Background

In Minnesota, over a quarter of Black youth report depressive symptoms; thus, it is unsurprising that Black residents in Minneapolis, Minnesota, highlight that mental health is one of their top health-related concerns. Despite this reality, little is known about how current local media narratives present the intersecting themes of Black youth and mental health. 

Stigma refers to negatively valued attributes, depersonalization, and negative attitudes or behaviors directed at or assigned to social identities, which are reinforced in systems of power.

One way stigma can be reinforced is through the news media. Local news is particularly important for communicating norms, values, and community cohesion.

In this study, we utilize the model of stigma communication (MSC) as a conceptual framework, which argues that stigmatizing messages contain labels, marks, accusations of responsibility, and emphasis on peril that stigmatize groups. Stigmatized group members may employ different coping strategies to cope with various media portrayals of their group. We, therefore, aimed to understand how local news was portraying Black youth and mental health, as well as, how the youth cope with such portrayals.

The study 

Phase 1: The media scan examined how Black youth are represented in local news programs using news coverage aired between July 1 and December 31, 2023, on Minneapolis’s four major television networks. Our final sample (n = 60) excluded stories that were not specific to Minnesota and were not about either youth or the Black community specifically. The coding scheme included variables that assessed how Black youth are framed in local TV news program clips and included considerations for context (e.g., specific locations and mental health conditions), content (e.g., story topic, groups represented, source/voice, etc.), and narrative tone (e.g., tone valence and framing of characters).

Phase 2: Four focus groups were conducted. Participants who identified as Black, were aged 13 to 19 years old, proficient in English, and resided in the Minneapolis metro region were included (n = 21). During each focus group, participants were asked questions covering the following four topics: 1) representation of Black youth and mental health, 2) reactions to the representation, 3) coping with stigmatizing representation, and 4) recommendations for changing representation. These questions served as discussion topics. Participants also built on each other’s answers and occasionally asked questions of the group.

Key findings 

Media Scan: Only six stories were specifically about Black youth and mental health. Within the six stories, five were characterized as negative and only one presented a positive angle. All six clips mentioned crime, and the other five clips did not provide any potential remedy or community resources for coping with conditions like trauma. We identified labels (n = 5; e.g., juvenile, bully) and marks of crime (n = 6) in the six video clips.

Although the Black youth with mental health conditions were not always portrayed as perpetrators of a crime, when they were portrayed as perpetrators, the news stories often suggested that the individuals were dangerous and responsible for their situation. Although the number of stories analyzed is limited, they suggest an intersection of stigma, such that Black youth with mental health conditions are presented as dangerous while Black youth who experience perilous community events are likely to develop mental health conditions.

Focus Groups:

Representation: Participants across the focus groups affirmed the intersectional and compounding stigma of being both a Black youth and someone with a mental health condition represented in the local news. They were frustrated with the labels used in the news (e.g., “juvenile” or “thugs”) and the criminality associated with Black youth. Participants with friends whose deaths were publicized on the local news highlighted their discontent with the misrepresentation of their stories. They noticed that systemic disparities related to mental health conditions in their social circles were overlooked in news stories with emphasis on criminality, police brutality, or drug use instead.

Reactions to the media: Participants highlighted that news representations of Black youth and mental health influenced how they talked about mental health in their communities and how they felt perceived by society at large. They noted that these conversations and perceptions are often stigmatizing. The most common factor associated with stigma toward mental health within their community stems from cultural differences. Participants argued that older generations (i.e., parents or grandparents) and family members who were raised in different cultures (e.g., Kenyan) do not share the vocabulary to talk about mental health. The news was interpreted as a source that promotes narratives that perpetuate stereotypes. They noted that stories about Black individuals often reinforce stereotypes and intensify stigma around mental health and seeking help in the Black community.

Coping: On an individual level, some participants noted hiding mental illness symptoms to maintain a positive perception, particularly from their parents. Others, however, ignored the stigma surrounding mental health conditions and proudly displayed their mental health statuses. School counselors, community information booths, and social media were mentioned as resources that helped them learn and cope with their mental health challenges. When among the general public, participants suggested that they practice more avoidance or concealing coping mechanisms because they felt stigma associated with their identity as a Black youth was perceived as more dangerous and would not allow for empathy for their mental health condition.

Recommendations for narrative change: Most of the participants noted that they themselves rarely watch local TV news. Some argued that journalists may need to use different media vehicles (e.g., social media platforms) to reach a younger audience. Other participants nonetheless advocated for local TV news stories that would increase individual understanding of mental health and close the mental health knowledge gap between them and their parents since the older generation is attuned to this local programming. Overwhelmingly, participants argued that the media should highlight celebratory community gatherings and relate the events to examples of mental well-being.  

Implications/importance

Our results highlight major disparities in news coverage as well as significant opportunities for improvement in news narratives about mental health and Black youth.

We found that the limited stories about Black youth and mental health followed the expected misrepresentation pattern, as the news stories were all focused on crime. We also suspect that the observed underrepresentation of stories, coupled with the youth in this study expressing that mental health concerns are rarely discussed in their community circles, may signify that local news media may reinforce the default that mental health is not a topic of concern for the Black community. 

It was clear from the conversations that parents and guardians are adamant about providing safety and shelter to their youth but may not have the language or cultural understanding to effectively talk about mental health. Future research should seek to understand what models for news production allow for positive messages that can be presented to Black guardians across various ethnicities and generations to promote mental health knowledge, encourage parent-child communication, and other mental wellness behaviors.

Read more related work from the COMM team:

• On building narrative infrastructure for health and racial equity
• On the importance of dreaming about and mobilizing to create equitable futures
• On centering historically minoritized populations in messages about policy to advance equity
• A review of strategic messaging approaches to promote policies that advance racial equity

This research was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation. 

Background

The COMM HSP team was founded with a clear purpose: to track how media narratives on topics relevant to racial justice and health equity impact communities most harmed by inequitable structures, through shaping public opinion and policy perceptions. From the beginning, we were clear that we must look beyond the halls of academia to learn how we can do this. We needed imaginative partnerships with community-based organizations that would challenge us to think creatively about research questions that are rapidly responsive to the needs of practitioners on the frontlines. Organizations like CHP (a people-powered, multi-racial, member-led organization in Colorado) organize working-class communities to challenge inequitable structures of the healthcare system that put corporate profit over the wellbeing of ordinary people. 

