Cultivation in Health and Risk Messaging
Abstract and Keywords
Cultivation theory examines the effects of the media, mainly television on viewer perception over an extended period of time. Television is seen by people throughout the globe, with many spending considerable amounts of time watching the medium. The act of watching television has been described as the first leisure activity to cut across social and ethnic divisions in society. This made it a unique mass media tool because mass message dissemination to diverse groups in a population was made possible. Cultivation scholars have studied the effects of the medium, trying to understand how television content can alter one’s social reality. Heavy viewers are considered to be most susceptible to the effects of cultivation. The reality of these effects poses important questions for health communication scholars considering the role television plays in disseminating health messages. Health communication scholars became interested in studying cultivation to understand the health-related effects the medium could have on viewers. Understanding the health effects of television is pivotal, considering that television and the structures that constitute television content set the agendas for many health topics, often disseminating negative and positive messages that can impact society, especially the young and impressionable. With television content addressing health issues such as nutrition, diet, body image, tobacco, cancer, drugs, obesity, and women’s health, cultivation theory can offer health communication scholars a framework to understand how health behaviors are shaped by the mass media and the roles these media play in reinforcing unhealthy behaviors. By establishing a basis for studying how such portrayals have direct health-related effects on viewers, cultivation theory creates openings for questioning the structures of the media that put out unhealthy content and for interrogating the roles and responsibilities of media agenda in inculcating positive health messages. Directions for future research include looking at contextually contrasting populations that share different cultural and community values, and different ways of consuming television. Research questions exploring the roles of community structures with different sets of subjective norms, or with different roles of community norms, in the realm of cultivation effects offer new areas for exploration.
Keywords: cultivation theory, health effects, television, health beliefs and perceptions, mass media, television, mediated messages, health outcomes, health communication, culture, cultural indicators, mean world index, media effects, popular media
Cultivation theory is a key theoretical framework for the study of mass media and its effects on society and on our everyday lives. Acknowledged as one of the most important communication theories, it is also known to be one of the most cited theories to date in communication studies (Morgan & Shanahan, 2010; Morgan, Shanahan, & Signorielli, 2015). The theory examines media effects and its influence on viewer perception over the long haul (Gerbner, 1969a, 1969b, 1973; Gerbner, Gross, Morgan, & Signorielli, 1986). Cultivation is defined as the development of perceptual understandings and belief systems among viewers over an extended period, due to media exposure (Gerbner, 1969b; Potter, 1993). A critical aspect of cultivation theory is a focus on the macrosystems approach, studying the macro effects of messages that are imprinted on the public through exposure to mass media over sustained periods of time (Potter, 2014). The theory does not postulate small or short-term effects, but rather long-term effects that have consequences for society. Gerbner noted that the contribution of cultivation theory is in understanding media effects, over time, not just effects in the present and short-term, thus seeking to map how transformations of “mass production and rapid distribution of messages across previous barriers of time, space, and social grouping, bring about systematic variations in public message content whose full significance rests in the cultivation of collective consciousness about elements of existence” (1969a, p. 138).
The focus of cultivation is on examining the overarching context of message interpretation by various groups and individuals from different frameworks of learning and processing (Gerbner, 1969a, 1969b). Shanahan and Morgan (1999) aptly summarize that “cultivation analysis is an attempt to say something about the more broad-based ideological consequences of a commercially supported cultural industry celebrating consumption, materialism, individualism, power, and the status quo along lines of gender, race, class, and age” (p. 39). Shanahan and Morgan (1999) succinctly outline that the original intent of cultivation theory was to contribute to the communication literature on the impact of mass media on society, specifically examining the role of television. This initial hypothesis had amounted to significant research, with divergent and opposing views regarding cultivation effects (e.g., Hawkins & Pingree, 1989; Hirsh, 1981; Morgan & Shanahan, 1997). To capture this debate, Morgan and Shanahan pulled together studies on cultivation effects over twenty years, conducting a meta-analysis to better understand effect sizes of cultivation research. The findings reported an overall small effect size of r = 0.091, with variation in effect sizes with different sample sizes of studies. Despite the small effect size reported by Morgan and Shanahan (1997), cultivation theory continues to elicit ongoing discussions and debates, exploring a span of topics (e.g., Hetsroni & Tukachinsky, 2006; Sink & Mastro, 2017).
Studies published globally have also reported a relationship between mass media consumption and altered social realities (Weimann, 2000). A study comparing content viewers of U.S. television in South Korean and in Indian societies reported a lack of satisfaction in relation to their material dispossessions in their own individual societies, with the Indian data also indicating dissatisfaction with one’s private life (Yang, Ramasubramanian, & Oliver, 2008). In a more recent study of Singapore audiences, Lee and Thein (2015) found that racial discernments in relation to crime shared a relationship with heavy media consumption of crime-related content on different media platforms (television, social media sites, and newspapers). Korean soap operas and their effects on South Korean audiences and beyond have also been studied widely, with these soap operas seeming to influence perceptions of and attitudes toward family structures and how specific relationships manifest (Jin & Jeong, 2010; Vu & Lee, 2013). Other international studies attend to the interplays between geographic proximity and cultivation effects, suggesting that knowledge about a culture closer to home relies on one’s own experience, but knowledge about a culture distant from one’s own experience relies on television as an information source (Hestroni, Elphariach, Kapuza, & Tsfoni, 2007). Studies of cultivation and health have explored the cultivating effects of television viewing on a variety of health-related perceptions such as perceptions of and attitudes toward alcohol, body image, violence, doctors and health information, nutrition, drugs, mental health, impairment and disability, cancer, and women’s health related issues
The Role of Television in the Study of Cultivation
With the onset of television, the channel became a key source of information for populations around the world (Oren & Shahaf, 2013; Signorielli, 1993; Signorielli & Morgan, 1990). The advent of television has reconstituted the ways in which different and varied groups of people, from different segments of society, spend their time for leisure. With television reaching a wide audience, the practice of watching television became an activity shared by individuals from all walks of life. This meant that, in a historic first, the act of watching television became a single activity that was shared across the masses, cutting across social class and ethnicity (Gerbner et al., 2002). Discussing the unique traits of the channel, Gerbner and Marvanyi (1977) put forth several arguments on the influential role television had on the wider audience. Television viewing was an activity that appealed to most demographic groups. Low literacy was sufficient to partake in the act of watching. This led to a reformation in shared culture among members of a community. With the television set simply situated at home, watching as a leisurely media activity could take place anytime. The advancement of this medium and the nature of the channel’s characteristics, shaped new types of effects that media could have on society. As a result, the arrival of television led to the capturing of a mass audience, changing the way social order was now arranged, as these systems were no longer maintained by religion, previously a central influence (Morgan, Shanahan & Signorielli, 2015). From a critical perspective, television was viewed as a tool of social control (Shanahan & Morgan, 1999). Cultivation theory was based on the idea that individuals were ritualistically watching a homogenized set of cultural symbols that were reproduced repetitively for mass consumption. Scholars of cultivation contend over whether this medium has the power to codify practices of social order and solidify national culture (Gerbner, 1969b, Gerbner et al., 2002). Gerbner (1970) problematized the mass media revolution, specifically the rise of television, as the mass production and transmission of cultural codes and signs, to formulate ideas that echo the power structure on society’s shared systems of knowledge, beliefs, and values in unifying ways. Gerbner et al. (2002), on the effect of television, that “programs that seem to be intended for very different market segments are cut from the same mold; when surface-level differences are wiped away, what remains are often surprisingly similar and complementary visions of life and society, consistent ideologies, and stable accounts of the “facts” of life” (p. 44). Gerbner (1969a, 1969b) reified the grave social implications and consequences television can have on societies and the problems with signifying homogenous sets of cultural symbols to the masses. With this social implication of the mass media in mind, cultivation theory set out to interrogate the ideological codes imprinted by media institutions, and the effects on large aggregates of viewers in societies and communities around the globe.
Early thinkers of cultivation, such as George Gerbner and Larry Gross, approached the theorizing of cultivation from a critical paradigm, especially in interrogating the power the media holds in its (re)production of cultural symbols (Gerbner & Gross, 1976). However, as the study of cultivation continued, it moved away from critically interrogating structures, to systematically trying to measure these critical assumptions, by studying cultivation effects through quantification of specific effects categories. This emphasis on audience effects needs to be situated in the backdrop of an overarching critical position about the role of television content, the nature of media structures as capitalist institutions, and the power held in these media structures. Questions of cultural imperialism and globalization, the global political economy of the media industry, the dynamic and shifting nature of culture, the role of the audience in socially constructing media content, and broader perspectives on competing media and content production remain relevant, but largely understudied in the cultivation literature.
Making Sense of Cultivation Theory
Cultivation theory works on the idea that an individual believes what is depicted on television as observed social reality. Cultivation scholars postulate that, with increased viewership of television, divergent groups of viewers “converge into a more cohesive perception of social reality as the amount of television viewing increases” (Belden, 2010, p. 22). Moreover, cultivation theory predicts that the behavior of audience members can possibly be determined by messages on television that are prevalent and have been repeated time and time again (Gerbner et al., 2002; Gerbner et al., 1994; Signorielli, 1993). To further confirm the presence of cultivation effects, there is a need to differentiate between various levels of viewership among individuals. Measurement of the magnified and distorted perception of reality on television (e.g., excessive representations of violent black people in the media) is compared with an individual’s usage of television, thus offering a framework for testing the pronounced and augmented effects of cultivation (Belden, 2010; Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). Gerbner (1966) reiterated the need to look at the “institutions, messages, and publics” when studying cultivation (Morgan and Shanahan, 2010, p. 338). These institutional structures produce mass mediated messages, composing mass produced signifying meanings, which are disseminated to mass aggregates of audiences. The mass messages, according to Gerbner (1969b), form “a common culture through which communities cultivate shared and public notions about facts, values, and contingencies of human existence” (p. 123). Therefore, cultivation analysis is conducted by examining structures of the media involved in producing the content for the media, the visual symbols (images) that are frequently orchestrated and reflected by the media, and television viewership and its relationship with the viewers’ belief systems and behaviors that reflect presuppositions about how the world is (Gerbner, 1973).
Morgan and Shanahan (2010) suggest that cultivation theory can be conceptualized and formalized from three positions. First, cultivation can be conceptualized as a theory with propositions and constructs. Second, it offers a framework for developing hypotheses to test relationships. To demonstrate an example of a hypothesis predicting cultivation—if an individual spends a significant amount of time watching television, he/she is more likely to perceive reality that reproduces from fictional salient messages on television (Morgan & Shanahan, 2010). A third way to study cultivation is to identify a particular media effect as a construct. To do so, one must identify topics salient to the study of cultivation. Topics can include the occurrence of certain forms of criminal activity and the perceptions of the occurrence of such activity, where there are persistent differences between the frequency of these acts on television and the frequency of these acts reflected in criminal records by law enforcement agencies (Gerbner, Gross, Jackson-Beeck, Jeffries-Fox, & Signorielli, 1978). Cultivation scholars (Gerbner, 1973; Jamieson & Romer, 2015; Signorielli, 1993; Signorielli & Morgan, 1990) determine this by conducting content analyses of television. For instance, a number of cultivation studies postulate that higher television viewership leads to a belief that the world is violent. The analyses indicate that, in fact, mass media reflect a much higher incidence of violent criminal activity than in the real world, leading to conflated perceptions of violence that are disproportionate to the real levels of violence in the world (Gerbner et al., 1978; Gerbner, Gross, Morgan, & Signorielli, 1980). In studying violence on television, an important resulting concept is the Mean World Syndrome. Gerbner (1998) argued that because there is extensive violence on television, heavy viewing and long-term television watching eventually cultivate a position that the world is a mean and unsafe space. To summarize, this perceived reality results in heavy television viewers feeling lower trust, desiring greater security, and thinking of fellow human beings as generally self-interested (Gerbner et al., 1980). Continuing this early interest in violence, the study of cultivation has been most pronounced in studying violence on television.
