The Rural Restaurant Healthy Options Program: Response of Rural, Local Newspapers to a Program Press Release

Abstract

Local media should be used to raise awareness of health promotion programs. In rural areas, local newspapers provide an opportunity to reach large numbers of residents. Although there are expert guidelines describing the process for successfully engaging local media, little has been documented regarding the range of responses that local, rural newspapers might have when approached about covering health promotion programs. This study describes the response of rural, local newspapers to a press release about a health promotion program taking place in 28 restaurants in different rural towns. The most common reason for not publishing a story was that it would constitute free advertising for the restaurant. Twenty-two stories were analyzed using descriptive statistics. The majority of the responding newspapers were weeklies, and 16 published the full press release verbatim. Three stories included photos, and five included quotes. Headlines typically included the name of the restaurant and the university partner. The overall response rate is encouraging; however, there is considerable room for improvement in terms of personalizing the story with photos or quotes. Greater efforts may be required to obtain this depth of coverage, including training for local journalists to increase their interest and confidence in covering health promotion issues.

INTRODUCTION

Local media are often leveraged to increase awareness of health promotion programs. Because of the demonstrated success of such coverage in increasing awareness of an issue, the Centers for Disease Control and Prevention (CDC, 2012) recommends use of a variety of media to spread news of health promotion programs. Even though many people go to the Internet and other news media channels to get important information, including health information (Beckjord et al., 2007; S. Fox, 2006), several recent reports have demonstrated that local newspapers are still among the most important means for residents in the United States to get health information in their everyday lives (American Dietetic Association, 2008; Borra, Earl, & Hogan, 1998). Some regional newspapers have suffered in recent years because of competition with the Internet (Franklin, 2008); however, local newspapers in U.S. rural areas are still strongly embedded in their communities as a key source of community information for residents (Viswanath, Randolph Steele, & Finnegan, 2006). For example, a 2010 survey found that 86% of rural adult Iowans of all ages read a newspaper each week (Iowa Newspaper Association, 2010). Similar numbers have been found in other largely rural states (Hoosier State Press Association, 2012; Louisiana Press Association, 2012). Small-town newspapers are often the only source of local information (Mohl, 2003). Therefore, rural newspapers represent one of the major, potential sources of health-related information for their local residents and should be used in the promotion of public health programs.

BACKGROUND

Many studies have analyzed newspaper coverage of health-related programs, but relatively few of these involve rural areas of the country. A study in rural Arkansas identified limited resources of program planners as one barrier to utilization of paid local media, reducing the reach and effectiveness of a campaign to promote physical activity for arthritis relief (Balamurugan, Rivera, Sutphin, & Campbell, 2007). In rural Missouri, investigators analyzed content of 23 local newspapers and documented increased nonpaid coverage of cardiovascular health issues as a result of a comprehensive community-based intervention (Brownson et al., 1996). A study in Kansas, a largely rural state, found that television, newspapers, and word of mouth were the most frequently cited sources of information during a statewide West Nile Virus health education campaign (M. H. Fox, Averett, Hansen, & Neuberger, 2006). In a statewide campaign directed toward breast cancer screening, researchers in a Midwestern state with both rural and urban populations found that health promotion groups, using largely paid advertising, were able to have more impact on the content of weekly newspapers than dailies (Martinson & Hindman, 2005).

Local newspapers have limited space for news stories (the “news hole”) and limited resources for covering a broad variety of stories. Journalists traditionally have a desire to maintain independence and objectivity, and some may resist press releases; others may place community service above professional detachment (Mohl, 2003). Thus, for unpaid health promotion content to be included, it is important for program organizers and newspaper decision makers to have a positive relationship with one another. In addition, to make story writing easier, experts recommend providing newspaper reporters with press releases or other brief forms of communication about a topic (CDC, 2012). For rural newspapers, a prepared news story may be particularly important, as tight budgets in the past few years have resulted in smaller staffs (Laakanemi, 2005). Although health journalists report using information subsidies such as press releases from public relations entities—including health promotion programs—less frequently than their own ideas or suggestions from the public, those who perceive themselves to be advocates for their audience are willing to incorporate subsidies in building the health news agenda (Len-Rios, Hinnant, Park, Cameron, et al., 2009). Journalists and editors are most likely to publish news based on press releases that discuss new health information that will benefit their readers along with having the potential for providing a local angle (Viswanath et al., 2008). This suggests that press releases tailored to particular communities will be successful in attracting editors’ attention.