The study 

Building narrative power is a foundational strategy used in community organizing. It involves both dismantling dominant narratives that uphold inequity and constructing counternarratives that advance health and racial justice by reshaping how people make sense of the world. Unfortunately, the pathways through which narrative power can influence public attitudes (and ultimately health policy change) are rarely evaluated with empirical research.

Over the course of two years, our core study team of COMM HSP researchers and CHP organizers designed a unique three-phase study to explore how narrative power can disrupt deeply entrenched myths about the U.S. healthcare system – and motivate people to take collective action to change it. But rather than relying on traditional message-testing methods, our team took a different approach. We began by building relationships between the research team and CHP staff and organizers/community leaders, to ensure our project remained anchored in CHP’s vision to develop member-led narrative frameworks about health equity and healthcare. As outlined in the article, this collaboration shaped each stage of our project:

• Centering CHP voices. Using a co-created interview guide, we conducted interviews with 7 community leaders on CHP’s narrative organizing committee, to surface their reflections on the healthcare system – with attention to how soaring costs and complexity have impacted the wellbeing of their families and communities.
• Co-designing counternarratives. Pairing the wisdom of CHP leaders shared in interviews with the foundational principles of the Race-Class Narrative (RCN) framework used often in organizing practice, we co-designed two distinct counternarratives – one focused on healthcare unaffordability and the other on system complexity – to test against a constructed “dominant narrative.” The dominant narrative was based on a review of health care corporate communication and was grounded in CHP leaders’ perspectives on the prevailing narratives about healthcare most harmful to their community.
• Testing what matters. Finally, we built a survey experiment to test the effects of these counternarratives (vs. the dominant narrative) on outcomes that truly matter to organizers: for example, whether counternarratives can shift public perceptions of blame for poor outcomes, and inspire people to take collective action to fix the system. See Figure 1 for a schemata of the randomized experiment study design.

Figure 1

Key findings 

Dominant narratives suppress action intentions. Affirming what organizers know and see in their everyday lives, we found that exposure to dominant narratives that “individualize” blame for poor health dampened participants’ motivation to engage in social justice behaviors or collective action. 

Counternarratives shift blame attributions. In our survey, exposure to counternarratives generated by CHP leaders successfully increased participants’ perception of blame attributed to powerful institutions, including the medical industry and the federal government (see Figure 2). 

Figure 2

Potential working-class mobilization: The unaffordability counternarrative was particularly potent for survey participants earning below the national median income, suggesting that such narratives may help build the working-class power needed to usher in healthcare system transformation.

Bipartisan resonance: Notably, despite a deeply polarized political climate concerning health policy, these narrative shifts occurred across the board. The narratives grounded in the lived experience of organizers resonated with Democrats, Republicans, and Independents alike. 

Implications / importance

In our partnership, we leveraged a research framework to test what community organizers do so effectively – expose how dominant narratives in a particular policy arena (such as health care) may constrain political possibilities, and seed resonant counternarratives that can mobilize coalitions and create opportunities for political change. 

The findings from this project – particularly those related to shifting blame attributions, which is an important part of strengthening analysis of the healthcare system and in leadership development – were immediately put into practice among CHP organizers. In one-to-ones (relational conversations designed to help identify one’s personal stake, values, and inclinations to organize), CHP organizers are more intentionally looking for indicators that people attribute their challenges to structural problems. This has become an important metric in evaluating CHP leaders’ development as they progress through the organization. Organizers also integrate these learnings in other relational tools, such as agitational conversations that support people to move beyond internalized beliefs.

Beyond the findings outlined above and in the full manuscript, we also offer a partnership model for health researchers and community organizers to consider. Organizers are key partners in pursuing empirical research to inform narrative strategy. Through these collaborations, researchers can deepen their research questions and anchor their methodology in the experience and stories of people most impacted by the harms of the health system. Importantly, by partnering with power-building organizations, health researchers can pursue projects that are truly responsive to people’s material conditions. In today’s rapidly shifting federal landscape – as public health research dedicated to health equity faces mounting political threats – building deep, relational alliances with community organizers offers a critical pathway for mutual support for continuing and deepening health justice work. 

Read more related work from the COMM team:

• On building narrative infrastructure for health and racial equity
• On the importance of dreaming about and mobilizing to create equitable futures
• On centering historically minoritized populations in messages about policy to advance equity
• A review of strategic messaging approaches to promote policies that advance racial equity

This research was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation. 

In this blog post, they reflect on their experience studying communication and health equity. The researchers interviewed here have engaged in a host of projects: analyzing the strategies communicators use to discuss health equity in practice; assessing news media coverage of topics including homelessness, Native people, Black youth mental health, and doulas; reviewing the literature on news media coverage of the social safety net; studying racialized and anti-trans messages in political campaign advertisements; partnering with community organizers to evaluate narrative strategy; investigating the politicization of public health, and more. This blog post serves as a reminder that the Collaborative on Media and Messaging for Health and Social Policy is not just a research team, but has also been an opportunity to train the future research workforce to engage in innovative, rapidly responsive and community-engaged communication research to meet today’s challenges. Below, they share their voices.

Q: The political landscape around health equity and communication has never been so fraught. How has this landscape impacted the research you’ve supported within COMM HSP?

Kene: The current political landscape has served as fuel and motivation for my future work. In one current project, where I am analyzing news media coverage of doulas contextualized within the maternal health crisis, I feel even more of a responsibility to accurately capture and document the mechanisms of racism. Literature and critical theories tell us that remaining colorblind is detrimental to population health. While the current administration has brought unique challenges to the work, unfortunately many impacted communities have faced far worse. It is evident that the need for health equity work is even more dire, and we cannot give up because health equity is no longer “trendy.” As a self-identifying scholar-activist, I encourage other scholars and practitioners interested in health equity to remain critical, get creative, and keep doing the work – because it is needed. 

