title: The H1N1 pandemic: media frames, stigmatization and coping.
abstract: BACKGROUND
  Throughout history, people have soothed their fear of disease outbreaks by searching for someone to blame. Such was the case with the April 2009 H1N1 flu outbreak. Mexicans and other Latinos living in the US were quickly stigmatized by non-Latinos as carriers of the virus, partly because of news reports on the outbreak's alleged origin in Mexican pig farms.
  
  
  METHODS
  In this exploratory study we examined the psychological processes of cue convergence and associative priming, through which many people likely conflated news of the H1N1 outbreak with pre-existing cognitive scripts that blamed Latino immigrants for a variety of social problems. We also used a transactional model of stress and coping to analyze the transcripts from five focus groups, in order to examine the ways in which a diverse collection of New England residents appraised the threat of H1N1, processed information about stereotypes and stigmas, and devised personal strategies to cope with these stressors.
  
  
  RESULTS
  Twelve themes emerged in the final wave of coding, with most of them appearing at distinctive points in the stress and coping trajectories of focus group participants. Primary and secondary appraisals were mostly stressful or negative, with participants born in the USA reporting more stressful responses than those who were not. Latino participants reported no stressful primary appraisals, but spoke much more often than Whites or Non-Hispanic Blacks about negative secondary appraisals. When interactions between participants dealt with stigmas regarding Latinos and H1N1, Latinos in our focus groups reported using far more negative coping strategies than Whites or Non-Hispanic Blacks. When discussions did not focus on stereotypes or stigmas, Latino participants spoke much more often about positive coping strategies compared to members of these same groups.
  
  
  CONCLUSIONS
  Participants in all five focus groups went through a similar process of stress and coping in response to the threat of H1N1, though individual responses varied by race and ethnicity. Stigmatization has often been common during pandemics, and public health and emergency preparedness practitioners can help to mitigate its impacts by developing interventions to address the social stressors that occur during outbreaks in highly-localized geographic regions.
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. mmccauley@mcw.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: McCauley
authors.forename: Sara
authors.initials: S
authors.lastname: Minsky
authors.forename: Kasisomayajula
authors.initials: K
authors.lastname: Viswanath
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D005239:Fear / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008402:Mass Media; D017058:Mexican Americans / Q000523:psychology; D008875:Middle Aged; D008960:Models, Psychological; D058873:Pandemics; D013240:Stereotyping; D013315:Stress, Psychological / Q000208:ethnology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology