. Discussion: Narratives that explain how food assistance programs reduce inequities could deepen their policy appeal and broaden public perceptions around recipients. Health Equity Implications: There are opportunities for news coverage to expand the discussion of how food assistance programs improve racial and health equity outcomes.

News Media Coverage of Childcare: How U.S. Local TV News Framed the Problem Before and During the Early Stage of the COVID-19 Pandemic.

Early care and education (ECE), or the care young children receive before entering formal schooling, can take multiple forms and is delivered in different settings, such as a center, church, or public school. Federal and state governments regularly fund ECE programs and policies through the Child Care and Development Block Grant Act (CCDBG). Many families, however, face significant challenges in access, cost, and quality of ECE programs, and ECE professionals report substantial challenges in the workplace (e.g., inadequate training) and beyond (e.g., low wages). Policies addressing issues related to ECE were proposed in 2021, but stalled on the U.S. federal policy agenda. In this study, we examine the ECE content of local television news coverage both for its representations of and for its potential influences on ECE policy agendas. We use data from local stations affiliated with the major networks (ABC, NBC, CBS, and FOX) in media markets across the U.S., airing before and during the pandemic. We analyze elements of coverage that could affect public recognition of ECE-related issues, including how problems were framed (e.g., news coverage highlighting scandals or adverse events at ECE facilities) and solutions identified (e.g., public policy). We find that during 2018 and 2019, more coverage highlighted scandalous activity than public policy. The reverse was true, however, during the early period of the pandemic (from mid-March through June of 2020). Researchers and health professionals were seldom included in stories in either sample, and very few stories offered context about the benefits of ECE for health and well-being. These coverage patterns have implications for the public's understanding of ECE policy and the perceived need for reform. Policymakers, advocates, and researchers looking to advance support for ECE should consider ways to use local television news to present health and policy-relevant information to broad segments of the public.

Strategic Messaging to Promote Policies that Advance Racial Equity: What Do We Know, and What Do We Need to Learn?

Policy Points Many studies have explored the impact of message strategies to build support for policies that advance racial equity, but few studies examine the effects of richer stories of lived experience and detailed accounts of the ways racism is embedded in policy design and implementation. Longer messages framed to emphasize social and structural causes of racial inequity hold significant potential to enhance support for policies to advance racial equity. There is an urgent need to develop, test, and disseminate communication interventions that center perspectives from historically marginalized people and promote policy advocacy, community mobilization, and collective action to advance racial equity. CONTEXT: Long-standing racial inequities in health and well-being are shaped by racialized public policies that perpetuate disadvantage among Black, Brown, Indigenous, and people of color. Strategic messaging can accelerate public and policymaker support for public policies that advance population health. We lack a comprehensive understanding of lessons learned from work on policy messaging to advance racial equity and the gaps in knowledge it reveals. METHODS: A scoping review of peer-reviewed studies from communication, psychology, political science, sociology, public health, and health policy that have tested how various message strategies influence support and mobilization for racial equity policy domains across a wide variety of social systems. We used keyword database searches, author bibliographic searches, and reviews of reference lists from relevant sources to compile 55 peer-reviewed papers with 80 studies that used experiments to test the effects of one or more message strategies in shaping support for racial equity-related policies, as well as the cognitive/emotional factors that predict their support. FINDINGS: Most studies report on the short-term effects of very short message manipulations. Although many of these studies find evidence that reference to race or use of racial cues tend to undermine support for racial equity-related policies, the accumulated body of evidence has generally not explored the effects of richer, more nuanced stories of lived experience and/or detailed historical and contemporary accounts of the ways racism is embedded in public policy design and implementation. A few well-designed studies offer evidence that longer-form messages framed to emphasize social and structural causes of racial inequity can enhance support for policies to advance racial equity, though many questions require further research. CONCLUSIONS: We conclude by laying out a research agenda to fill numerous wide gaps in the evidentiary base related to building support for racial equity policy across sectors.

Prevalence and Potential Consequences of Exposure to Conflicting Information about Mammography: Results from Nationally-Representative Survey of U.S. Adults.

As scientific evidence evolves and clinical guidelines change, a certain amount of conflicting health information in the news media is to be expected. However, research is needed to better understand the public's level of exposure to conflicting health information and the possible consequences of such exposure. This study quantifies levels of public exposure to one paradigmatic case: conflicting information about breast cancer screening for women in their 40s. Using a nationally-representative survey of U.S. adults aged 18-59 in 2016, we implemented four distinct types of measures of exposure to conflicting mammography information: an ecological measure based on keyword counts of local news closed-captioning, an inferred exposure measure based on a series of knowledge questions, a thought-listing exercise where respondents described their perceptions of mammography without prompting, and an explicit measure of self-assessed exposure to conflict. We examined the relationship between these exposure measures and four outcomes: confusion about mammography, backlash toward mammography recommendations, and confusion and backlash about health information more generally. We found moderate amounts of exposure to conflicting information about mammography, more among women than men. Exposure to conflicting information - across multiple measures - was associated with more confusion about mammography, more mammography-related backlash, and general health information backlash, but not general confusion about health information. These observational findings corroborate experimental-based findings that suggest potentially undesirable effects of exposure to conflicting health information. More research is needed to better understand how to mitigate these possible outcomes, in the context of a media landscape that proliferates exposure to multiple scientific perspectives.

Local TV News Coverage of Racial Disparities in COVID-19 During the First Wave of the Pandemic, March-June 2020.

The COVID-19 pandemic has disproportionately impacted health and social outcomes for people of color in the United States. This study examined how local TV news stories attributed causes and solutions for COVID-19-related racial health and social disparities, and whether coverage of such disparities changed after George Floyd's murder, during the first wave of the COVID-19 pandemic. We systematically validated keywords to extract relevant news content and conducted a content analysis of 169 discrete local TV news stories aired between March and June 2020 from 80 broadcast networks within 22 purposefully selected media markets. We found that social determinants of COVID-19 related racial disparities have been part of the discussion in local TV news, but racism as a public health crisis was rarely mentioned. Coverage of racial disparities focused far more attention on physical health outcomes than broader social impacts. Stories cited more structural factors than individual factors, as causes of these disparities. After the murder of George Floyd, stories were more likely to mention Black and Latinx people than other populations impacted by COVID-19. Only 9% of local news stories referenced racism, and stories referenced politicians more frequently than public health experts.

Television airings of U.S. federal COVID-19 public service announcements in 2020 were associated with market-level political orientation, not COVID-19 rates.

Televised public service announcements were one of the ways that the U.S. federal government distributed health information about the COVID-19 pandemic to Americans in 2020. However, little is known about the reach of these campaigns or the populations who might have been exposed to the information these ads conveyed. We conducted a descriptive analysis of federally-affiliated public service announcement airings to assess where they were aired and the market-level social and demographic characteristics associated with the airings. We found no correspondence between airings and COVID-19 incidence rates from March to December 2020, but we found a positive association between airings and the Democratic vote share of the market, adjusting for other market demographic characteristics. Our results suggest that PSAs may have contributed to divergent exposure to health information among the U.S. public during the first year of the COVID-19 pandemic.

Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.

The objective of this research was to examine the health messages conveyed in public service announcements (PSAs) affiliated with the U.S. federal government response to the COVID-19 pandemic in 2020. To do so, we conducted a content analysis of 132 federally-affiliated PSAs that were aired 170,820 times between March 12 and December 16, 2020. Using a quantitative coding instrument, we analyzed health behavioral guidance, messages about groups, people depicted, and other PSA features. We calculated frequencies of exposure to messages at the airing-level to account for the varying number of times each PSA was aired. Far more PSAs aired between March and June than between July and December. The most common health guidance was to stay at home (80.7%), practice social distancing (61.9%), and wash hands (54.5%); 36.1% of airings included guidance to wear masks. Few PSAs referenced group differences in risk of infection or transmission, nor did they reference scientific evidence or the future availability of vaccines. PSAs aired in 2020 missed opportunities to convey important information to the public and to center health equity in public communication.

Association of Funding Cuts to the Patient Protection and Affordable Care Act Navigator Program With Privately Sponsored Television Advertising.