CeRon: My commitment to community-engaged and policy-relevant research was further shaped through my work with COMM HSP, particularly amid an increasingly polarized political landscape around health equity, media, and messaging. This work examines health disparities and inequities alongside the powerful role media and messaging play in shaping health and social policy across the life course. At a time when health equity research is often politicized or contested, this work has underscored the importance of using rigorous qualitative, quantitative, and mixed-methods approaches to document inequities and elevate evidence-based narratives. By identifying underrepresented groups most affected by structural and communicative barriers to care, this research informs strategies to reduce inequities among at-risk populations. For example, by examining how intersecting social positions (e.g., being Black and young) shape media representations of mental health experiences in local television news, this work highlights how political and media environments can either reinforce or challenge stigma. These findings have implications for improving inclusive and culturally responsive communication practices and for informing political initiatives aimed at dismantling institutional barriers that disproportionately impact marginalized communities. More broadly, this experience has reinforced my understanding that media and public opinion are not neutral forces; they shape policy priorities and other political determinants of health. As a result, my future work remains firmly grounded in community-based participatory research and in centering the voices and experiences of underrepresented communities, especially in politically fraught contexts where those voices are most at risk of being sidelined.

Ben: Health equity work is political—a reality the current moment has brought into sharp relief. This is true for my current project which analyzes anti-trans narratives in political advertising from a health equity perspective. It is also true for the many interconnected fields of research that compose COMM HSP: racism, health communication, and community organizing, to name a few. As the longstanding material scarcities affecting this work intensify, I am grateful for the members of this team who have modeled the critical work I aspire to and support me in speaking my mind. 

Q: Moving forward, where should the field focus its energy to advance health equity through communication?

Quin: The political moment we live in may have impacted funding, stability, and the overall vibes around health equity and communication research right now – but certainly not my dedication to the work. Regardless of what the government decides to say or do, the work will get done by passionate people who care deeply about health equity and how we talk about it. I’m still invested – even when others (be they funders, journals, or reporters) are moving along. That’s fine! The way I see it, one of academia’s weaknesses has become one of our strengths at this time: our inability to quickly mold ourselves and adapt to the current moment. I say this because it would be very easy to “give in” right now…to solely follow the money, to stop researching things we care about, to stop speaking out against injustice both related and unrelated to our areas of study. While funding is important, so are our principles. Those willing to stand resiliently and say that health equity is still necessary when it isn’t “in fashion” are communicating clearly where they stand – and that strength is something we will need once we maneuver out of this chaotic time in American politics. 

Yusra: As conditions continue intensifying around us, and more and more scholars, community organizers, and journalists find themselves navigating increasingly sharp terrain, I have been so inspired and heartened by our shared commitments to find our role in amplifying the stories of people on the ground who are leaning into their power to resist, refuse, and fight back. When I started my work as a research assistant with COMM HSP, one of my first projects centered around the work of a group of community organizers in Colorado, building a base of mostly immigrants to fight for access to health care. The first stage of this research involved interviews with community leaders from the base – ordinary people who had decided to devote their time and energy to struggling together against behemoth healthcare institutions and powerful political and economic forces who are compromising our access to affordable and dignified care. It can be so easy to fall into despair, looking at the political landscape, and wonder, “how are we going to get out of this?” As I think about my future work, I think about how research can serve as a tool to uplift and amplify the incredible work of community organizers building collective power to transform our conditions, and keep us rooted and anchored in a politics of imagination, not despair.

Q: How will you bring the research methodologies you have used within COMM HSP into your future work? 

Kristina: Working with COMM HSP has taught me to understand communication about health and social policy holistically. Understanding the media environment using media content analysis, designing powerful narratives with community partners, and examining the effects of messages through experimental design are skills that will all be used in my future research. I am deeply appreciative of the diverse skills I have gained, and I look forward to advancing message strategies for health equity through my research.

CeRon: The research methodologies I used within COMM HSP, particularly qualitative and quantitative approaches, will remain central to my future work examining health inequities in political and media contexts. I plan to continue pairing quantitative analyses that identify structural patterns with qualitative methods that center lived experiences, allowing for a more nuanced understanding of how communication and policy shape health outcomes. These approaches also reinforce my commitment to community-engaged research that produces evidence that is rigorous and directly relevant to the development of equitable health policies and practices.

Yusra: Within COMM HSP, I have learned and practiced three methodologies that feel aligned with my core research topics: media content analysis, writing and administering surveys, and conducting focus groups/interviews. Most importantly, I have seen how bridging these methods — for example, drawing from focus groups with housing justice organizers to develop a message-testing survey — challenges us to develop more nuanced research questions and sharpens our ability to answer them, even though it may extend the timeline of our projects. Particularly in projects involving community partners, I have deeply appreciated a culture of moving at the speed of trust and rejecting urgency, enabling us to offer research that is responsive to the needs of our partners and their members on the ground.

Q: Engagement, Dissemination, and Implementation are the key themes of the Minnesota “hub”. Do you have any tips for how to do dissemination effectively?

Muna: To disseminate effectively, I focus on two core principles: accessibility and application. My priority is to translate our research, which examines communication strategies for health and racial equity, into formats that are immediately useful for key audiences like practitioners and journalists.

As the external communications coordinator, I deeply value making our findings accessible. This means developing clear, actionable outputs from complex studies –think tip sheets, easy-to-read briefs, and blog posts that highlight the “so what.”

Then, we share this information strategically. We distribute it through our newsletters and host webinars with collaborators that connect our insights directly to practitioners’ work. This includes building relationships through local events and direct outreach, ensuring our research becomes a tool for their community reporting.

We also actively share on platforms like LinkedIn and Bluesky. This allows us to reach a broader community interested in changing narratives to advance health and racial equity, sparking conversations and ensuring our work doesn’t get siloed in the research space, but actively informs real-world communication strategies.

Q: Many of the researchers on the team have done content analysis work, developing coding instruments and applying them to media, mainly local television and political campaign ads. This is often very hard work, having to be systematic in watching and rewatching broadcast content, and the content itself is often negative – exposing some very difficult themes about how marginalized populations are socially constructed. Do you have any ideas on why this work is important? 

Chloe: Though the work can be difficult, content analysis in the health equity space is important because it forces us to slow down and sit with the narratives people are exposed to every day, even when those narratives are upsetting. Systematically examining media content allows us to identify recurring patterns in how marginalized populations are portrayed (e.g., who is blamed, who is left out, which harmful stereotypes are reinforced, etc.). Documenting and quantifying these patterns helps us build evidence to understand how media may be contributing to and upholding harmful social constructions. Without that evidence base, it’s difficult to develop effective counterstrategies or to imagine alternative narratives that might disrupt those patterns. Although the work can be emotionally taxing and laborious, I see it as valuable groundwork for change in that it helps us more clearly see one part of a much larger puzzle before trying to address it more broadly.

