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Broniatowski DA, Kerchner D, Farooq F, Huang X, Jamison AM, Dredze M, Quinn SC, Ayers JW. Correction: Twitter and Facebook posts about COVID-19 are less likely to spread misinformation compared to other health topics. PLoS One 2024; 19:e0298907. [PMID: 38346059 PMCID: PMC10861040 DOI: 10.1371/journal.pone.0298907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0261768.].
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Jamison AM, Brewer J, Hamlin MD, Forr A, Roberts R, Carey A, Fugal A, Mankel ME, Tovar Y, Adams S, Shapcott K, Salmon D. The Be REAL Framework: Enhancing Relationship-Building Skills for Community Health Workers. Health Promot Pract 2024:15248399231218937. [PMID: 38189324 DOI: 10.1177/15248399231218937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Trust plays an integral part in the effective functioning of public health systems. During the COVID-19 pandemic, distrust of public health fueled vaccine hesitancy and created additional barriers to immunization. Although most Americans have received at least one COVID-19 vaccine, the percentage of fully immunized adults remains suboptimal. To reach vaccine-hesitant communities, it is vital that public health be worthy of trust. As trusted members of their communities, community health workers (CHWs) can serve as ideal messengers and conversation partners for vaccination decision-making. We developed the Be REAL framework and training materials to prepare CHWs to work with vaccine-hesitant communities nationwide. Through the four steps of "Relate," "Explore," "Assist," and "Leave (the door open)," CHWs were taught to prioritize relationship building as a primary goal. In this shift from focusing on adherence to public health recommendations (e.g., get vaccinated) to building relationships, the value of vaccine uptake is secondary to the quality of the relationship being formed. The Be REAL framework facilitates CHWs harnessing the power they already possess. The goal of the Be REAL framework is to foster true partnership between CHWs and community members, which in turn can help increase trust in the broader public health system beyond adherence to a specific recommendation.
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Affiliation(s)
- Amelia M Jamison
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Janesse Brewer
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mary Davis Hamlin
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Perdido, LLC, Alexandria, VA, USA
| | - Amanda Forr
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Perdido, LLC, Alexandria, VA, USA
| | - Robin Roberts
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Perdido, LLC, Alexandria, VA, USA
| | - Aleen Carey
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Adriele Fugal
- Center for Global Education, Earlham College, Tucson, AZ, USA
| | | | | | | | | | - Daniel Salmon
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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3
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Salmon DA, Dudley MZ, Brewer J, Shaw J, Schuh HB, Proveaux TM, Jamison AM, Forr A, Goryn M, Breiman RF, Orenstein WA, Kao LS, Josiah Willock R, Cantu M, Decea T, Mowson R, Tsubata K, Bucci LM, Lawler J, Watkins JD, Moore JW, Fugett JH, Fugal A, Tovar Y, Gay M, Cary AM, Vann I, Smith LB, Kan L, Mankel M, Beekun S, Smith V, Adams SD, Harvey SA, Orton PZ. Corrigendum: LetsTalkShots: personalized vaccine risk communication. Front Public Health 2023; 11:1311055. [PMID: 38026293 PMCID: PMC10643483 DOI: 10.3389/fpubh.2023.1311055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1195751.].
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Affiliation(s)
- Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Department of Public Health and Preventive Medicine, State University of New York, Upstate Medical University, Syracuse, NY, United States
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, NY, United States
| | - Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michelle Goryn
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Michelle Cantu
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Tori Decea
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Robin Mowson
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | | | | | | | - James D. Watkins
- Williams County Combined Health District, Montpelier, OH, United States
| | - Jamie W. Moore
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - James H. Fugett
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Adriele Fugal
- Monongalia County Health Department, Morgantown, WV, United States
| | - Yazmine Tovar
- Monongalia County Health Department, Morgantown, WV, United States
| | - Marie Gay
- Orange County Department of Health, Goshen, NY, United States
| | - Aleen M. Cary
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iulia Vann
- Utah County Health Department, Provo, UT, United States
| | - Lee B. Smith
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Lilly Kan
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Magda Mankel
- Border Studies Program, Earlham College, Tucson, AZ, United States
| | - Sumayya Beekun
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Victoria Smith
- Williams County Combined Health District, Montpelier, OH, United States
| | | | - Steven A. Harvey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Z. Orton
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Broniatowski DA, Simons JR, Gu J, Jamison AM, Abroms LC. The efficacy of Facebook's vaccine misinformation policies and architecture during the COVID-19 pandemic. Sci Adv 2023; 9:eadh2132. [PMID: 37713497 PMCID: PMC11044214 DOI: 10.1126/sciadv.adh2132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
Online misinformation promotes distrust in science, undermines public health, and may drive civil unrest. During the coronavirus disease 2019 pandemic, Facebook-the world's largest social media company-began to remove vaccine misinformation as a matter of policy. We evaluated the efficacy of these policies using a comparative interrupted time-series design. We found that Facebook removed some antivaccine content, but we did not observe decreases in overall engagement with antivaccine content. Provaccine content was also removed, and antivaccine content became more misinformative, more politically polarized, and more likely to be seen in users' newsfeeds. We explain these findings as a consequence of Facebook's system architecture, which provides substantial flexibility to motivated users who wish to disseminate misinformation through multiple channels. Facebook's architecture may therefore afford antivaccine content producers several means to circumvent the intent of misinformation removal policies.
