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  • The data source was the Newseum (www.newseum.org), an online daily repository containing electronic front pages of more than 300 US newspapers. For 6 weeks in 2007 (October 12 to November 22), we collected front-page newspaper coverage of high-profile medical stories in the US. We first relied on Newseum editors' daily analyses to identify each day's 10 most interesting front pages and then confirmed that any medical stories had national or international relevance, and immediate or potential public health implications. The full selection of front pages is available daily at 08:30 hours (US Standard Eastern Time) and Newseum editors' analysis appears soon after. Because Newseum displays newspaper front pages for only 24 hours and archives only front pages of historical significance, we checked the site daily at 23:00 hours Hong Kong time (11:00 hours US Standard Eastern Time) and collected data during the specific days of interest. Four different high-profile medical stories were reported during our search period. Story 1 appeared on Friday, October 12, 2007, and originated from a public health announcement made by a trade organization representing manufacturers of over-the-counter drugs that recommended the voluntary withdrawal of over-the-counter infant cold and cough medications [19]. Story 2, reported on Monday, October 15, 2007, originated from an annual national report on cancer in the US published in the journal Cancer [20]. Story 3, dated Wednesday, October 17, 2007, reported research findings showing an increase in the number of methicillin-resistant Staphylococcus aureus (MRSA) cases in the US and was based on an article published in the Journal of the American Medical Association [21]. Story 4, dated Wednesday, November 21, 2007, covered research reported in Cell [22] and Science [23] that described the generation of stem cells from skin cells. A high-profile non-medical story was used as a positive control to determine the “maximum” level of front-page coverage. We chose the news story (Story 5) about gun shootings at the Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, Virginia, which was reported nationwide on Tuesday, April 17, 2007, because it was the highest-ranking solitary news event of 2007 according to Time Magazine [24] and newspaper front pages on that date had been archived by the Newseum. In that incident, a student killed 32 students and staff, and then himself, on the morning of April 16, 2007. Newspaper titles on the chosen days were categorized by whether they covered the target medical or non-medical story on their front pages and by the source of the report. We first counted any mentions of the story topics, including banner headings and boxed or unboxed summaries, to measure total front-page coverage given by all newspaper titles. Next, author bylines were used to categorize the news sources as newspaper staff writers, news syndicates, or wire services. A news syndicate was defined as a newspaper publisher or publishing group producing media reports that are also simultaneously licensed to subscribers (e.g. Washington Post Company, McClatchy Newspapers). Wire services were defined as organizations that do not print or publish news but supply news to subscribers (e.g. Associated Press). If a staff writer had declared that the primary source was a syndicate or wire, we still classified the source as a staff writer. None of the summaries had bylines, whereas all full reports did. Any mentions of the target stories without a byline were thus classified as unauthored briefs and were excluded before odds ratios were calculated for each known source of each medical story, with Story 5 acting as the reference. We also calculated the proportion of unauthored briefs that were standalone or referred the reader to an inside page. To determine the total daily circulation of all titles bearing each target story (i.e. front-page coverage by circulation), we used the March 31, 2007 quarterly edition of the Audit Bureau of Circulations report, Top 200 Newspapers by Largest Reported Circulation[25]. The Top 200 US newspapers, ranked according to their individual audited circulations, together have a cumulative daily circulation of 46.3 million. Accordingly, this part of the analysis was limited to the ranked newspapers that appeared in the Newseum during the specific days of interest. We therefore used three denominators in our analyses: 1) all newspaper titles; 2) ranked newspaper titles; and 3) total circulation of ranked newspapers. Other Medical News Reported on Front Pages: To further understand how newspapers prioritize medical stories, we identified all other front-page medical news reported on the same days as the four medical stories (labeled as low profile). We noted their topic and assessed their news sources and coverage by newspaper title, ranked title, and circulation, as described above. Two trained coders used a coding form to review downloaded newspaper front pages. The two coding items were (a) whether the front page contained the target news story, and (b) whether the front-page story was produced by a newspaper staff writer, news syndicate, or wire service, or if it was an unauthored brief. The interrater agreement was high for deciding whether or not the five target news stories appeared on a front page (96.0%, 98.2%, 98.8%, 98.8%, 100.0% observed agreement; kappa = 0.92, 0.96, 0.98, 0.98, 1.00 for stories 1, 2, 3, 4, and 5, respectively), and for identifying the sources (94.8%, 97.0%, 97.6%, 95.8%, 94.4% observed agreement; kappa = 0.92, 0.94, 0.96, 0.94, 0.91 for stories 1, 2, 3, 4, and 5, respectively). Interrater reliability (kappa) was calculated with SPSS version 15.0 (SPSS Inc, Chicago, Illinois), and chi-square analysis of categorical data was performed with JMP version 5.1 (SAS Institute, Cary, North Carolina). A P value of <0.05 was considered statistically significant; for multiple combinations (n = 10) of pairwise comparisons, a more stringent P value of <0.005 was used. Odds ratios and 95% CIs with reference to Story 5 were calculated using online software (www.hutchon.net/ConfidOR.htm). In chi-square comparisons of Top 200 newspapers, circulation figures were expressed as count per 100,000 to ensure comparable cell sizes.
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