Cultural Indicators and the Cultural Indicators Project
Gerbner (1969a), while developing the term cultivation in his seminal piece titled “Towards Cultural Indicators,” refers prominently to what he coins as the measurement of cultural indicators to test effects of cultivation. Cultural indicators document cultural symbols and phenomena, capturing for instance imprinted cultural articulations on television that the viewer induces while watching (Gerbner, 1969a; Potter, 1993). A cultivation indicator is a single constituent among others in determining cultivation (Potter, 1993). Cultural indicators help us decode cultivation in messages reproduced by television. Spotting cultural indicators to determine the effects of cultivation are a way of tracking content and discourse in media messages that serve as cultural references. This process of locating cultural indicators includes mapping out what are the most frequent, consistent, and recurring symbols on television. These symbols have been studied extensively by cultivation scholars. Some common indicators include the portrayal of colored communities in stereotypical representations, gender-based symbols denoting gendered roles, and violence and violent visuals, displayed over an extended period (Potter, 2011; Signorielli, 1993). Gerbner (1969a) demonstrates the need to understand and capture cultural indicators “to know what general terms of collective cultivation about existence, priorities, values, and relationships are given in collectively shared public message systems before we can reliably interpret facts of individual and social response” (p. 141). Cultural indicators tell us what topics the media is attending to, the kinds of the messages being shared, how many times these messages are recirculated, the importance given to specific discourses, whom messages align with, and finally, how certain concepts that are reflected in the media tie in together with one another (Signorielli, 1989; Signorielli, 1993).
The institutionalization of the cultural indicators project was initiated to research and measure these shared cultural symbols in similar ways to social and economic indicators (Gerbner, 1973). The cultural indicators project intended to formalize and chart the display, arrangement, and patterns of circulating culture via media (Morgan & Shanahan, 1997). Topics include “sex and age role stereotypes, health, science, the family, educational achievement and aspirations, politics, and religion” (Gerbner & Gross, 1976, p. 22). To chart this process, Gerbner and Gross (1976) outlined three identified research strategies, institutional process analysis, message system analysis (content analysis), and cultivation analysis, the least familiar and used being institutional analysis. In positioning this argument, Gerbner (1973) proposed that institutional analysis traces how messages are produced and distributed through the masses, cultivating mass consciousness (Gerbner, 1969b). However, the literature is still inadequate in addressing a clear and analytical conceptualization of institutions that is up-to-date with current research on institutions. As Hodgson (2006) alludes, the lack of analytical precision on what counts as an institution gives room for any kind of research that looks at institutions in opaque ways. Since the inception of cultivation, research in this area have identified many different variables as institutions, such as actors, interests, ideas, and goals.
How Has Cultivation Research Advanced?
With scholars constantly advancing studies in cultivation, different mental faculties have challenged the earlier assumptions of cultivation. Part of much of the debate, commenced with challenging the initial ambiguity on audience passivity (Gerbner, 1969a, 1969b, 1973; Gerbner & Gross, 1976; Gerbner et al., 1978; Gerbner et al., 1980, 1986, 1994). Despite obscurity on this aspect of the theorizing of cultivation, it was understood that initial research in cultivation viewed audiences as passive recipients of content, as opposed to already actively selecting content on media in socially constructed ways. This led to research in the direction of audience passivity (Gerbner, 1969a, 1969b, 1973; Gerbner & Gross, 1976; Gerbner et al., 1978; Gerbner et al., 1980, 1986, 1994). However, we started to see a gradual shift and advancing of cultivation, engaging with ideas of mainstreaming and resonance.
Mainstreaming suggests that heavy television viewing influences similarity and connections in ways that were not previously present, because of social, political, economic, and cultural diversity. Heterogenous communities that were heavy viewers of television watching, and with different attitudes and opinions, were more likely to be drawn toward mainstream standpoints. Mainstreaming thus refers, to the manifestation on the cohesion of views by specific demographic groups that are heavy television viewers, while light television viewers seemed to hold differing or deviating perspectives (Gerbner, 1998; Hammermeister, Brock, Winterstein, & Page, 2005; Hetsroni & Tukachinsky, 2006). The variance and degree to which a difference exists regarding perceived conceptions of reality between heavy and light viewing of television within the same demographic band is known as the cultivation differential (Gerbner & Gross, 1976). Using a mean world index (scale measuring violence related items), it was found that both heavy viewers with no college experience and heavy viewers with college experience reflected high levels of perceiving mean world syndrome, mainstreamed through television watching (Signorielli, 1990). Comparably, studies looking at gender mainstreaming on women and gender roles, elicited similar results among heavy viewers. Mainstreaming was attributed to power residing in the way media institutions were being governed, systematized, and controlled to produce and appeal to mass audiences (Hirsch, 1981; Shrum, 2001, 2004; Shrum & Lee, 2011), with a consequence of producing uniformity and stability in message dissemination.