Q: What advice do you have for other early career researchers who are interested in communication and health equity? What opportunities and challenges do you foresee for future research in this space?

Muna: My advice and what I have learned from our COMMHSP work is to actively collaborate with community partners and communication practitioners from the start. This ensures that your research is relevant and can be translated into real-world action. I think a major opportunity is using digital media to challenge dominant narratives and center community voices. Conversely, a key challenge will be navigating the complex information ecosystem where misinformation can easily undermine evidence-based messages aimed at advancing equity.
Yusra: There is a remarkable wealth of wisdom in this space — within journalism, academia, community organizing, and at their intersections. I have consistently found that everyone I have asked for support or mentorship has been willing, enthusiastic, and curious — whether that is political science faculty with rich knowledge about the journalistic landscape or communications organizers at local labor unions. I also find that more and more early-career researchers and graduate students are finding their research topic has something to do with communication, dominant narratives and counter-narratives; it is increasingly clear that no matter how much rigorous research we can get published to expand our academic understanding of housing deprivation, reproductive justice, food security, or otherwise, we often see an ever-growing uphill battle on the terrain of public discourse and public opinion. We are going to face immense challenges in the years ahead, but none of us are alone.

The University of Minnesota hub of COMM HSP has included the following early career researchers, staff, or students in the past year: Elizabeth Al, Marissa Evans, CeRon Ford, Chloe Gansen, Muna Hassan, Kristina Medero, Yusra Murad, Quin Mudry Nelson, Kene Orakwue, and Ben Weideman

This post was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation.

Public Concern about Threats to Public Health and Science Remains Modest 

Exhibit 1a: Any Reported Awareness of Key Actions Affecting Public Health and Science, by Partisanship (N=1,120)

Note. “Media sources” were defined as “e.g., social media, print or online news, podcasts, radio, and television”; “other people” were defined as “e.g., family, friends, health care providers.” <15 missing on any item. Items were randomly ordered. P values based on chi-square analyses. ^*Split ballot item, with no significant difference across groups in any reported awareness.

Exhibit 1b: Recent Reported Awareness of Key Actions Affecting Public Health and Science

Note. Question only asked of those who previously reported any awareness on the corresponding item (Exhibit 1a). Media sources” were defined as “e.g., social media, print or online news, podcasts, radio, and television”; “other people” were defined as “e.g., family, friends, health care providers.” Items were randomly ordered. ^*Split ballot item, with no significant difference across groups in frequency of awareness.

Exhibit 2: Agreement with Positive and Negative Consequences of NIH Funding Cuts (N=1,120)

Note. Overall agreement calculated by combining “agree” and “strongly agree” responses. “Don’t know” responses (<10 on any item) collapsed into “neither agree nor disagree”; <15 missing on any item. Items were randomly ordered and did not include the headers suggesting “positive” or “negative.”

Exhibit 3: Opposition to Cutting Funding for Health and Science Research (N=1,120)

Note. Overall oppose cutting calculated by combining “strongly oppose cutting” and “somewhat oppose cutting” responses. “Don’t know” responses (<10 on any item) collapsed into “neither agree nor disagree”; <10 missing on any item. Items were randomly ordered.

Exhibit 4: Mobilization around Funding for Health and Science Research (N=1,120)

Note. Overall likelihood calculated by combining “likely” and “very likely” responses. “Don’t know” responses (<5 on any item) collapsed into “neither agree nor disagree”; <15 missing on any item. Items were randomly ordered.

Exhibit 5: Personal experience with interruptions or difficulties accessing services or information, by partisanship (N=1,120)

Note. <10 missing on any item. Items were randomly ordered. P values based on chi-square analyses.

Exhibit 6: Personal experience with firings, layoffs, and/or departures, by partisanship (N=1,120)

Note. <15 missing on any item. Items were randomly ordered. P values based on chi-square analyses.

When over 5,500 non-Native survey respondents were asked to recall depictions of Native Americans they had seen or heard about in film and television, they had little to say. In other words, researchers found that both well-known living and deceased Native American people escape the general public’s memory.

What are the consequences of such findings for Native American people—what does it mean when the society around them has little recollection of their continued existence? Analysis of representation in the news media is an important step in answering this critical question. Local TV news is an essential media type to explore for Native American depictions, given it is relatively highly trusted and covers issues in a local community context. Given the prevalence of Native residents varies across geographic areas, non-Natives may see different depictions of Native Americans depending on where they live.

In our 2024 report synthesizing research questions from health communicators, some participants asked why reporting on minoritized groups such as Native Americans is rare, and when they are in the news, the topics are often negative. With this question as our motivation, our team initiated the Native American Communication Project: an exploratory study that aims to investigate trends and patterns of attention to Native Americans in local TV news to understand where and when Native people are visible in local TV news, and what topics are discussed alongside them. 

Our pilot study analyzed closed captions snippets from evening local TV news broadcasts from ABC, NBC, CBS, and Fox affiliated stations across the United States that aired between 01/01/2024 and 12/31/2024. We focused on evening local TV news for the pilot, knowing that this form of media is still a broadly trusted and frequently viewed source of news and information.

Our preliminary results revealed three important findings: 

1) Native Americans receive the most news coverage in October and November. We attribute this to the U.S. federally-recognized holiday of Indigenous People’s Day which occurs on the second Monday of October, as well as November being American Indian Heritage Month.

2) More attention is given to people in the Western region of the country clustered around large and well-known Native American tribal reservations while there is minimal coverage in the Midwest, Northeast, and Southern regions of the country, even near tribal lands.