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Affiliation(s)
- David A. Broniatowski
- Department of Engineering Management and Systems
Engineering, The George Washington University, Washington, DC 20052, USA
- Institute for Data, Democracy, and Politics, The
George Washington University, Washington, DC 20052, USA
| | - Joseph R. Simons
- Office of the Assistant Secretary for Financial
Resources, United States Department of Health and Human Services, Washington, DC 20543,
USA
| | - Jiayan Gu
- Department of Prevention and Community Health, The
George Washington University, Washington, DC 20052, USA
| | - Amelia M. Jamison
- Department of Health, Behavior, and Society, Johns
Hopkins University, Baltimore, MD 21218, USA
| | - Lorien C. Abroms
- Institute for Data, Democracy, and Politics, The
George Washington University, Washington, DC 20052, USA
- Department of Prevention and Community Health, The
George Washington University, Washington, DC 20052, USA
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Sundelson AE, Jamison AM, Huhn N, Pasquino SL, Sell TK. Fighting the infodemic: the 4 i Framework for Advancing Communication and Trust. BMC Public Health 2023; 23:1662. [PMID: 37644563 PMCID: PMC10466697 DOI: 10.1186/s12889-023-16612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The proliferation of false and misleading health claims poses a major threat to public health. This ongoing "infodemic" has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal. METHODS A multi-pronged search strategy was used to identify tools and approaches for combatting health-related misinformation and disinformation. The search strategy included a scoping review of academic literature; a review of gray literature from organizations involved in public health communications and misinformation/disinformation management; and a review of policies and infodemic management approaches from all U.S. state health departments and select local health departments. A team of annotators labelled the main feature(s) of each tool or approach using an iteratively developed list of tags. RESULTS We identified over 350 infodemic management tools and approaches. We introduce the 4 i Framework for Advancing Communication and Trust (4 i FACT), a modified social-ecological model, to characterize different levels of infodemic intervention: informational, individual, interpersonal, and institutional. Information-level strategies included those designed to amplify factual information, fill information voids, debunk false information, track circulating information, and verify, detect, or rate the credibility of information. Individual-level strategies included those designed to enhance information literacy and prebunking/inoculation tools. Strategies at the interpersonal/community level included resources for public health communicators and community engagement approaches. Institutional and structural approaches included resources for journalists and fact checkers, tools for managing academic/scientific literature, resources for infodemic researchers/research, resources for infodemic managers, social media regulation, and policy/legislation. CONCLUSIONS The 4 i FACT provides a useful way to characterize the current ecosystem of infodemic management strategies. Recognizing the complex and multifaceted nature of the ongoing infodemic, efforts should be taken to utilize and integrate strategies across all four levels of the modified social-ecological model.
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Affiliation(s)
- Anne E Sundelson
- Johns Hopkins Center for Health Security, 700 E. Pratt Street, Suite 900, Baltimore, MD, 21202, USA.
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7527, Baltimore, MD, 21205, USA.
| | - Amelia M Jamison
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Noelle Huhn
- Johns Hopkins Center for Health Security, 700 E. Pratt Street, Suite 900, Baltimore, MD, 21202, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7527, Baltimore, MD, 21205, USA
| | - Sarah-Louise Pasquino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Tara Kirk Sell
- Johns Hopkins Center for Health Security, 700 E. Pratt Street, Suite 900, Baltimore, MD, 21202, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E7527, Baltimore, MD, 21205, USA
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6
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Schuh HB, Rimal RN, Breiman RF, Orton PZ, Dudley MZ, Kao LS, Sargent RH, Laurie S, Weakland LF, Lavery JV, Orenstein WA, Brewer J, Jamison AM, Shaw J, Josiah Willock R, Gust DA, Salmon DA. Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences. Front Public Health 2023; 11:1192676. [PMID: 37670826 PMCID: PMC10475941 DOI: 10.3389/fpubh.2023.1192676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases. Methods We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video. Results Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns. Conclusion Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.