Resonance, a contrary perspective to mainstreaming, alludes to the idea that if the lived experiences of television viewers resonate with how they identify with intended television messages, the message effects are more amplified (Shrum & Bischak, 2001). Unlike mainstreaming, resonance builds on the idea that with experiences closer to mass media messages, the effect on the individual is greater. Resonance suggests that mass media content and life experiences interact with each other (Shrum & Bischak, 2001). Gerbner, Gross, Morgan, and Signorielli (1980) studied cultivation effects in the context of crime and violence in America, explaining that when there were individual experiences with violence and crime, such as in areas where there was greater crime, substantial viewing of television portraying crime and violence resulted in an even greater exposure to message content on television, increasing cultivation effects (Gerbner et al., 1980). To sum, resonance is the notion that viewers’ life experiences affected their perceptions of televised messages. If the viewers’ life experiences are akin to the media content they are viewing, the media messages are more likely to have an effect (Shrum & Bischak, 2001). Another area in which cultivation has expanded includes involvement with narratives seen on media (transportability) as a specific quality or trait that fundamentally constitutes cultivation effects (Bilandzic & Busselle, 2008).
New ways of thinking about cultivation included moving the audience from passive message recipients, to cognitively engaged recipients. L. J. Shrum, along with his colleagues, further asserted that audiences are rational, and thus, adopt mental heuristics (cognitive thinking) in processing knowledge on television when acquiring it (Shrum & Bischak, 2001; Shrum & Lee, 2012). Shrum and Bischak (2001) inform that advancing cultivation meant that we needed to think about the kinds of questions researchers ask, suggesting psychological variance in different measures used for measurement of cultivation. They make this distinction by first (demographic) and second order measures (value-systems). Cultivation effects can be measured both by topic and type (Potter, 1991). Researchers use first order measures to capture actual statistics for estimations and frequencies (Shrum & Lee, 2012), to compare it to second order measures, such as percentage of law enforcement officials (Schnauber & Meltzer, 2016). Second order measures capture “generalized beliefs that are supposedly inferred by viewers from first-order information” (Potter, 1991, p. 92), for example their assumptions, values, and opinions about crime rates. Later work on cultivation operationalized these measures as having two different processing needs, with first order measures as heuristically informed, while second order measures focused on evaluatively based judgments (Shrum, Lee, Burroughs, & Rindfleisch, 2011). In pushing cultivation forward, Morgan et al. (2015) proposed the solidifying of cultivation in a way that clarifies its position as a framework that can explain the macrosocial impact of media. Additionally, the authors call for greater interrogation of the various cognitive factors that may impact cultivation, such as mental graphs, the ways in which sense is made from memory and schemas, and how people learn and observe behaviors on television.
Cultivation Research in Health
Cultivation theory has significantly contributed to understanding the health effects mass media can have at a societal level. Using cultivation theory as a framework, health communication scholars have tried to study health-related effects over the years, with the rise of health as an important topic for information and entertainment on television (Signorielli, 1993). This section focuses on the effects of television on health. Television shows a significant amount of content regarding health and health information consumed by large masses. Topics on television include alcohol, body image issues, violence, doctors and health information, nutrition, drugs, mental health, impairment and disability, cancer, and women’s health related issues among many others. Often, unhealthy behaviors are depicted on the media and can have significant implications for audiences, especially the young. Signorielli (1993) lays out how television in particular can have significant health effects among avid watchers because the medium has become an important channel of information for individuals across the globe, especially among the youth. Based on an extensive review of studies on television and health, she concluded that television conveyed to audiences that healthcare resources were infinitely available typically for all individuals. Biomedicine was also viewed as the only way to cure oneself from disease. Other health portrayals on television tended to convey impractical individual-level health suggestions to keep healthy, for example Gray’s (2007) study on the portrayal of breast cancer narrative on a U.S. television drama, reflected unexploited openings to convey positive health messages, gendered assumptions about healthcare providers, or poor depictions of surviving breast cancer. Similarly, Quick’s (2009) study of another medically oriented U.S. television drama reflected cultivation effects on patients’ reading of healthcare providers as portrayed on television as dependable. Additionally, Signorielli (1993) adds that health portrayals on the medium attributed disease to individual level behavioral choices, as opposed larger structural barriers concerning the political, social, and economic circumstances (Wallack, 1990).
A summary of the various studies on health and media are explained in the next section of the article, covering specifically the areas of tobacco use, obesity and nutrition, body image, and various forms of health beliefs. Because television violence is itself an extensive body of literature, that literature will not be covered here, although it may be argued that violence is a direct threat to health.
Tobacco Use and Media Exposure
Tobacco use is a well-documented cause of a multitude of diseases, and has been a public health concern for decades (U.S. Department of Health and Human Services, 2012a). Although smoking rates have decreased over the years, in part due to increased prices of cigarettes and policy restrictions, the numbers still have not met targets set by public health departments across nation states (Centers for Disease Control and Prevention, 2015). In addition, there has been an increase in smoking among youth and adolescents (Nan & Zhao, 2016). Curbing the rates of smoking initiation, especially among youth and adolescents, has been an important public health strategy to reduce the negative health outcomes associated with smoking. The media play key roles in influencing the likelihood of tobacco use, in both direct and indirect ways, through exposure to smoking behavior on the media, its portrayal of smoking, and portrayal of social approval or disapproval of smoking (Gidwani, Sobol, DeJong, Perrin, & Gortmaker, 2002; Sidney et al., 1996; Villanti, Boulay, & Juon, 2011; Wakefield, Flay, Nichter, & Giovino, 2003). Recognizing the relationship between media use and smoking behavior, the U.S. government introduced a ban on cigarette advertising on television and radio in 1971, which paved the way for restrictions on tobacco marketing and advertising that target children (Centers for Disease Control and Prevention, 2007). Since then, portrayal of tobacco use on television has been on the decline. In a study on substance use on prime-time television shows popular among teens and adults in the United States, it was found that relatively few (19%) of the episodes featured tobacco use, and 23% of these were negative portrayals about smoking (Christenson, Henriksen, & Roberts, 2000; Jamieson & Romer, 2014). However, tobacco use is still prevalent in other media forms such as movies, and was seen to be on the rise since 2002, after a decline in the 1950s (Charlesworth & Glantz, 2005).