Importance: Many individuals eligible for coverage in the Patient Protection and Affordable Care Act (ACA) marketplace remain unenrolled because of information barriers. Whether the private sector or the public sector should conduct outreach to address these barriers is a topic of active debate. Objective: To determine whether cuts to the funding of the ACA navigator program were associated with changes in the volume of private sector advertising. Design, Setting, and Participants: Using data from the 2015 to 2019 open enrollment periods, this economic evaluation analyzed the changes in advertising associated with 2017 to 2019 cuts to navigator program funding. A difference-in-difference analysis was used to compare outcomes before and after the cuts in counties with higher and lower exposure to the navigator program. Health insurance advertising was measured using data from Kantar/Campaign Media Analysis Group in collaboration with the Wesleyan Media Project, the most comprehensive data available on local broadcast and national cable advertising. The data set included all counties that met the eligibility criteria for the navigator program from 2015 through 2019. Data were analyzed from August 2021 to May 2022. Exposures: Counties were classified as having higher or lower exposure to the navigator program according to the intensity of program activity in 2016, before the funding cuts. Counties served only by statewide navigator programs were categorized as lower exposure, while those also served by local navigator programs were categorized as higher exposure. Main Outcomes and Measures: Number of privately sponsored television advertisement airings for the ACA individual health insurance marketplace during the 2015 to 2019 open enrollment periods in each county, adjusted for population. Results: All counties in 33 states that met the eligibility criteria for the navigator program from 2015 through 2019 were included in the analysis (2435 counties). Cuts to the navigator program were not associated with changes in the number of privately sponsored health insurance advertisements aired. Results were similar under several alternative approaches including an event study specification. Conclusions and Relevance: In this study of the association between television advertising and navigator funding in the ACA marketplaces, private sector entities did not increase their advertising to compensate for declines in government-sponsored navigator activity. This finding can inform policy debates about the extent to which the private sector adjusts in response to changes in government outreach, and thus improve the design of state waivers and federal funding allocations.

Americans' perceptions of health disparities over the first year of the COVID-19 pandemic: Results from three nationally-representative surveys.

COVID-19 has illuminated health inequity in the United States. The burdens of disease are much higher among Black and Indigenous people and other people of color. Disparities by income are also profound, as lower-wage workers were less able to adopt mitigating behaviors compared to higher-income counterparts. These disparities became part of public health discourse in 2020, with commentators frequently highlighting the connection between racism, socioeconomic position, and COVID-19. But what proportion of the public-and among key subgroups-recognized these social group disparities, relative to disparities associated with age and chronic illness, and did public recognition change over the first year of the pandemic? To address these questions, we analyzed data from three nationally-representative cross-sectional public opinion surveys, collected using the NORC AmeriSpeak panel in April 2020 (N = 1007), August 2020 (N = 2716), and April 2021 (N = 1020). The key outcomes were respondents' agreement with statements about disparities in COVID-19 mortality by age, chronic illness, income, and race. We found little change from 2020 to 2021 in Americans' recognition of disparities. At all three time points, most respondents acknowledged age and chronic illness disparities, while no more than half at any time point recognized income- and race-based disparities. Political party affiliation was not statistically associated with agreement with age or illness-related disparities, but was strongly associated with views about income- and race-based disparities. Efforts to promote recognition of racial and socioeconomic health disparities in the United States need to be mindful of the ways in which public understanding of health inequities is linked to partisanship.

Health Insurance Ad Messages Targeted to English- and Spanish-Speaking Populations in a Period of Limited Federal Investment in Marketplace Outreach.

Federal funding cuts to enrollment outreach and marketing of the Affordable Care Act (ACA) marketplace options in 2017 has raised questions about the adequacy of the information the public has received, especially among populations vulnerable to uninsurance. Using health insurance ads aired from January 1, 2018, through December 21, 2018, we conducted a content analysis focused on (a) the messaging differences by ad language (English vs. Spanish) and (b) the messaging appeals used by nonfederally sponsored health insurance ads in 2018. The results reveal that privately sponsored ads focused on benefit appeals (e.g., prescription drugs), while publicly sponsored ads emphasized financial assistance subsidies. Few ads, regardless of language, referenced the ACA explicitly and privately sponsored Spanish-language ads emphasized benefits (e.g., choice of doctor) over enrollment-relevant details. This study emphasizes that private-sponsored television marketing may not provide specific and actionable health insurance information to the public, especially for the Spanish-speaking populations.

Effects of politicized media coverage: Experimental evidence from the HPV vaccine and COVID-19.