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Affiliation(s)
- Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rajiv N. Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | - Leo F. Weakland
- Center for Global Health Innovation, Atlanta, GA, United States
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Center for Ethics, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Department of Medicine, Emory University, School of Medicine, Atlanta, GA, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Deborah A. Gust
- Department of Psychology, Education Division, Gwinnett Technical College, Lawrenceville, GA, United States
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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7
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Alperstein N, Pascual-Ferrá P, Ganjoo R, Bhaktaram A, Burleson J, Barnett DJ, Jamison AM, Kluegel E, Mohanty S, Orton PZ, Parida M, Rath S, Rimal R. Correction: Social network analysis of COVID-19 vaccine YouTube videos in Odisha, India: mapping the channel network and analyzing comment sentiment. BMC Proc 2023; 17:16. [PMID: 37443025 DOI: 10.1186/s12919-023-00267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Affiliation(s)
- Neil Alperstein
- Department of Communication, Loyola University, Maryland, Baltimore, USA.
| | | | - Rohini Ganjoo
- School of Medical and Health Sciences, George Washington University, Washington, D.C., USA
| | - Ananya Bhaktaram
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julia Burleson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel J Barnett
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amelia M Jamison
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleanor Kluegel
- Department of Communication, Loyola University, Maryland, Baltimore, USA
| | | | | | - Manoj Parida
- Development Corner (D-COR), Bhubaneswar, Odisha, India
| | | | - Rajiv Rimal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Alperstein N, Pascual-Ferrá P, Ganjoo R, Bhakktaram A, Burleson J, Barnett DJ, Jamison AM, Kluegel E, Mohanty S, Orton PZ, Parida M, Rath S, Rimal R. Social network analysis of COVID-19 vaccine YouTube videos in Odisha, India: mapping the channel network and analyzing comment sentiment. BMC Proc 2023; 17:9. [PMID: 37420218 DOI: 10.1186/s12919-023-00260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Abstract
India has reported more than 35 million confirmed cases of COVID-19 and nearly half a million cumulative deaths. Although vaccination rates for the first vaccine dose are quite high, one-third of the population has not received a second shot. Due to its widespread use and popularity, social media can play a vital role in enhancing vaccine acceptance. This study in a real-world setting utilizes YouTube videos in Odisha, India where the platform has deep penetration among the 18-35 target population, and secondarily their family and peers. Two contrasting videos were launched on the YouTube platform to examine how those videos operate within the broader recommender and subscription systems that determine the audience reach. Video analytics, algorithms for recommended videos, visual representation of connections created, centrality between the networks, and comment analysis was conducted. The results indicate that the video with a non-humorous tone and collectivistic appeal delivered by a female protagonist performed best with regard to views and time spent watching the videos. The results are of significance to health communicators who seek to better understand the platform mechanisms that determine the spread of videos and measures of viewer reactions based on viewer sentiment.
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Affiliation(s)
- Neil Alperstein
- Department of Communication, Loyola University, Baltimore, Maryland, USA.
| | | | - Rohini Ganjoo
- School of Medical and Health Sciences, George Washington University, WashingtonD.C., USA
| | - Ananya Bhakktaram
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julia Burleson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel J Barnett
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amelia M Jamison
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleanor Kluegel
- Department of Communication, Loyola University, Baltimore, Maryland, USA
| | | | | | - Manoj Parida
- Development Corner (D-COR), Bhubaneswar, Odisha, India
| | | | - Rajiv Rimal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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9
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Salmon DA, Dudley MZ, Brewer J, Shaw J, Schuh HB, Proveaux TM, Jamison AM, Forr A, Goryn M, Breiman RF, Orenstein WA, Kao LS, Josiah Willock R, Cantu M, Decea T, Mowson R, Tsubata K, Bucci LM, Lawler J, Watkins JD, Moore JW, Fugett JH, Fugal A, Tovar Y, Gay M, Cary AM, Vann I, Smith LB, Kan L, Mankel M, Beekun S, Smith V, Adams SD, Harvey SA, Orton PZ. LetsTalkShots: personalized vaccine risk communication. Front Public Health 2023; 11:1195751. [PMID: 37457264 PMCID: PMC10348877 DOI: 10.3389/fpubh.2023.1195751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Vaccine hesitancy is a global health threat undermining control of many vaccine-preventable diseases. Patient-level education has largely been ineffective in reducing vaccine concerns and increasing vaccine uptake. We built and evaluated a personalized vaccine risk communication website called LetsTalkShots in English, Spanish and French (Canadian) for vaccines across the lifespan. LetsTalkShots tailors lived experiences, credible sources and informational animations to disseminate the right message from the right messenger to the right person, applying a broad range of behavioral theories. Methods We used mixed-methods research to test our animation and some aspects of credible sources and personal narratives. We conducted 67 discussion groups (n = 325 persons), stratified by race/ethnicity (African American, Hispanic, and White people) and population (e.g., parents, pregnant women, adolescents, younger adults, and older adults). Using a large Ipsos survey among English-speaking respondents (n = 2,272), we tested animations aligned with vaccine concerns and specific to population (e.g., parents of children, parents of adolescents, younger adults, older adults). Results Discussion groups provided robust feedback specific to each animation as well as areas for improvements across animations. Most respondents indicated that the information presented was interesting (85.5%), clear (96.0%), helpful (87.0%), and trustworthy (82.2%). Discussion Tailored vaccine risk communication can assist decision makers as they consider vaccination for themselves, their families, and their communities. LetsTalkShots presents a model for personalized communication in other areas of medicine and public health.