MENTIONS OF NATIVE AMERICAN BY MEDIA MARKET IN U.S. EVENING LOCAL TV NEWS COVERAGE (2024)

3) The most frequently co-occurring topic mentioned alongside Native Americans was Celebrations & Cultural Identity, which included words referencing positive-leaning celebrations and cultural depictions such as “powwow”, “ceremony”, “community”, “language”, and “tradition”. The second most mentioned topic was Pop Culture & Entertainment, which included any mentions of film, TV, art, cuisine, and fashion. Thirdly, we found Native-past keywords (such as “history”, “museum”, “artifact”, “old”, “ancestor”, and “primitive”), were more common than Native-contemporary keywords (such as “today”, “present”, “progress”, “plan”, and “modern”). This finding demonstrates how Native American portrayals in the news center narratives about the past, rather than news stories grounding Native communities in the present and sharing progress or plans for the future.

Our pilot results reflect the beginning of a much larger ongoing project investigating representation of Native American people in U.S. media and the consequences of that representation. We look forward to sharing more about our findings in future posts. 

Special thanks to the members of the Native American Communication project team: Sarah Gollust, Neil Lewis Jr, Erika Franklin Fowler, Kari Waters, and Breeze Floyd for their help and guidance on this work.

Read more related work from the COMM team:

• An Update on Attention to Local TV News Racism & Counter-messaging
• Strategies and Challenges for Public Health Communicators
• How declarations of racism as a public health crisis were geospatially distributed across the U.S.
• How local TV news covered controversy surrounding masks during the COVID-19 pandemic

This post was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation.

COVID-19 cases continue to impact our communities while public attitudes about the vaccine to protect against COVID remain mixed. This is due in part to shifting guidance from the federal government about vaccine eligibility and rising levels of health skepticism, or mistrust or doubt in the ability of medical care and related institutions to improve health. Public health leaders, researchers and communicators face urgent questions of what can be done to mitigate health skepticism, as well as what could have been done to prevent this rise.

In 2021, members of our team conducted a content analysis of federally-sponsored public service announcements (PSAs) about COVID-19. Our goals were to understand the messages that were used to stop the spread of COVID-19 and to see what, if any, appeals were used to highlight the potential with the vaccine. There were no PSAs in our sample of content that aired from mid-March – mid-December of 2020 that mentioned the vaccine. To our team, this was the first missed opportunity to convey information about the vaccine that may promote trust in its efficacy and encourage uptake. In effect, sharing content about the vaccine ahead of its release could have mitigated health skepticism. 

Building on what we learned – and inspired by what we had yet to observe in federally-sponsored PSAs  – we completed a separate analysis of the period immediately following, to include federally-sponsored PSAs aired from mid-December through the end of June 2021. This work was just published in Preventive Medicine Reports. We focused on explicit appeals to get vaccinated, broadly conceptualized to include any message that may be perceived as direct encouragement to get vaccinated, such as a message to “get the shot”. Additionally, we analyzed PSAs for additional content about the vaccine, including that it was free and safe and effective. Fewer than twenty percent (17.1%) of PSAs in our sample included messages encouraging vaccination and just over a quarter (25.5%) included messages about the safety or effectiveness of the vaccine. Considering the potential for federally-sponsored content to promote trust in and encourage uptake of the vaccine, these findings were disappointing. 

Our efforts also contributed key insights worth sharing with public health researchers and practitioners invested in health equity. The first underscores the importance of local messengers and messages: absent key content about the vaccine in federally-sponsored guidance, local public health organizations have a key role relaying critical public health information. And second, while these results may explain in part why attitudes about the vaccine are mixed and health skepticism is on the rise, they also implore us to continue to consider available media and messaging and identify effective strategies for reducing the deleterious effects of health skepticism. 

Read more related work from the COMM team:

• Analysis of COVID-19 PSA airings in 2020 and their association with communities political orientation
• Data on partisan differences in public perceptions of disparities in COVID-19
• Insights into public sentiment at the end of the COVID-19 Public Health Emergency
• A study on local TV news coverage of controversy over masks during COVID-19 

This post was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation.

What makes some health policies feel controversial while others are embraced as common sense? It’s not the data — it’s the narrative. Strong public health narratives are why people today overwhelmingly accept drunk-driving laws or tobacco regulations that keep airplanes, restaurants, and other common spaces smoke-free. But those policies — and the narratives surrounding them — were not always popular. It took decades of advocacy and coordinated efforts across institutions and sectors to shift people’s beliefs about health from one of personal choice to one of shared responsibility. Now, the freedom to travel safely and breathe clean air is the norm. 

We can similarly change the narrative around other public health issues like racial equity, health care access, and housing security by applying lessons from previous public health battles and working strategically to create strong coalitions across institutions, organizations, and media. This form of power is known as narrative infrastructure, and it’s the basis for a recent perspective by BMSG Director Lori Dorfman and co-authors Sarah Gollust, Makani Thema, Pritpal S. Tamber, and Anthony Iton. The perspective, published last month in Milbank Quarterly, discusses how tactics from community organizing can help shift the public’s values and beliefs to better support policies that improve health. 

To learn more about narrative power and why public health needs an infrastructure to build it, I sat down with Gollust, Professor of Health Policy and Management at the University of Minnesota School of Public Health.

Q&A

Responses have been lightly edited for length and clarity.

Could you tell me a little bit about what you do, your background, and what brought you to this work?

The predominant role I have in research is as one of the co-directors of the Collaborative on Media and Messaging for Health and Social Policy, an interdisciplinary research group based at the University of Minnesota, Wesleyan University, and Cornell University, which seeks to do responsive communication research around health equity and social policy. That’s been a major part of my research over the last three years, although I’ve been researching the intersection of health communication and health policy for well over 15 years. 

My academic training is in health policy, but communication has long been a core interest of mine — specifically, understanding the role of communication in shaping health policy and politics. I’ve always been really interested in understanding how messages in the media shape the public’s attitudes about health policy, and, consequently, how the public’s opinion shapes political possibilities for systems and policy change. In my academic training, I’ve been really steeped in the fields of health policy and health communication, and the subfield of political communication within political science. I’m a relative newcomer to community organizing — that’s really where the ideas of narrative power that shaped this article come from. I recently became engaged in learning about community organizing as a field of practice when I started attending organizing trainings. I then started a partnership with Center for Health Progress, a community organizing nonprofit in Colorado, to do a community-based participatory research project with them. It was then, through my own education and training, and this research partnership, that I became much more open to the ideas from community organizing — particularly, how the ideas of power and narrative that stem from community organizing practice, rather than traditional academic health communication, can provide a really important complementary understanding of how communication shapes politics.

