title: Impact of mass media on public behavior and physicians: an ecological study of the H1N1 influenza pandemic.
abstract: BACKGROUND
  The mass media plays an important role in public health behavior.
  
  
  OBJECTIVE
  The objective of the present study was to investigate the effect of mass media coverage of the H1N1 pandemic on the number of emergency department (ED) visits and hospital admission rates.
  
  
  METHODS
  An ecological study of ED visits to 8 general Israeli hospitals due to influenza-like illness during the period June-October 2009 was performed. Data on the number of visits per day for children and adults and daily hospitalization rates were analyzed. Associations with the estimated value of H1N1-related publications and weekly reports from nationwide sentinel clinics were assessed. The analysis was performed in 2012-2013.
  
  
  RESULTS
  There were 55,070 ED visits due to influenza-like illness during the study period. The overall number of media reports was 1,812 (14.3% radio broadcasts, 9.8% television broadcasts, 27.5% newspaper articles, and 48.5% major website reports). The overall estimated value of advertising of publications was $16,399,000, excluding the Internet. While H1N1 incidence recorded by Israeli sentinel clinics showed no association with mass media publications, peaks of media reports were followed by an increase in the number of ED visits, usually with a delay of 3 days (P = .005). This association was noted in children (P < .001) but not in adults (P > .1), with a corresponding decrease in hospital admission rates. Publications' framing had no association with ED visits.
  
  
  CONCLUSIONS
  During the 2009 H1N1 influenza outbreak in Israel, an increase in mass media coverage was associated with an increase in pediatric ED visits.
authors.affiliation: Division of Internal Medicine, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Codish
authors.forename: Lena
authors.initials: L
authors.lastname: Novack
authors.forename: Jacob
authors.initials: J
authors.lastname: Dreiher
authors.forename: Leonid
authors.initials: L
authors.lastname: Barski
authors.forename: Alan
authors.initials: A
authors.lastname: Jotkowitz
authors.forename: Lior
authors.initials: L
authors.lastname: Zeller
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
mesh_terms: D000328:Adult; D002648:Child; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000523:psychology; D007557:Israel; D008402:Mass Media; D058873:Pandemics; D011634:Public Health