Research indicates that health journalists are more favorable to writing their own news stories or using parts of press releases when the information comes from local health organizations, universities, and public health departments rather than federal or for-profit entities (Len-Rios, Hinnant, & Park, 2009). In small, rural towns, there is a greater chance that news editors and reporters know the program organizers or other participants personally, which should further increase the likelihood of a press release's success. Rural areas are also likely to have fewer resources for health promotion programming and may need to rely on free media coverage of program activities. Program organizers need to understand and be prepared for the range of responses that the media may have to their information or events. Little is documented about the success rate in obtaining free newspaper coverage in rural areas and about the nature or extent of the stories when published (Zittleman et al., 2009). In this study, we describe the response of rural, local newspapers to a press release about a healthy eating intervention taking place in local restaurants.

METHOD

Data from this study are from a larger study involving the statewide dissemination of a restaurant intervention designed for owner-operated rural restaurants called the Rural Restaurant Healthy Options Program. The intervention was designed after much previous collaborative work with restaurant owners and their customers. It was intended to be simple, low cost, and low risk in order to maximize the likelihood of future dissemination. Results from previous phases of the restaurant study are described elsewhere (Nothwehr, Snetselaar, Dawson, Hradek, & Sepulveda, 2010; Nothwehr, Snetselaar, Dawson, & Schultz, 2012). Final results from the dissemination phase in terms of program maintenance are currently being analyzed. In the dissemination phase, a total of 28 restaurants in different towns adopted the program. All restaurants were owner-operated, family style, sit-down restaurants in counties designated as rural (there was no town with a population greater than 50,000). The program consists of placing signs on restaurant tables that encourage customers to ask for healthier options, for example, meat or fish baked or broiled instead of fried, low-fat dressing, whole wheat bread, and so on. The program did not require menu changes or nutritional analyses. At the time the owners agreed to adopt the free program, they were asked if they would like a press release to be given to their local newspaper that described the program and their participation. All owners agreed to this and provided the name of the local newspaper to be contacted. In the majority of cases, there was only one newspaper available in the local area. The press release was provided primarily as an incentive to the owner to participate in the program, rather than as a part of the intervention itself. Our previous research had shown that it was very difficult to control the timing of local newspaper coverage, so its unique effect on customer behavior in this case would be nearly impossible to measure. On the other hand, owners very much appreciated any media coverage because they were typically unable to afford to pay for advertising. In previous research, we found that most editors of rural, local papers are very involved in story writing and tend to have only one or two reporters on staff; therefore, research staff attempted to address communications to the editors, initially through e-mail, with some follow-up contact via telephone.

The press release was written with assistance from the College of Public Health Media office, and the Institutional Review Board of the University of Iowa approved the content. The release contained four paragraphs. The first stated the name of the respective restaurant and that it was partnering with the University of Iowa in a research project that “encourages customers to make healthy choices from a restaurant's existing menu.” Examples of table sign content were then provided. The second paragraph mentions that although dining away from home can be enjoyable, “foods eaten away from home tend to be higher in fat, calories and cholesterol and lower in other important nutrients than those eaten at home.” In the third paragraph, the importance of a healthy weight, as well as possible health outcomes of overweight and obesity are mentioned. The final paragraph stated that in previous research, it was found that “half of Iowa restaurant customers were trying to make changes to improve their diet. The (name of restaurant) has taken a great step toward helping customers reach their goals.” The entire press release fit on one page and was 307 words in length. No particular headline was suggested. The writing style, length, and readability of the release were in line with public relations guidelines for writing successful press releases (Foster, 2008).

Measures

Records were kept of the press releases sent out, and the date. Stories were obtained by contacting the newspapers and requesting copies. In situations where a story was not published within a few weeks, research personnel attempted to contact the newspaper editor to determine the reason. Published stories were analyzed for the following factors: page of publication as an indicator of prominence, presence of a photograph or graphic (yes/no), whether the story included quotes from the owner and/or research personnel (yes/no), elements of the original press release that were included, and headline content, specifically the presence of the name of the restaurant, name of the university, and mention of the program as a research project or study.

Analysis

Data were reviewed by two research staff and there were no discrepancies in their findings. The analysis used descriptive statistics to characterize the published stories and the newspapers.

RESULTS

The 28 press releases given to local newspaper editors resulted in 23 published stories, each from different newspapers. Research staff were unable to obtain a copy of one of the published stories after multiple attempts, leaving 22 stories for analysis. When a newspaper declined to publish a story, another local newspaper was approached if available. This was the case in several towns. Reasons given for not publishing a story included the following: the story would constitute free advertising for the restaurant (response from seven newspapers approached for coverage of three restaurants, three of which were weeklies), the restaurant closed before the newspaper could run the story (one paper, a weekly), and one newspaper offered no reason (a daily).