Although concerns about politicization of health and science are not new, the COVID-19 pandemic has amplified attention to how political disagreement over scientific guidelines and recommendations might influence attitudes and behaviors about the health topics in question and might even spill or carry over to affect other attitudes important to public health. The literature employs differing definitions of politicization-at times referring to controversy in the public sphere, at others referring to the exploitation of the uncertainty inherent in science, and at still others referring to whether the issue enters political discourse-all of which are viewed as distinct dimensions by the public. What is not known is how these different aspects of politicization influence public attitudes about the health topics and or broader attitudes about scientific guidelines, and-assuming adverse effects-what strategies might be effective at mitigating the consequences. This paper draws on a survey experiment of 3012U.S. respondents fielded in summer 2020 that was designed as a pilot study to assess the effects of different dimensions of politicization. Findings do not suggest that one type of politicization is necessarily more pernicious than the others. In fact, all types of politicization increased negative emotional responses and confusion, both with respect to the health topic in question (HPV vaccine and COVID-19) but also on other domains, although opinions about policy were unaffected. The findings also suggest that inoculation may have potential as a messaging strategy for blunting the adverse effects of exposure to politicization.

Changes in Marketplace competition and television advertising by insurers.

OBJECTIVES: The Trump administration ended television advertising for the Health Insurance Marketplace prior to the 2018 open enrollment period, leaving insurers as the predominant source of health insurance advertising. Prior research findings are mixed on the effectiveness of private advertising on Marketplace enrollment, but no work to date has examined how competitive changes in health insurance markets are related to marketing patterns. This study provides the first evidence on how insurers are altering their marketing in response to changes in competition. STUDY DESIGN: This study links data capturing Marketplace participation (CMS Qualified Health Plan Landscape files) by county and health insurance advertising (Kantar Media/Campaign Media Analysis Group) by media market for the 2014 through 2018 open enrollment periods. METHODS: We used population-weighted county fixed effects models to estimate the relationship between year-over-year changes in Marketplace competition and changes in (1) total private advertising and (2) advertising per insurer. RESULTS: Going from multiple insurers to a single insurer resulted in 465 fewer private ads aired within a county during open enrollment (P < .01), a 17% to 38% reduction. Losing monopoly status is associated with a drop in advertising of 452 airings per insurer (P < .01), and becoming a monopolist is associated with 293 more airings per insurer (P < .01). CONCLUSIONS: Insurers are not replacing the decline in government-sponsored advertising. We find that insurers behave as if they are responding to strategic incentives, advertising more when they become a monopolist but not filling the hole left by their former competitor, which has implications for the volume of messages seen by consumers.

Evidence-Based Message Strategies to Increase Public Support for State Investment in Early Childhood Education: Results from a Longitudinal Panel Experiment.

Policy Points  Investments in early childhood education can have long-lasting influence on health and well-being at later stages of the life course.  Widespread public support and strategies to counter opposition will be critical to the future political feasibility of enhancing early childhood policies and programs.  Simple advocacy messages emphasizing the need for affordable, accessible, high-quality childcare for all can increase public support for state investments in these policies.  Policy narratives (short stories with a setting, characters, and a plot that unfolds over time and offers a policy solution to a social problem) that describe structural barriers to childcare and policy solutions to address these barriers may be particularly effective to persuade individuals inclined to oppose such policies to become supportive.  Inoculation messages (messages designed to prepare audiences for encountering and building resistance to opposing messages) may protect favorable childcare policy attitudes in the face of oppositional messaging. CONTEXT: Early childhood education (ECE) programs enhance the health and social well-being of children and families. This preregistered, randomized, controlled study tested the effectiveness of communication strategies to increase public support for state investments in affordable, accessible, and high-quality childcare for all. METHODS: At time 1 (August-September 2019), we randomly assigned members of an online research panel (n  =  4,363) to read one of four messages promoting state investment in childcare policies and programs, or to a no-exposure control group. Messages included an argument-based message ("simple pro-policy"), a message preparing audiences for encountering and building resistance to opposing messages ("inoculation"), a story illustrating the structural nature of the problem and solution ("narrative"), and both inoculation and narrative messages ("combined"). At time 2 (two weeks later) a subset of respondents (n  =  1,436) read an oppositional anti-policy message and, in two conditions, another narrative or inoculation message. Ordinary least squares regression compared groups' levels of support for state investment in childcare policies and programs. FINDINGS: As hypothesized, respondents who read the narrative message had higher support for state investment in childcare policies than those who read the inoculation message or those in the no-exposure control group at time 1. Among respondents who were initially opposed to such investments, those who read the narrative had greater support than respondents who read the simple pro-policy message. Those who received the inoculation message at time 2 were more resistant to the anti-policy message than respondents who did not receive such a message, but effects from exposures to strategic messages at time 1 did not persist at follow-up. CONCLUSIONS: Results offer guidance for policy advocates seeking to increase public support for early childhood policies and programs and could inform broader efforts to promote high-value policies with potential to improve population health.