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Affiliation(s)
- Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Department of Public Health and Preventive Medicine, State University of New York, Upstate Medical University, Syracuse, NY, United States
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, NY, United States
| | - Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michelle Goryn
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Michelle Cantu
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Tori Decea
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Robin Mowson
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | | | | | | | - James D. Watkins
- Williams County Combined Health District, Montpelier, OH, United States
| | - Jamie W. Moore
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - James H. Fugett
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Adriele Fugal
- Monongalia County Health Department, Morgantown, WV, United States
| | - Yazmine Tovar
- Monongalia County Health Department, Morgantown, WV, United States
| | - Marie Gay
- Orange County Department of Health, Goshen, NY, United States
| | - Aleen M. Cary
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iulia Vann
- Utah County Health Department, Provo, UT, United States
| | - Lee B. Smith
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Lilly Kan
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Magda Mankel
- Border Studies Program, Earlham College, Tucson, AZ, United States
| | - Sumayya Beekun
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Victoria Smith
- Williams County Combined Health District, Montpelier, OH, United States
| | | | - Steven A. Harvey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Z. Orton
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Burleson J, Ganjoo R, Rath S, Rath N, Bhaktaram A, Jamison AM, Alperstein N, Pascual-Ferra P, Barnett DJ, Mohanty S, Parida M, Orton P, Kluegel E, Rimal RN. Production of vaccination videos in India: learnings from a science-art partnership. BMC Public Health 2023; 23:736. [PMID: 37085863 PMCID: PMC10119828 DOI: 10.1186/s12889-023-15607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Cross-cultural communication, often conceptualized along culture and language dimensions, is an important issue for collaborative teams that include both scientists and artists. Such teams must balance the standardization needs of rigorous scientific methods, on the one hand, with openness for artistic creativity, on the other. The scientific literature does not provide clear guidance on how to structure such collaborations. DISCUSSION We created eight videos manipulating the type of appeal, message tone, and gender of the vaccine promoter in a 2 × 2 × 2 between-subjects experiment. The four stages of the filmmaking process were 1) conceptualizing filmmaking and script writing through a scientific lens, 2) pilot testing and finalizing the script, 3) video production and editing, and 4) dissemination. We describe the process and learnings from a collaboration that included filmmakers, researchers, and vaccine experts from India and the United States in producing, disseminating, and evaluating videos that promoted vaccine uptake in Odisha, India. CONCLUSIONS When projects require close collaborations between scientists and artists, committing to a unified vision is essential for facilitating open, bidirectional communication and building trust between the partners. Clearly denoting research boundaries ensures that the scientific needs of the project are met while simultaneously welcoming space for the filmmakers' creativity, fostering a sense of ownership, and enhancing the final product.
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Affiliation(s)
- Julia Burleson
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Rohini Ganjoo
- Department of Biomedical Laboratory Sciences, George Washington University, Ashburn, 20147, USA
| | - Sidharth Rath
- Swasthya Plus Network, Chandrasekharpur, , Bhubaneswar, 751017, Odisha, India
| | - Nilambar Rath
- OdishaLIVE, Samanta Vihar, Bhubaneswar, 751017, Odisha, India
| | - Ananya Bhaktaram
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Amelia M Jamison
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Neil Alperstein
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Paola Pascual-Ferra
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Daniel J Barnett
- Department of Environmental Health & Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Satyanarayan Mohanty
- D-Cor (Development Corner) Consulting, Satya Nagar, Bhubaneswar, 751007, Odisha, India
| | - Manoj Parida
- D-Cor (Development Corner) Consulting, Satya Nagar, Bhubaneswar, 751007, Odisha, India
| | | | - Eleanor Kluegel
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
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11
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Bhaktaram A, Ganjoo R, Jamison AM, Burleson J, Pascual-Ferra P, Alperstein N, Barnett DJ, Mohanty S, Orton PZ, Parida M, Kluegel E, Rath S, Rimal RN. Creation, dissemination, and evaluation of videos to promote COVID-19 vaccination in India: A research protocol. Gates Open Res 2022; 6:82. [PMID: 36415882 PMCID: PMC9652135 DOI: 10.12688/gatesopenres.13628.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vaccine hesitancy is one of the greatest challenges to the success of coronavirus disease 2019 (COVID-19) vaccination campaigns. Videos promoting vaccines have a narrow scope focusing solely on facts, and less on the emotional and narrative elements of communication that can be equally persuasive. The role of humor, for example, has remained largely unexplored. Objective: This study investigates whether theory-based videos can change people's attitudes, beliefs, and intentions to receive the second COVID-19 vaccine. Our primary research question is: How do collectivistic and individualistic appeals, humor, and protagonist gender individually and jointly affect vaccination attitudes, beliefs, and intentions? Methods: This project tapped into the underutilized Indian film industry-the world's largest film producer-to promote vaccination messaging through short videos. Feedback from a community advisory board was utilized to inform the video scripts that were then shot by a production team. Eight videos were filmed and shared by adopting a 2 (appeal: individualistic or collectivistic) x 2 (tone: humor or non-humor) x 2 (protagonist gender: male or female) between-subjects design approach. Our sample includes Odia-speaking participants aged between 18 - 35 years old randomly assigned to watch one of the eight study videos. An online survey questionnaire, social media network analysis, and small group qualitative interviews will be utilized to explore how the entertainment-education videos can be used to reduce vaccine hesitancy. Discussion: Vaccine messages do not fall into a cultural or cognitive vacuum. People process and make sense of information based on their prior experience, properties of the message, and their social environment. Yet, these considerations have taken secondary importance in vaccine communications. This research shows that it is possible to deliver high-caliber videos created in accordance with the audience's cultural and cognitive background. Conclusions: This study will inform future health promotion messaging through brief videos on the internet.