Table 1 summarizes the key findings of the story analysis. Of the 22 stories analyzed, most were in weekly newspapers, and most were on a page other than the first. Page number was unknown for five because only a web version of the story was provided to the research team. Three stories included photographs of the restaurant, three included quotes from the owner, whereas five included quotes from research staff. In all cases where the restaurant owner was interviewed, a research staff member was interviewed as well. In 16 stories, all four paragraphs of the press release were used, usually verbatim. Typically, in cases where less of the press release was used, the story included information provided by the restaurant owner and/or research staff. The majority of headlines included the name of the restaurant, and many included the name of the university as well. Two named only the town where the restaurant was located, and one used the word “study” in the headline.

TABLE 1.

Characteristics of Published Stories (n = 22)

Characteristic	n (%)
Type of newspaper
Daily	5 (23)
Weekly	17 (77)
Page of publication
First page	6 (27)
Other page	11 (50)
Unknown	5 (23)
Presence of photo(s)
Yes	3 (14)
No	19 (86)
Presence of quotes from owner
Yes	3 (14)
No	19 (86)
Presence of quotes from research staff
Yes	5 (23)
No	17 (77)
Paragraphs of press release used
1, 2, 3, 4	16 (73)
1, 2, 3	1 (5)
1, 2	2 (9)
1, 4	1 (5)
1	2 (9)
Restaurant name in headline
Yes	17 (77)
No	5 (23)
University name in headline
Yes	8 (36)
No	14 (64)

DISCUSSION

This study demonstrates that a majority of local, rural newspapers were willing to publish a story about the restaurant intervention when provided with a press release, which supports the experience of a previous rural health intervention (Zittleman et al., 2009). Although the study did not test whether provision of a press release resulted in greater coverage than not providing such information, it is clear that the vast majority of newspapers in this study used the information provided when publishing a story. In this study, editors were found to be very busy and sometimes difficult to reach. This points to the need to provide well-written press releases when coverage of programs is desired, as this minimizes the effort required by the editor or reporter.

It is disappointing that only a few newspapers chose to include pictures or quotes, elements that would lend a more personal appeal to the story. In rural newspapers with small staffs, however, this is not particularly surprising because they may lack time or other resources to enhance or expand on a press release in this way. Additional efforts beyond provision of a press release may be needed to secure this depth of coverage, such as maintaining communication and collaboration between program coordinators and the media, a process discussed in detail by others (CDC, 2012). This finding may also simply reflect varying levels of interest and/or perceived competence in health reporting by editors. A study by Caburnay et al. (2003) found very few stories about health promotion in local papers in four midsized, Midwestern communities, and a large majority did not include a local angle, quotes, or calls to action. Also, few local journalists who are in charge of writing health and nutrition stories have had formal training in public health (Tanner, 2004). Efforts are needed to train reporters to provide more and better coverage of health promotion stories, but the findings also suggest that rural, local newspapers may require additional attention compared with those in urban areas with larger staffs.

A total of seven of the newspapers in this study (approached regarding three of the restaurants) declined to publish a story, saying it amounted to advertising for the restaurant. Although this is a small proportion of the total sample, and the majority of published stories included the restaurant name in the headline, it is somewhat concerning that the health issue addressed by the program did not override this objection. Program coordinators need to be prepared to deal with this objection and perhaps negotiate the framing of a story with an editor if free coverage is to be obtained. Further research is needed to determine why some editors are more willing than others to work with health promotion campaigns; such knowledge would aid planning in future rural campaigns.

This study involved a relatively small sample in a particular area of the country, and findings may not generalize to other regions. The sample size also precluded determination of whether there are meaningful differences in story coverage by daily versus weekly papers. In a study cited earlier (Martinson & Hindman, 2005), program organizers found weekly papers to be more responsive to them, believing they may have greater interest in local events. It is also likely that weekly papers have fewer resources and are thus more likely to rely on information subsidies. The publication success rate observed in this study may be in part because of the fact that the majority of the newspapers were weeklies.

This study was not able to determine the extent to which having a university name on the press release may have affected the editor's decision to run a story. The name of the university was mentioned in more than one third of the headlines and in all of the stories; however, suggesting university involvement may have given the story increased importance. Health promotion professionals could benefit from naming other influential or respected partners in their press releases.

CONCLUSIONS

This study demonstrates that local, rural newspapers are likely to be responsive to a press release concerning a health promotion program but that more personalized stories are unlikely to result without greater efforts on the part of program coordinators. Future research could evaluate the effects of such efforts in different areas of the country, as well as associations between newspaper coverage and intervention results. Greater encouragement and training of reporters to write health promotion stories is also likely necessary.