A number of studies have used cultivation theory to test the effect of television or media exposure on an individual’s smoking intention or behavior. Cultivation theory posits that frequent or excessive media exposure (e.g., television, movies, and/or print media) will shape viewers’ perceptions of smoking behavior and smokers to reflect media depictions, but not necessarily the reality (Gidwani et al., 2002; Shanahan & Morgan, 1999). For example, one concern is that viewers might think that smoking is common and acceptable in society. Nan (2011) found that higher levels of television viewing were significantly associated with higher estimates of smoking prevalence among peers. In an earlier study, Shanahan, Scheufele, Yang, and Hizi (2004) hypothesized that heavy viewers of television would underestimate smoking levels in society as the depictions of smoking on television are lower than in reality. However, their findings suggested that heavy television viewers actually overestimated the prevalence of smoking, contrary to what was hypothesized by cultivation theory (Shanahan et al., 2004). One explanation put forth by the authors is that viewers do not actually form perceptions of the prevalence of smokers according to what they see on TV, debunking cultivation theory. Another possibility is that the steady increase of anti-smoking messages on TV over the years might have influenced viewers to believe that smoking is a common problem in society. Yet another concern is that media portrayals of smoking as attractive and glamorous would encourage smoking behavior. Nan (2011)’s study concluded that adolescents who are heavy viewers of television were also significantly more likely to have a positive perception of smokers, perceiving them to be popular, attractive, cool, and daring. Exposure to cigarette advertisements and movie scenes that depicted smoking were shown to have a positive relationship with adolescents’ perceived approval of smoking among peers (Nan & Zhao, 2016).
There have also been a number of studies that demonstrated the association between portrayals of smoking in the media and actual smoking among adolescents (Charlesworth & Glantz, 2005; Sargent et al., 2005). Findings from a study on peer, parent, and media influences on youths indicated that high levels of exposure to cigarette advertising in movies, TV, or billboards, was significantly and positively associated with smoking among adolescents, and also with previous smoking habits (Villanti et al., 2011). Similarly, Cin, Stoolmiller, and Sargent (2012) concluded that viewing smoking in movies was significantly correlated to experimenting with cigarettes, but no significant relationship was established with forming a permanent smoking habit.
These studies demonstrate that the relationship between media use and smoking is often a complex one. Among researchers, there appears to be a keen recognition that behavioral processes are complex and can be influenced or mediated by multiple factors other than media use, such as peer pressure, social norms, and an individual’s personality traits. As a result, health communication scholars are also increasingly using cultivation theory in combination with other theories to take into account other important contextual factors. For instance, Yang, Salmon, Pang, and Cheng (2015) used a modified cultivation theory, combining social learning theory and social norms theory to examine how peer influence moderated the relationship between media exposure and youth’s intention to smoke. The effects of media exposure on youth’s intention to smoke were not significant (Yang et al., 2015). However, the findings were significant in showing that media exposure could indirectly increase intention to smoke if the adolescent perceives that smoking is prevalent among his/her peers, and provided her/his friends do not disapprove of smoking (Yang et al., 2015). Therefore, the relationship between media use and smoking is mediated by norms within an adolescent’s social circle. Overall, cultivation theory in its various iterations has had a major influence on our understanding of how smoking portrayals in the media impact viewers. Today, much of the media research on smoking has moved toward the effectiveness of anti-smoking campaign messages on smoking cessation.
Obesity, Nutrition, and Television
Obesity, a growing problem in developed and industrialized countries, is increasingly receiving public attention as a major health issue, as it is a risk factor for chronic illnesses such as diabetes, cardiovascular disease, and hypertension (Ogden et al., 2006; U.S. Department of Health and Human Services, 2012b). Media, according to cultivation theory, are avenues that can influence the beliefs and norms that viewers form about the real world (Gerbner et al., 1994; Shanahan & Morgan, 1999). Media scholars have paid attention to the medium of television in particular, as statistics show that American youths spend more than 18 hours watching television in a typical week (Russell & Buhrau, 2015). Watching television is the number one leisure activity, with the average American spending approximately 2.8 hours per day on television (United States Department of Labor, 2015). In addition, commercial advertising on food dominates more and more of television screen time, and 89% of these advertisements are for fast food or unhealthy food products that are high in sugar or fat (Bell, Cassady, Culp, & Alcalay, 2009; Harrison & Marske, 2005; Russell & Buhrau, 2015).
Understandably, health communication scholars are especially concerned about the effect of the content of television programming on children, as they are more susceptible to influence, especially from persuasive advertising (Chernin, 2008). They also spend more time watching television than on any other activity. In a study conducted with elementary school students in the United States, Signorielli and Lears (1992) found that there was a statistically significant relationship between television viewing and unhealthy eating patterns among children. Children who watched more television were more likely to have unhealthy diets, such as eating cereals high in sugar, chips, sweets, or fast food. This finding is supported by other similar studies that have demonstrated the relationship with high exposure to television and consumption of junk food (e.g., Dixon, Scully, Wakefield, White, & Crawford, 2007). There was also a statistically significant relationship, albeit less strong, between television viewing and having an incorrect understanding of food and nutrition. For instance, a child that watches more television is more likely to incorrectly describe a healthy breakfast or might perceive fast food to be as healthy as a home-cooked meal, compared to a child who watches less television. This relationship was observed across all demographic groups, including boys, girls, whites, and non-whites (Signorielli & Lears, 1992).
A later study by Signorielli and Staples (1997) reinforced these findings. The researchers found that although the children in the study generally appeared to know what was healthy, minority children were statistically more likely to mistake the unhealthy food as the healthier option compared to white children: for example, ice-cream versus yogurt. In terms of healthy eating, high television viewing was similarly statistically more likely to have a positive relationship with a child’s preference for the less healthy option. Here, boys and minority children were more likely to choose the unhealthy option, compared to girls and white children respectively. Although the results seem to point toward a relationship between minority status and poor nutrition or knowledge of nutrition, the overall results in fact showed that high television viewing was the only significant predictor. This confirms findings by Goldberg, Gorn, and Gibson (1978), which also found a relationship between children’s food preferences for snacks and breakfast foods and their television exposure.