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Affiliation(s)
- Ananya Bhaktaram
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA,
| | - Rohini Ganjoo
- Biomedical Laboratory Sciences, George Washington University, Washington, D.C, 20052, USA,
| | - Amelia M. Jamison
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Julia Burleson
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Paola Pascual-Ferra
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Neil Alperstein
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Daniel J. Barnett
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA,Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Satyanarayan Mohanty
- D-Cor (Development Corner) Consulting Pvt. Ltd, Satya Nagar, Bhubaneswar, Odisha, 751008, India
| | | | - Manoj Parida
- D-Cor (Development Corner) Consulting Pvt. Ltd, Satya Nagar, Bhubaneswar, Odisha, 751008, India
| | - Eleanor Kluegel
- Department of Communication, Loyola University of Maryland, Baltimore, MD, 21210, USA
| | - Sidharth Rath
- Swasthya Plus, Odisha, India, Chandrasekharpur, Bhubaneswar, Odisha, 751017, India
| | - Rajiv N. Rimal
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
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12
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Broniatowski DA, Kerchner D, Farooq F, Huang X, Jamison AM, Dredze M, Quinn SC, Ayers JW. Twitter and Facebook posts about COVID-19 are less likely to spread misinformation compared to other health topics. PLoS One 2022; 17:e0261768. [PMID: 35020727 PMCID: PMC8754324 DOI: 10.1371/journal.pone.0261768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic brought widespread attention to an "infodemic" of potential health misinformation. This claim has not been assessed based on evidence. We evaluated if health misinformation became more common during the pandemic. We gathered about 325 million posts sharing URLs from Twitter and Facebook during the beginning of the pandemic (March 8-May 1, 2020) compared to the same period in 2019. We relied on source credibility as an accepted proxy for misinformation across this database. Human annotators also coded a subsample of 3000 posts with URLs for misinformation. Posts about COVID-19 were 0.37 times as likely to link to "not credible" sources and 1.13 times more likely to link to "more credible" sources than prior to the pandemic. Posts linking to "not credible" sources were 3.67 times more likely to include misinformation compared to posts from "more credible" sources. Thus, during the earliest stages of the pandemic, when claims of an infodemic emerged, social media contained proportionally less misinformation than expected based on the prior year. Our results suggest that widespread health misinformation is not unique to COVID-19. Rather, it is a systemic feature of online health communication that can adversely impact public health behaviors and must therefore be addressed.
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Affiliation(s)
- David A. Broniatowski
- Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, United States of America
- Institute for Data, Democracy and Politics, The George Washington University, Washington, DC, United States of America
| | - Daniel Kerchner
- George Washington University Libraries, The George Washington University, Washington, DC, United States of America
| | - Fouzia Farooq
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Xiaolei Huang
- Department of Computer Science, University of Memphis, Memphis, TN, United States of America
| | - Amelia M. Jamison
- Department of Family Science, Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, United States of America
| | - Mark Dredze
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sandra Crouse Quinn
- Department of Family Science, Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, United States of America
| | - John W. Ayers
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States of America
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13
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Passmore SR, Jamison AM, Abdelwadoud M, Rogers TB, Wiggan M, Mullins DC, Thomas SB. Use of a Qualitative Story Deck to Create Scenarios and Uncover Factors Associated with African American Participation in Genomics Research. Field methods 2021; 33:159-174. [PMID: 34326707 PMCID: PMC8318208 DOI: 10.1177/1525822x20982089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To gain a complex understanding of willingness to participate in genomics research among African Americans, we developed a technique specifically suited to studying decision making in a relaxed social setting. The "Qualitative Story Deck," (QSD) is a gamified, structured elicitation technique that allows for the spontaneous creation of scenarios with variable attributes. We used the QSD to create research scenarios that varied on four details (race/ethnicity of the researcher; research goal; biospecimen requested; and institutional affiliation). Participants created scenarios by randomly choosing cards from these categories and provided: (1) a judgement about their willingness to participate in the research project represented; and (2) their thought process in reaching a decision. The QSD has applicability to topics involving decision making or in cases where it would be beneficial to provide vignettes with alternate attributes. Additional benefits include: rapid establishment of rapport and engagement and the facilitation of discussion of little known or sensitive topics.