The perspective emphasizes the importance of narrative power. Can you explain what that means in the context of public health? How is narrative power different from a strong message?

Narrative power is the idea that those who hold sway over the stories we tell about how the world works hold power. For example, the idea that we’re personally responsible for our health or that we deserve health care when we work hard are the narratives that we call dominant narratives. Dominant narratives are a form of power because they shape what policies and politics are possible. 

As a concrete example, we know that in 2025, work requirements for Medicaid have been passed at the federal level. One of the reasons that the policy is politically possible and viewed as common sense is because of the widespread dominant narrative that links health care with hard work and deservingness. Without that narrative, it might not make sense to condition health insurance on work. This deep-seated narrative about what it means to be hardworking — and that when you’re hardworking, you deserve what comes to you — allows that policy to exist. 

The reason it’s different from a powerful message or persuasive message is because these fundamental narratives about deservingness are held up across so many different areas in society: In law, in schools, in popular culture, in the news media, in political speech. While we definitely need all the persuasive messages we can to shift public understanding about health and health care — those are necessary — they’re not sufficient to change the overall big picture, the big narrative about how we understand health and wellbeing. 

You and your co-authors argue that public health needs something called narrative infrastructure. What does this infrastructure entail, and how does it support movement-building?

If we’re to make narratives that support health equity the common-sense narratives, then these stories have to be sustained across many different arenas of meaning-making — not just within a narrow public health understanding. In the paper, we define narrative infrastructure as the set of institutions, actors, organizational networks, and systems of cultural meaning-making that build and maintain the narratives that we use to make sense of the world. So it’s really, really broad. Thinking about changing narratives and changing policies and systems requires us to think really big and think beyond public health as one sector. One thing I really enjoyed about working on this article was learning more about Lori’s extensive experience in tobacco control that informed our understanding of narrative power and narrative infrastructure. One of the key messages of the article is that changing narratives is absolutely possible when you have the right infrastructure in place.

If we think back to the middle of the 20th century, the dominant narrative about smoking tobacco was that it was a choice. It was even fashionable; it was normative. Everyone did it. By the end of the 20th century, the dominant narrative of smoking became that it is a health hazard. It is bad for you, and government and society all have responsibilities to address smoking and reduce the prevalence of smoking. It was a light-bulb moment while working on this paper to realize that the shift of the dominant narrative of smoking as a personal choice to one of a collective health hazard was a really, really giant narrative shift. We take it for granted now, and that is the point of narrative power: When an idea becomes this sort of common-sense, unquestioned thing, like tobacco being a health hazard, that signifies that a narrative shift has happened. And it wasn’t an accident. It happened because of a lot of synergistic work across various sectors of society. 

How, exactly, did this narrative change happen, and what can we learn from efforts to shift mindsets on smoking cessation and the tobacco industry?

What we can learn from that history is to remember all the different inputs and all the different components that had to be aligned for this shift to happen. We itemized them in the paper. The body of scientific research documenting the health harms of smoking and the harms of secondhand and thirdhand smoke was very important. Then, there was money. So much money was invested into funding that science in the federal NIH budget, and public dollars were collected through excise taxes on cigarettes. There were huge investments by philanthropy, and charitable and advocacy organizations like the American Cancer Society or the American Heart Association. There was litigation and regulation, like marketing restrictions, taxes on cigarettes, clean indoor laws, no-smoking sections, and then, finally, no smoking indoors generally, which created this huge societal shift. 

There was organizing to build that legal infrastructure and then diffuse it across states. Relationships, coalitions, and networks were built and sustained to do this advocacy and education. As a health communication scholar, I would have first thought about public service announcements. That traditional public health communication played a role, but there was also all of this other infrastructure. Within the communication space, there were working strategic relationships with Hollywood to change how pop culture depicted smoking. All of these things add up to show how society began to and, ultimately, did change the meaning of smoking. The case reinforces that it wasn’t just a compelling message; it wasn’t just saying that smoking is bad for health, it was this aggregation and coordination across different components of the narrative infrastructure that ultimately made the difference. 

The perspective notes that narrative change is necessary to address other public health issues like structural racism. Isn’t it more complicated to address problematic narratives surrounding racism than those surrounding a specific product?

It’s absolutely more complicated to address narratives about structural racism, in part because the dominant narrative that needs to change  — the idea of a racial hierarchy — is even more deeply, historically entrenched in the fabric of U.S. history and society. So, like tobacco control, the idea that racism is a hazard to health has to confront the idea that health is mainly an issue of personal responsibility, but that’s just one aspect of it. The narrative of structural racism linked to health tells us that health is the consequence not only of personal choices, but also of the structures and environments that often advantage some people and disadvantage others because of their race. The narrative of racism as a public health crisis began to emerge with a lot of momentum in 2020, during the uprisings for racial justice, and offers lessons that we document in the paper about how this emergent narrative infrastructure could be sustained. 

In the paper, we discuss how, during COVID-19, it was really clear how environments shape health. People’s occupations and living circumstances directly affected who was more likely to get sick and die in the early days of COVID and who was less vulnerable to infection and death. During this time, health departments, county governments, states, and cities constructed this narrative of health as a consequence of racism through more than 260 declarations that racism is a public health crisis. That was an emergent narrative seed linking structural racism to health. During this time, as we document in the article, we saw a whole host of new coalitions and partners that came together. There were new funding mechanisms to put the spotlight on structural racism and health in both public and private dollars and private philanthropy dollars. There was — and still is — an enormous amount of research being produced identifying the mechanisms through which structural racism harms health. 

We saw attention to these issues in health agencies, in private corporations, and in our public health schools, where attention to racism became commonplace in courses like the ones that I teach. This is the start of building narrative infrastructure. Unfortunately, this momentum is really threatened by political backlash to these ideas. But, as we say in the article, these narrative seeds were planted across all different sectors with the strategic focus on racism as a public health crisis in 2020 and 2021. 

Are there emerging examples of narrative work happening to shift people’s understanding of racism?