In terms of fast food consumption, Russell and Buhrau (2015) found substantive evidence that youths with higher levels of television viewing were more likely to overestimate the positive effects of eating fast food and underestimate the negative health consequences of eating fast food. However, this effect is more pronounced for those who had little direct experience with actually eating fast food, meaning that most of their views of the health consequences of eating fast food were based on TV portrayals and not on personal experience (Russell & Buhrau, 2015). Similarly, high exposure to television and commercial programs were associated with adolescents’ positive attitudes toward unhealthy snacks, perception that consuming junk food is normal among other children, decreased consumption of fruits and vegetables, and higher consumption of junk food (Boynton-Jarrett, Thomas, Peterson, Wiecha, Sobol, & Gortmaker, 2003; Dixon et al., 2007; Taras, Sallis, Patterson, Nader, & Nelson, 1989).
Cultivation theory has had a major impact on the study of how media messages affect behaviors and corresponding perceptions of diet and nutrition, especially among adolescents. In fact, there are many medical and public health researchers who have attempted to establish the relationship between television viewing and dietary choices and preferences, even without using cultivation theory explicitly (e.g. Utter, Scragg, & Schaaf, 2006; Vereecken, Todd, Roberts, Mulvihill, & Maes, 2006). Similar to the research on smoking, there is a growing body of research that documents the effects of pro-nutrition messages in the media on eating preferences and choices, and on perceptions of healthy food.
Body Dissatisfaction and the Media
According to the National Eating Disorder Association (2016), more than 20 million women and 10 million men in the United States are struggling with some form of eating disorder, such as anorexia nervosa or bulimia. Beyond patients who are clinically diagnosed, some studies have estimated that between 40% and 60% of young girls and women are unhappy with their physical appearance (Stice & Shaw, 1994). The most common contributing factor to the development of an eating disorder is body dissatisfaction (Stice, 2002). Research has shown that the media play significant roles in shaping society’s perception of an ideal body type, especially among women, and they are key players in perpetuating a standard of thinness that does not correspond with the average woman (Byrd-Bredbenner, 2003; Harrison, 2003a; Myers & Biocca, 1992; Strasburger, Jordan, & Donnerstein, 2010). This occurs across various media forms including print media, television, and increasingly, new media, such as video games. For instance, Greenberg, Eastin, Hofschire, Lachlan, and Brownell (2003) found that 33% of women in the ten most popular American prime-time television shows were underweight, while only 5% of American women were underweight in real life. There is also a rising ideal of the “curvaceous thin,” which refers to a woman with a large bust, small waist, and narrow hips, proportions which are actually very difficult to achieve through natural means (Harrison, 2003b).
In turn, it is argued that audiences tend to internalize and normalize such standards of thinness, leading to greater social pressure to achieve the idealized body type as portrayed in the media (Botta, 1999). According to cultivation theory, those with higher media exposure will be more likely to have perceptions of body size that reflect what they see in the media, but are actually incongruent with the body size of the average woman (Hesse-Biber, Leavy, Quinn, & Zoino, 2006; Shanahan & Morgan, 1999). Such perceptions breed body dissatisfaction and, in serious cases, cause health calamities such as eating disorders or mental health problems. A meta-theoretical piece also reported that women who have higher media exposure are more likely to place importance on being thin, have body dissatisfaction, have minor or major eating disorders, and may even undergo cosmetic surgery to change their bodies to fit the “ideal” body type seen in the media (Hesse-Biber et al., 2006).
One of the earliest studies on this issue, conducted by Tan (1979), sought to understand the effect of TV beauty commercials on the perceived importance of physical attractiveness, youthfulness, and sexiness on various life roles among women. These roles included “success in career or job,” “success as a wife,” “to be popular (or liked by men),” and “for you, personally, to be desirable as a woman” (Tan, 1979, p. 285). The findings of the experimental study showed that women who were exposed to beauty commercials were significantly more likely to attach more importance to being beautiful in order to be popular with men, compared to women in the control group who were shown commercials that were neutral (Tan, 1979). The differences between the experimental and control groups were not significant for the roles related to career and marriage, and this was attributed to current social norms and values that were starting to downplay the role of beauty in these social roles (Tan, 1979). Although the findings were for short-term exposure in a laboratory setting, and did not speak to the additive effects of media exposure as posited in cultivation theory, Tan (1979) argued that these effects would be even more pronounced with long-term exposure. Among children, the findings from a longitudinal panel study by Martins and Harrison (2012) concluded that high television exposure was significantly associated with a lower self-esteem among white girls and black girls and boys. Interestingly, the study discovered that white boys’ self-esteem actually increased with higher television exposure. This was explained by the typically positive portrayal of white males on television as dominant and strong, versus white females and black males and females who are portrayed more negatively (Martins & Harrison, 2012).
Eisend and Möller (2007) linked cultivation theory, theories of self-concept, and gender theory to explore how television viewing would impact both male and female body images and their patterns of consumption. The study found that high television viewing was significantly associated with body dissatisfaction and with skewed perceptions of ideal body types in both males and females (Eisend & Möller, 2007). In another study proposing a new process model integrating cultivation theory, social cognitive theory, and peer and parent influences, Kinally and Van Vonderen (2014) found that viewing reality TV that promoted the “thin-ideal” and social influences from peers and family directly influenced the importance placed on thinness in the social setting by the subject. However, there was indirect relationship between media exposure to the “thin ideal” of reality TV and the internalization of thinness as the ideal and body dissatisfaction, indicating that there are other mediating factors at play that affect an individual’s perception of themselves (Kinally & Van Vonderen, 2014). In other words, a heavy viewer of such reality TV shows may perceive that being thin is important in his/her social world, but this alone may not lead her/him to feel dissatisfied with her/his physical appearance.