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14
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Quinn SC, Jamison AM, Freimuth V. Communicating Effectively About Emergency Use Authorization and Vaccines in the COVID-19 Pandemic. Am J Public Health 2021; 111:355-358. [PMID: 33237801 PMCID: PMC7893369 DOI: 10.2105/ajph.2020.306036] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sandra Crouse Quinn
- Sandra Crouse Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland. Vicki Freimuth is with Center for Health and Risk Communication (Emeritus), University of Georgia, Athens
| | - Amelia M Jamison
- Sandra Crouse Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland. Vicki Freimuth is with Center for Health and Risk Communication (Emeritus), University of Georgia, Athens
| | - Vicki Freimuth
- Sandra Crouse Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland. Vicki Freimuth is with Center for Health and Risk Communication (Emeritus), University of Georgia, Athens
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15
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Broniatowski DA, Jamison AM, Johnson NF, Velasquez N, Leahy R, Restrepo NJ, Dredze M, Quinn SC. Facebook Pages, the "Disneyland" Measles Outbreak, and Promotion of Vaccine Refusal as a Civil Right, 2009-2019. Am J Public Health 2020; 110:S312-S318. [PMID: 33001718 DOI: 10.2105/ajph.2020.305869] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To understand changes in how Facebook pages frame vaccine opposition.Methods. We categorized 204 Facebook pages expressing vaccine opposition, extracting public posts through November 20, 2019. We analyzed posts from October 2009 through October 2019 to examine if pages' content was coalescing.Results. Activity in pages promoting vaccine choice as a civil liberty increased in January 2015, April 2016, and January 2019 (t[76] = 11.33 [P < .001]; t[46] = 7.88 [P < .001]; and t[41] = 17.27 [P < .001], respectively). The 2019 increase was strongest in pages mentioning US states (t[41] = 19.06; P < .001). Discussion about vaccine safety decreased (rs[119] = -0.61; P < .001) while discussion about civil liberties increased (rs[119] = 0.33; Py < .001]). Page categories increasingly resembled one another (civil liberties: rs[119] = -0.50 [P < .001]; alternative medicine: rs[84] = -0.77 [P < .001]; conspiracy theories: rs[119] = -0.46 [P < .001]; morality: rs[106] = -0.65 [P < .001]; safety and efficacy: rs[119] = -0.46 [P < .001]).Conclusions. The "Disneyland" measles outbreak drew vaccine opposition into the political mainstream, followed by promotional campaigns conducted in pages framing vaccine refusal as a civil right. Political mobilization in state-focused pages followed in 2019.Public Health Implications. Policymakers should expect increasing attempts to alter state legislation associated with vaccine exemptions, potentially accompanied by fiercer lobbying from specific celebrities.
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Affiliation(s)
- David A Broniatowski
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Amelia M Jamison
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Neil F Johnson
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Nicolás Velasquez
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Rhys Leahy
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Nicholas Johnson Restrepo
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Mark Dredze
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
| | - Sandra C Quinn
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, and the Institute for Data, Democracy, and Politics, The George Washington University, Washington, DC. Amelia M. Jamison is with the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Neil F. Johnson is with the Institute for Data, Democracy, and Politics, and the Department of Physics, and the Corcoran College of Arts and Sciences, The George Washington University. Nicolás Velasquez, Rhys Leahy, and Nicholas Johnson Restrepo are with the Institute for Data, Democracy, and Politics, The George Washington University. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Sandra C. Quinn is with the Maryland Center for Health Equity, School of Public Health, and the Department of Family Science, School of Public Health, University of Maryland
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Jamison AM, Broniatowski DA, Dredze M, Sangraula A, Smith MC, Quinn SC. Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter. Harv Kennedy Sch Misinformation Rev 2020; 1:10.37016/mr-2020-38. [PMID: 34368805 PMCID: PMC8345314 DOI: 10.37016/mr-2020-38] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In February 2020, the World Health Organization announced an 'infodemic' -- a deluge of both accurate and inaccurate health information -- that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the 'infodemic' during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the 'infodemic,' researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information -- from both reliable and unreliable sources -- that the public is likely to encounter online.