The structural racism story is about going upstream. We must think about the upstream causes of so many of our health, public health, and health care issues, which stem from who has access to power, who has power, and who doesn’t have power. This work is happening in lots of different sectors, for example, racism within criminal justice, or the power that shows up in the housing sector. Tenant organizing is a really important example of where power is being built among renters who tend to also be members of minoritized, racialized groups as well. There are so many different sectors that point toward the upstream structural determinants of health that include, but are not limited to, racism. The answer to this question is complex because it’s happening in so many places.

Why is now the right time for public health to focus on narrative infrastructure? 

The attacks on health equity and the concepts of equity, diversity, inclusion, and beyond are all the more reason to focus on thinking strategically and long-term. This will allow coalitions to maintain focus on these concepts and build the necessary momentum for narrative — and policy — change when it’s politically possible.

There is a lot of nuance to this work, and social change takes a long time. What’s one step public health practitioners can take right away to begin building narrative power?

This goes back to the tobacco control lesson, which emphasizes the importance of building relationships and coalitions across funders, advocacy, philanthropy, entertainment, news, and media. In this time of threat, the worst thing that can happen is to become isolated and atomized. And it’s understandable when that happens, right? Because when you’re afraid or feeling threatened, it’s easy to curl up and dig in. But, for public health practitioners, reaching out to partner with those in education, in schools of public health, in the journalistic community, in other advocacy organizations, and in community organizing, and building those relationships is going to be critical. The infrastructure can only be built on top of those trusted relationships — it can’t come up out of individuals in silos. 

To learn more, read the full perspective in Milbank Quarterly: “Changing the Story on Health and Racial Equity: Why Public Health Needs an Infrastructure for Building Narrative Power.” 

The passage of the Trump Administration’s so-called “One Big Beautiful Bill” in 2025 directs billions of dollars into immigration enforcement efforts and detention centers, a significant increase over prior funding. The law in many ways follows through on Republican campaign promises made in the 2024 election campaign, when the volume of Republican messaging in campaign advertising about immigration  was historically high. A deep dive into the narratives about immigrants and immigration in the 2024 campaign indicates that the messaging from both parties was more negative than in prior cycles. Although campaigns strategically craft political messages in response to public opinion and there is evidence that concern over immigration was rising in 2024, the blitz of negatively framed messaging on the topic may have further contributed to increasing negative views of immigration and immigrants and a permission structure for expansive action, such as the passage of the OBBB. In this analysis, we provide a more in-depth look – using both computational and qualitative analysis – at the discourse surrounding immigration in political advertising in the 2024 election and its potential consequences.

Figure 1: Screenshots from Television Advertising Mentioning Immigration

To identify the main themes in the political ads during the 2024 general election, we first employed a computational technique called BERT-based topic modeling, which analyzes language in an attempt to find patterns for grouping similar text together. (We removed candidate names and geographic locations from this analysis since they would otherwise be prominent words distinguishing specific campaign ads as similar. Spanish ads were not included in the analysis). In addition to immigration, other common topics in the ads included abortion bans, Medicare, social security, drug prices, tax increases, and rising gas prices. The most frequent topics related to immigration portrayed the situation at the southern U.S. border as a national emergency and liberal open-border policies as worsening the issue. Other significant themes included support for conservative fiscal and immigration policies, debates about amnesty for illegal immigrants and government spending on illegal immigrants, and criticism of opponents for ignoring border security and drug crisis. 

We then dug in qualitatively to analyze more of the nuanced discussion on immigration, including earlier election cycles. Advertising that touched on immigration in 2024 – no matter the sponsor – almost always conceded that there was a border issue that required a solution. More than that, however, law enforcement and security were prominently featured as the solutions with very little discussion of amnesty for anyone or an acknowledgment of the complexity of ways in which immigrants find their way into the United States. Perhaps in part because of the acceptance of the border framing, there was also vanishingly little language that painted a positive vision of immigration and its benefits to the United States beyond individual acknowledgements in Democratic sponsored Spanish ads of coming from a hard-working immigrant family. This stands in contrast to what we found in earlier election cycles, in which ads featured explicit discussion of immigration as essential to America’s economic strength, the need for compassionate DACA reform, and America being a nation of immigrants where anyone can get ahead.

Although Republican advertising featured immigration more prominently, both parties emphasized negatively valenced messages about immigration. However, their messaging differed in focus and framing. 

Republican ads frequently portrayed the border as a crisis caused by Democratic policies, often linking undocumented immigration to violent crimes, trafficking of fentanyl across the border and economic/resource drain. Examples included phrases such as “murdered by illegals” and “Kamala allowed dangerous criminals through our border.” Multiple ads directly tied the fentanyl crisis to border security failures, claiming Democratic policies had allowed cartels and “illegals” to bring drugs into the country (e.g., “Don Davis, Joe Biden, and Kamala Harris have failed us on the border. Woke Democrat policies have illegals and fentanyl pouring in).” Some ads also claimed Democrats supported providing benefits like Medicare and Social Security to undocumented immigrants, arguing this came at the expense of American taxpayers (e.g. “Now Kamala wants struggling seniors to pay more social security taxes, while she gives Medicare and social security to illegals”). Several ads extended this argument to healthcare systems, claiming hospitals were “overwhelmed” by immigrants at the expense of American patients (e.g., “Hospitals everywhere are overwhelmed and American patients are paying the price”). In other words, immigrants were not just dangerous but also a drain on resources.

Figure 2: Screenshots from Pro-Republican Sponsored Television Advertising 

Democratic ads, meanwhile, focused on policy solutions, such as hiring more border agents and improving security technology. They frequently cited law enforcement figures, including images or speakers who were sheriffs and Border Patrol agents, to reinforce and toughen their stance on border security. While Democratic ads featured immigration less often than Republican ads and tended to avoid overtly inflammatory language, some of their proposed solutions, such as “deporting violent criminals” and combating the fentanyl crisis – aligned with GOP messaging. 

Figure 3: Screenshots from Pro-Democratic Sponsored Television Advertising 

As noted earlier, there was a near total absence of positive portrayals of immigrants in campaign ads in 2024. Messages highlighting immigrants’ contributions, such as filling essential jobs, paying taxes, and strengthening communities were virtually non-existent in Republican ads. Spanish-language Democratic ads stood out as an exception, highlighting immigrant contributions through personal narratives, such as stories of immigrant parents working hard to support their families and/or personal stories of immigrant resilience (e.g., “When you’re raised by an immigrant mother, you know what’s possible with determination”). These ads, though few in number, stood in stark contrast to the dominant narrative by emphasizing immigrant perseverance and bipartisan solutions. Nevertheless, the overall discourse remained skewed toward negativity, with little recognition of immigrants’ economic or social contributions.