Media scholars have argued that there is a greater need for additional research in the media effects literature on the impact of television portrayals of ideal female body types on body dissatisfaction among women (Hendriks, 2002). This remains true today. In recent times, there has been more attention devoted to the portrayal of female bodies in new media forms such as video games and social media, and how these impact body satisfaction or dissatisfaction. For instance, Martins, Williams, Harrison, and Ratan (2009) conducted a content analysis of 150 video games, which revealed important implications for the future of cultivation research. The findings of Martins et al. (2009) challenge assumptions in cultivation theory that mass media forms portray consistent images and messages, as the portrayal of female bodies in video games were not homogenous and did not follow a set pattern. This is an important theoretical consideration for cultivation research looking at new media platforms, which may differ significantly from traditional media.
Media and the Construction of Health Beliefs
A relatively new area of cultivation research looks at the relationship between media exposure and the construction of health beliefs among viewers. According to cultivation theory, this cultivates perceptions of health risks that do not reflect current medical knowledge (Wåhlberg & Sjöberg, 2000; Shanahan & Morgan, 1999). In particular, researchers are interested in the perceptions of risk and health outcomes, and the shaping of fatalistic health beliefs about diseases, such as feelings of helplessness or pessimism about preventing a disease (Niederdeppe, Fowler, Goldstein, & Pribble, 2010). Media research suggests that health issues such as cancer are often covered in the news in a way that does not provide a holistic and accurate picture of the disease, such as not providing context to new and controversial claims, or not providing follow-up or prevention information (Russell, 1999; Taubes, 1995). A content analysis of local TV news coverage of cancer revealed that local TV news was more likely to contain stories about causes of cancer, ranging from well-established causes to more unusual and contentious causes, compared to local newspaper stories (Niederdeppe et al., 2010). Given that many chronic diseases are preventable through lifestyle changes, the construction of fatalistic health beliefs represents a threat to public health initiatives that promote healthy behaviors as a preventative measure.
One key issue being researched at the moment investigates the relationship between media exposure and the formation of fatalistic beliefs about cancer prevention. Niederdeppe et al. (2010) sought to understand the effect of higher levels of local TV news viewing on the likelihood of having fatalistic beliefs about cancer prevention. Subjects with fatalistic views were more likely to agree with the following statements: “It seems like almost everything causes cancer,” “There are so many recommendations about preventing cancer, it’s hard to know which ones to follow,” and “There’s not much people can do to lower their chances of getting cancer” (Niederdeppe et al., 2010, p. 241). Lee and Niederdeppe (2011) also made similar conclusions from a two-wave longitudinal study, which found that the cultivation effect was present only for local TV news and not for national TV, which provides support for a common criticism that more attention needs to be paid to the differences in cultivation effects between genres of TV content. In contrast, Hetsroni (2014) found no significant cultivation effect between watching medical dramas and viewers’ overestimation of dramatic health diagnoses and death rates of common diseases, which are typically seen in television programs but do not correspond to the numbers in real life. However, there was a significant cultivation effect of local news, backing up the original premise of cultivation theory (Hetsroni, 2014).
Besides news coverage, media researchers are increasingly looking toward medical dramas as a potential source of influence on health beliefs and perceptions of health risks or recovery. Chung (2014) investigated the relationship between high viewership of medical dramas and health beliefs and established that subjects who spent more time watching medical dramas were also more likely to have a poorer understanding of the severity of chronic diseases. Heavy viewers were also less likely to identify cancer and heart disease as serious health problems in society (Chung, 2014). This was attributed to the content of medical dramas, which may provide inaccurate representations of the disease. Similar to Niederdeppe et al. (2010)’s findings, Chung (2014) discovered a significant relationship with heavy viewership of medical dramas and fatalistic views about cancer.
Directions for Future Research
The studies reviewed in this article document the various health effects of heavy media consumption, with an emphasis on examining the ways in which social realities mediatized on television are reflected in the perceptions of heavy viewers. In the realm of health, media (including television and print) not only cultivate normative perceptions around behaviors such as smoking and eating unhealthy foods, they also shape behaviors over the long run. Increasingly, health communication scholars point to the mediating and moderating role of other variables such as peer norms, parental influences, and the messaging received in the school environment. In this section, we highlight some of the key directions for future research in cultivation theory in the realm of health communication.
One of the critiques of cultivation theory is its decontextualized approach, without accounting for the cultural contexts within which media consumption takes place (Dutta, 2005). Increasingly, as health communication scholars highlight the role of culture in constituting the reception and response to mediated messages, it is worth exploring the ways in which culture shapes the processes of cultivation, the reception of mediated messages, the negotiation of these messages, and the negotiation of agency in responding to these messages. For instance, how do cultural contexts differ in the ways in which they constitute the reception of mass media messages? Do mediated cultural messages from different contexts have different effects, or are the effects similar? The individualized study of cultivation effects, primarily through individually based self reports, does not account for the everyday contexts of television consumption across cultures. It might be argued, for instance, that communitarian cultures with strong community ties provide adequate communicative resources that counter the influence of the mass media, with the community serving as a storytelling resource. At the same time, cultural codes and norms are increasingly subjected to the influences of homogeneous mass media globally, driven by dominant global structures embedded in the neoliberal ideology of individualization, consumerism, and market-based participation. How then do cultures respond to the cultivation effects of global media industries?
Also worth exploring here are the norms around health behaviors situated at the intersections of cultural values and values represented in global mass media. For instance, how do collective cultures respond to the individualistic messages of individual responsibility reiterated in U.S.-driven global mass media? Future research on cultivation might explore the ways in which cultivation effects differ across cultures, as well as the ways in which cultivation effects impact cultural values and norms. This is particularly salient in health domains. For instance, how do Asian cultures, many of which emphasize collectivism and filial piety, respond to health-based entertainment content on Hollywood shows that foreground individualism, privacy, and individual-level decision-making? Are all messages cultivated equally among heavy viewers? Do some messages have greater effects among certain cultures compared to other messages? What are the intersections among cultural values and mass media messages? Serious attention to the question of culture in cultivation effects creates openings for exploring the nuances in cultural reception and resistance to mass media messages. Moreover, the study of the reception of television content treats the communicative process of watching television as an individualized activity, ignoring the varieties of relational contexts in which television is watched (Dutta, 2005).
Role of Community
What is the role of the community as a normative space for circulating beliefs, attitudes, and behaviors? The examination of subjective norms in cultivation research needs to be complemented by examination of community norms and community structures. How do communities with pluralistic structures, for instance, respond to mass media messages, and how do they differ from more monolithic community structures where there is a greater pressure on agreement to community norms? Moreover, community norms converge and diverge from mass media norms, depending upon the context. To what extent are community norms convergent with the images and values presented on the media? What role does community play in shaping the influence of media portrayals on individual perceptions, beliefs, and behaviors? The role of the community is particularly salient in cultures where community norms exist in direct opposition to the norms that are presented and circulated on the media. Communities, for instance, offer repositories for challenging the codes and narratives presented in the media. The unhealthy foods presented on television are countered in some instances by community-based movements seeking to improve the quality of food within health systems. Similarly, community norms around exercising and playing outdoors might counter the very sedentary lifestyles that are integral to heavy consumption of media. Communities offer both resources and scripts for enacting health behaviors that interact with the narratives presented on the media.
Structures of Media Ownership
The evidence that long terms exposure to unhealthy media content cultivates unhealthy beliefs, attitudes, and behaviors offers an entry point for closely examining the ideologies that are present in media content and the broader structures of power that are served by these ideologies. Marking and highlighting these ideologies and the overarching power structures that constitute these ideologies serve as anchors for developing communication strategies of transformation that counter the unhealthy or health threatening messages. This is particularly salient in the context of unequal burdens of health risks that are borne globally and the unhealthy lifestyles that are directed at the global margins through the mass media. Attending to patterns of media ownership and situating health messaging on media within these media ownership structures offers a framework for tracing the ideologies of market and consumerism that are promoted through the mass media. Also attending to the structures of ownership, which are mostly privatized and are transnational in nature, creates openings for creatively developing policies and solutions that are health promoting. Situating cultivation effects structurally thus is critical to the development of health promoting solutions, particularly so in a mass media environment that has been entirely privatized and commoditized. For instance, understanding the advertising driven model of media revenues offers a framework for developing regulatory solutions directed at advertising strategies. One such solution that emerges from close interrogation of media structures is the development of community radio and television programs that are run by communities and retain sovereignty in the hands of communities. Similarly, exploring the role of independent television in promoting health offers another avenue for rethinking structures. With the emergence of new media, health communicators may explore strategies for cultivating positive health behaviors without being limited by the private ownership structures of traditional mass media.
Transforming Unhealthy Portrayals
As increasingly demonstrated by a growing body of health communication scholarship, scholars are gradually turning their attention to drawing on the findings of cultivation to create messages that directly interrupt the health threatening messages of the mainstream media. For instance, creating anti-tobacco messages offers direct avenues for challenging the messages of coolness and desirability around smoking circulated in mainstream media. Similarly, creating positive messages about healthy eating counter the messages on mainstream media promoting unhealthy foods. Greater research is needed in this area of health promotion through cultivation on mainstream media, documenting the strategies of health promotion that are salient to countering the unhealthy effects of media messages, and encouraging positive health behaviors instead. Similarly, health communication scholarship in the future may explore the ways in which easily affordable social media may be leveraged to counter the negative mass media effects on health. The development of specific community-grounded strategies of health promotion might offer avenues for challenging the perceptions and beliefs circulated on mainstream media.
The structures of mediated institutions cultivate beliefs, attitudes, and values in their audiences. Studies of cultivation effects, mostly focused on documenting effects at the individual level, need to pay more attention to the structures that constitute media and shape the flows of images. Moreover, further research might explore the relationship between health information, resonance with media content, and cultivation effects. In the realm of health communication, television has been coined by communication scholars as a passive, health reducing, and entertainment oriented medium (Dutta-Bergman, 2004). Dutta (2007), in an attempt to understand individual level differences in learning positive health behaviors from entertainment oriented education content on television, reported that health oriented individuals were learning from multiple and diverse health content on television, compared to those who were not health oriented. Future studies on cultivation theory and health can explore the ways in which resonance (lived experiences with health issues illness), heavy viewership of health reducing media, and cultivation effects capture the effects of television on health information processing.
Another central question asked by scholars today is if cultivation continues to be applicable with the emergence of new media (Morgan et al., 2015; Potter, 2014). Media content is diverse and is disseminated to fragmented audiences, changing the ritualistic practices of once a collective, shared television watching experience (Morgan et al., 2015). With far more options for audience members today to customize the content they watch on platforms such as YouTube, Netflix, and other Internet mediums, how do the effects of cultivation change? Will cultivation remain relevant in the new media context?
Research on media exposure and the construction of health beliefs and perceptions is still a relatively new and unexplored topic, presenting an opportunity for health communication scholars to tap into. The current state of research suggests that there is still some variance in the findings, especially with regards to the cultivation effects of television versus genre-specific programs. Furthermore, health beliefs and perceptions are mediated by multiple factors, such as peer influence, personal experience, physician-patient interactions, or education level. As mentioned earlier, cultivation scholars are now starting to incorporate these new variables and relevant theoretical frameworks in their studies to develop new insights on cultivation effects today. Moreover, increasingly, health communication scholars point toward the defining role of context in the realm of media exposure and health beliefs. Cultural context offers yet another avenue for future exploration documenting the relationship between media exposure and a variety of health outcomes.
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