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Affiliation(s)
| | - David A Broniatowski
- Institute for Data, Democracy, and Politics & Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, USA
| | - Anu Sangraula
- Center for Health Equity, University of Maryland, USA
| | - Michael C Smith
- Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Sandra C Quinn
- Department of Family Science & Center for Health Equity, University of Maryland, USA
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Jamison AM, Broniatowski DA, Dredze M, Sangraula A, Smith MC, Quinn SC. Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter. Harv Kennedy Sch Misinformation Rev 2020; 1. [PMID: 34368805 DOI: 10.37016/mr-2020-007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In February 2020, the World Health Organization announced an 'infodemic' -- a deluge of both accurate and inaccurate health information -- that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the 'infodemic' during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the 'infodemic,' researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information -- from both reliable and unreliable sources -- that the public is likely to encounter online.
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Affiliation(s)
| | - David A Broniatowski
- Institute for Data, Democracy, and Politics & Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, USA
| | - Anu Sangraula
- Center for Health Equity, University of Maryland, USA
| | - Michael C Smith
- Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Sandra C Quinn
- Department of Family Science & Center for Health Equity, University of Maryland, USA
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Jamison AM, Broniatowski DA, Dredze M, Sangraula A, Smith MC, Quinn SC. Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter. Harv Kennedy Sch Misinformation Rev 2020. [PMID: 34368805 DOI: 10.37016/mr-2020-012] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In February 2020, the World Health Organization announced an 'infodemic' -- a deluge of both accurate and inaccurate health information -- that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the 'infodemic' during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the 'infodemic,' researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information -- from both reliable and unreliable sources -- that the public is likely to encounter online.
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Affiliation(s)
| | - David A Broniatowski
- Institute for Data, Democracy, and Politics & Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, USA
| | - Anu Sangraula
- Center for Health Equity, University of Maryland, USA
| | - Michael C Smith
- Department of Engineering, Management and Systems Engineering, The George Washington University, USA
| | - Sandra C Quinn
- Department of Family Science & Center for Health Equity, University of Maryland, USA
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Affiliation(s)
- David A Broniatowski
- David A. Broniatowski is with the Institute for Data, Democracy, and Politics and the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Sandra C. Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Amelia M. Jamison is with the Maryland Center for Health Equity
| | - Sandra C Quinn
- David A. Broniatowski is with the Institute for Data, Democracy, and Politics and the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Sandra C. Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Amelia M. Jamison is with the Maryland Center for Health Equity
| | - Mark Dredze
- David A. Broniatowski is with the Institute for Data, Democracy, and Politics and the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Sandra C. Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Amelia M. Jamison is with the Maryland Center for Health Equity
| | - Amelia M Jamison
- David A. Broniatowski is with the Institute for Data, Democracy, and Politics and the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Sandra C. Quinn is with the Department of Family Science and the Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park. Mark Dredze is with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD. Amelia M. Jamison is with the Maryland Center for Health Equity
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Passmore SR, Jamison AM, Hancock GR, Abdelwadoud M, Mullins CD, Rogers TB, Thomas SB. "I'm a Little More Trusting": Components of Trustworthiness in the Decision to Participate in Genomics Research for African Americans. Public Health Genomics 2020; 22:215-226. [PMID: 31955173 PMCID: PMC7037806 DOI: 10.1159/000505271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/08/2019] [Indexed: 11/19/2022] Open
Abstract
AIMS This study sought to explore the decision to participate in genomics research for African American individuals. Our overall goal was to explore (1) the attributes that significantly contribute to willingness to participate in genomics research; (2) how these attributes are interpreted (what is their meaning?); (3) how trustworthiness is estimated in the decision to participate in research (i.e., what are the symbolic representations or heuristics of trustworthiness in decision-making?); and (4) how participants see factors to counterweigh each other. METHODS We sought a methodology that would afford exploration of the compensatory nature of decision-making where some choice attributes may be weighed differently than others as well as the use of heuristics (shortcuts to estimate key concepts in the mentally taxing task of decision-making) for concepts such as trustworthiness. We used a qualitative story deck to create hypothetical research scenarios with variable attributes (i.e., researcher race/ethnicity; institutional affiliation; research goal; and biospecimen requested) to determine how individuals find and interpret information to make decisions about research participation. These semi-structured interviews (n = 82) were conducted in African American barbershops in Baltimore City and Prince George's County, Maryland. RESULTS Quantitative and qualitative analysis was completed. Findings include that, even in the absence of interpersonal connection, trustworthiness can be communicated through multiple factors, such as (1) shared values with researchers and (2) familiarity. Conversely, (1) ambiguity, especially regarding the use of biospecimens, (2) negative reputations, and (3) perceptions of "hidden agendas" were associated with a lower willingness to participate. However, the alignment of participant and research goals was weighed more heavily in decisions than other factors. CONCLUSION This study finds that negatively assessed characteristics in research design do not result in automatic rejections of participation. Negative assessments can be mitigated by emphasizing the multiple factors that communicate trustworthiness in the consent process, which may improve rates of research participation.