Political advertising is important, not just because it is a primary vehicle through which candidates for office communicate their policy priorities, but also because it can actively shape the public’s perceptions of important issues and acceptable policy solutions. This detailed analysis of immigration narratives in 2024 suggests that messages surrounding immigration were prominent and dominated by Republicans. When Democrats talked about the issue, their framing of the topic was also negative,  leaving the rare Democratic Spanish-language ad to provide any positive perspective. The one-sided narrative on the border as problematic, with security and enforcement as the solutions, likely helped to create the conditions that led to the passage of President Trump’s signature legislation to date that has directed historic increases to immigration authorities for deportation and detention.

Public opinion is not set in stone, and future election cycles may shift the tenor of political conversations about immigrants and immigration policy. For example, evidence from other countries suggests that the success of populist parties in one round of elections might also restore more positive views of immigration. In fact, Gallup’s June 2025 survey already suggests a decrease in concern over immigration and an increasing belief to a historically high level that immigration is a good thing for the United States.

Read more related work from the COMM team:

• What was and wasn’t covered in 2024 campaign advertising
• How political candidates discussed racial and gender identity in 2022 – and what it means for 2024
• On the population health-relevant content of campaign advertising in past presidential elections
• On how exposure to crime in campaign ads can increase worry among Republicans
• On what explains campaign ad attention to social determinants of health

This post was funded by the Robert Wood Johnson Foundation (Grant no. 79754). The views expressed here do not necessarily reflect the views of the foundation.

Given the second Trump Administration’s focus on dismantling diversity, equity, and inclusion (DEI) programs, it seemed likely that local TV news attention to these concepts would have grown since Trump took office. In an updated analysis of trends in local TV news coverage that extends through April 2025, and in light of the 5-year anniversary of George Floyd’s murder, we confirm not only that news attention to counter-messaging has grown but also that the news attention it has received in early 2025 is of a magnitude similar to the level of attention to structural racism in the wake of George Floyd’s murder and disparities revealed by the COVID-19 pandemic in the summer of 2020.

As shown in Figure 1 below, attention to DEI in local TV news in particular spiked following Inauguration Day as Trump signed the first of a series of executive orders targeting diversity policies and programs in the public and private sectors alike. Moreover, attention to DEI has remained high (with seven-day averages hovering around 200 stories) since February. These data come from keyword and pattern searches of the closed captioning on local TV news programs (790 stations affiliated with ABC, CBS, NBC, Fox, and PBS across 212 U.S. local media markets) from January 1, 2020 through April 30, 2025.

Figure 1. Local media attention to structural racism, critical race theory and DEI initiatives. Trendlines are seven-day rolling averages.

This sustained attention – which likely can be attributed not only to Trump executive orders and discourse as well as responses from the corporate, education, and non-profit sectors – is not only large, but as demonstrated by the top trendline, it lacks inclusive discussion of structural racism concerns that led to the adoption of many of these programs and initiatives in the first place. As we identified in January, these trends fit the pattern of progress on social justice being followed by the politics of backlash.

Our ongoing work-in-progress suggests that growing backlash against DEI initiatives is accompanied by heightened contention between different perspectives and discussion of controversy. This assessment might explain why opinion about DEI has polarized but not cratered, with political Independents along with Democrats being much more supportive of DEI programs than Republicans. Importantly, survey work has shown that support for the underlying ideas surrounding diversity, equity, and inclusion are still widely supported when the term DEI itself is excluded, and some corporations are reporting consequences of their decisions to roll back DEI. That said, advocates for racial and health equity continue to face strong anti-messaging headwinds that have only increased in the media attention cycle in 2025.

Read more relevant work from the COMM team:

• Our earlier report on attention to, predictors of, and potential consequences of racism and counter-messaging in mainstream media
• What was and wasn’t featured in 2024 campaign advertising
• How political candidates discussed racial and gender identity in 2022 – and what it means for 2024
• What role did local news play in the controversy about masks?

The ongoing work-in-progress described here includes contributions from Meiqing Zhang, Natália de Paula Moreira, Breeze Floyd, Steven Moore, Erika Franklin Fowler, Yujin Kim, Furkan Cakmak, Neil Lewis, Jr., Jeff Niederdeppe, and Sarah Gollust. Support for this research was provided by the Robert Wood Johnson Foundation (grant #79754). The views expressed here do not necessarily reflect the views of the Foundation.

We present percentages below for the overall sample and for subgroups of respondents – by political party identification, insurance status, and whether they live in a “red” or “blue” state, according to the results of the 2024 electoral college. 

Exhibit 1 shows the percentages of people who wanted Congress to “increase,” “keep the same,” or “decrease” spending on Medicaid. 

Exhibit 2 shows the percentages of people who thought protecting Medicaid from cuts in federal funding would be “very effective,” “effective,” or “somewhat effective” compared to those who thought it would be only “slightly effective” or “not at all effective” in producing four different outcomes. 

Exhibit 3 shows the percentages of people who were “extremely likely” or “likely” to engage in a variety of advocacy-related behaviors compared to those who were “neither likely nor unlikely,” “unlikely,” or “extremely unlikely” to do so. 

Exhibit 4 provides a summary of the sample demographics. 

Notes. ¹ Weighted to Black & White U.S. adults. Margin of Standard Error: +/- 3.2%. ² Party column omits “Another party” (N = 35).  

Notes. ¹ Weighted to Black & White U.S. adults. Margin of Standard Error: +/- 3.2%. ² Party column omits “Another party” (N = 35).  

Notes. ¹ Weighted to Black & White U.S. adults. Margin of Standard Error: +/- 3.2. ² Party column omits “Another party” (N = 35). 

This research was conducted through the Collaborative on Media and Messaging for Health and Social Policy and included contributions from Drs. Jamila Michener, Sarah Gollust, Jeff Niederdeppe, Norman Porticella, and Erika Franklin Fowler. 

Support for this research was provided by the Robert Wood Johnson Foundation (grant #79754). The views expressed here do not necessarily reflect the views of the Foundation.