Paid family leave on local television news in the United States: Setting the agenda for policy reform.

Access to paid family and medical leave ("paid leave") has bipartisan support among lawmakers in the United States, but the issue remains stalled on the public policy agenda. The U.S. does not currently have a federal paid leave policy, and unpaid leave-guaranteed by the Family and Medical Leave Act of 1993-is all that is available to the majority of workers. In this study, we examine the content of local television news as representations of, and potential influence on, paid leave policy agendas. To do so, we analyze the extent to which local television news coverage describes the problem of lack of employment leave, and whether coverage highlights public policy as a solution. We use data from local television stations affiliated with the four major networks (ABC, NBC, CBS, and FOX) in all 210 media markets in the U.S. during a period pre-pandemic, from October 2018 until July 2019. We find that 64% of local television news coverage related to paid leave discussed the issue in the context of public policy. Coverage more often cited early-stage policy actions such as a policy idea - reflected in 40% of stories discussing stages of public policymaking - or the introduction of a bill - detailed in 22% of these stories. This coverage aligns with actual policy activity at the state-level during the same time period. News coverage infrequently included elements that could shape public understanding of paid leave as a population health issue, such as including health-related sources of providers or researchers. Policymakers, advocates, and researchers looking to advance public support for paid leave should consider efforts to use local television news as a vehicle to present health and policy-relevant information to broad segments of the public and set the agenda for policy reform.

Exposure to televised political campaign advertisements aired in the United States 2015-2016 election cycle and psychological distress.

CONTEXT: Prior research suggests the potential for political campaign advertisements to increase psychological distress among viewers. The current study tests relationships between estimated exposure to campaign advertising and the odds of respondents reporting that a doctor told them they have anxiety, depression, insomnia, or (as a negative control) cancer. METHODS: A secondary analysis of U.S. data on televised campaign ad airings from January 2015 to November 2016 (n = 4,659,038 airings) and five waves of a mail survey on television viewing patterns and self-reported medical conditions from November 2015 to March 2017 (n = 28,199 respondents from n = 16,204 unique households in the U.S.). FINDINGS: A 1 percent increase in the estimated volume of campaign advertising exposure was associated with a 0.06 [95% CI 0.03-0.09] percentage point increase in the odds of a respondent being told by a doctor that they have anxiety in the past 12 months. We observed this association regardless of the political party of the ad sponsor, the political party of the respondent, or their statistical interaction. We also observed this association for both Presidential campaign ads and non-Presidential (including local, state, and U.S. congressional election) campaign ads, providing evidence that these relationships were not driven by the unique divisiveness of the race between Donald Trump and Hilary Clinton. Some topic-specific models offered additional evidence of association between estimated volume of campaign advertising exposure and the odds of being told by a doctor that they have depression or insomnia, but these patterns were less consistent across models that utilized different categories of campaign exposure. Campaign ad exposure was not associated with cancer, which served as a negative control comparison. CONCLUSIONS: There was a consistent positive association between the volume of campaign advertising exposure and a reported diagnosis of anxiety among American adults.

Relationship between Drug Overdose Mortality and Coverage of Drug-Related Issues in US Television Political Campaign Advertising in the 2012 and 2016 Election Cycles.

CONTEXT: Understanding the role of drug-related issues in political campaign advertising can provide insight on the salience of this issue and the priorities of candidates for elected office. This study sought to quantify the share of campaign advertising mentioning drugs in the 2012 and 2016 election cycles and to estimate the association between local drug overdose mortality and drug mentions in campaign advertising across US media markets. METHODS: The analysis used descriptive and spatial statistics to examine geographic variation in campaign advertising mentions of drugs across all 210 US media markets, and it used multivariable regression to assess area-level factors associated with that variation. FINDINGS: The share of campaign ads mentioning drugs grew from 0.5% in the 2012 election cycle to 1.6% in the 2016 cycle. In the 2016 cycle, ads airing in media markets with overdose mortality rates in the 95th percentile were more than three times as likely to mention drugs as ads airing in areas with overdose mortality rates in the 5th percentile. CONCLUSIONS: A small proportion of campaign advertising mentioned drug-related issues. In the 2016 cycle, the issue was more prominent in advertising in areas hardest hit by the drug overdose crisis and in advertising for local races.