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Affiliation(s)
- Susan Racine Passmore
- Collaborative Center for Health Equity, University of Wisconsin, Madison, Wisconsin, USA,
| | - Amelia M Jamison
- Center for Health Equity, University of Maryland, College Park, Maryland, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - Taylor B Rogers
- Department of Health Policy and Management, University of California, Los Angeles, California, USA
| | - Stephen B Thomas
- Department of Health Policy and Management, University of Maryland, College Park, Maryland, USA
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Lama Y, Hancock GR, Freimuth VS, Jamison AM, Quinn SC. Using classification and regression tree analysis to explore parental influenza vaccine decisions. Vaccine 2019; 38:1032-1039. [PMID: 31806534 DOI: 10.1016/j.vaccine.2019.11.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Influenza poses a public health threat for children and adults. The CDC recommends annual influenza vaccination for children <18 years, yet vaccine uptake remains low for children (57.9%) and adults (37.1%). Given that parental decision-making is key in childhood vaccine uptake, there is a critical need to understand vaccine hesitancy among parents who decide not to vaccinate their children. This study aims to explore predictors of children's influenza vaccine status given parental vaccination status and examine the factors that contribute to concordance or discordance between parental and children's vaccine uptake. METHODS Classification and regression tree (CART) analyses were used to identify drivers of parental decisions to vaccinate their children against influenza. Hierarchy and interactions of these variables in predicting children's vaccination status were explored. RESULTS From a nationally representative sample of non-Hispanic Black and White parents who completed an online survey (n = 328), the main factors influencing parents' decisions to vaccinate their children were vaccine behavior following physician recommendation, knowledge of influenza recommendations for children, influenza vaccine confidence and disease risk. Among unvaccinated parents, the greatest concordance was observed among parents who usually do not get vaccinated following physician recommendation and had lower knowledge of recommendations for influenza vaccination for children. The greatest discordance was observed among unvaccinated parents who had lower hesitancy about recommended vaccines. CONCLUSIONS Understanding drivers of parental decisions to vaccinate themselves and their children can provide insights on health communication and provider approaches to increase influenza vaccine coverage and prevent influenza related mortality.
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Affiliation(s)
- Yuki Lama
- Department of Family Science, University of Maryland, College Park, MD, United States.
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States
| | - Amelia M Jamison
- Center for Health Equity, University of Maryland, College Park, MD, United States
| | - Sandra Crouse Quinn
- Department of Family Science, University of Maryland, College Park, MD, United States; Center for Health Equity, University of Maryland, College Park, MD, United States
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Jamison AM, Broniatowski DA, Dredze M, Wood-Doughty Z, Khan D, Quinn SC. Vaccine-related advertising in the Facebook Ad Archive. Vaccine 2019; 38:512-520. [PMID: 31732327 DOI: 10.1016/j.vaccine.2019.10.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2018, Facebook introduced Ad Archive as a platform to improve transparency in advertisements related to politics and "issues of national importance." Vaccine-related Facebook advertising is publicly available for the first time. After measles outbreaks in the US brought renewed attention to the possible role of Facebook advertising in the spread of vaccine-related misinformation, Facebook announced steps to limit vaccine-related misinformation. This study serves as a baseline of advertising before new policies went into effect. METHODS Using the keyword 'vaccine', we searched Ad Archive on December 13, 2018 and again on February 22, 2019. We exported data for 505 advertisements. A team of annotators sorted advertisements by content: pro-vaccine, anti-vaccine, not relevant. We also conducted a thematic analysis of major advertising themes. We ran Mann-Whitney U tests to compare ad performance metrics. RESULTS 309 advertisements were included in analysis with 163 (53%) pro-vaccine advertisements and 145 (47%) anti-vaccine advertisements. Despite a similar number of advertisements, the median number of ads per buyer was significantly higher for anti-vaccine ads. First time buyers are less likely to complete disclosure information and risk ad removal. Thematically, anti-vaccine advertising messages are relatively uniform and emphasize vaccine harms (55%). In contrast, pro-vaccine advertisements come from a diverse set of buyers (83 unique) with varied goals including promoting vaccination (49%), vaccine related philanthropy (15%), and vaccine related policy (14%). CONCLUSIONS A small set of anti-vaccine advertisement buyers have leveraged Facebook advertisements to reach targeted audiences. By deeming all vaccine-related content an issue of "national importance," Facebook has further the politicized vaccines. The implementation of a blanket disclosure policy also limits which ads can successfully run on Facebook. Improving transparency and limiting misinformation should not be separate goals. Public health communication efforts should consider the potential impact on Facebook users' vaccine attitudes and behaviors.
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Affiliation(s)
- Amelia M Jamison
- Center for Health Equity, 3302 School of Public Health Building, 4200 Valley Drive, University of Maryland, College Park, MD, USA.
| | - David A Broniatowski
- Department of Engineering Management & Systems Engineering, School of Engineering & Applied Sciences, George Washington University, Washington DC, USA
| | - Mark Dredze
- Computer Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Zach Wood-Doughty
- Computer Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - DureAden Khan
- Center for Health Equity, 3302 School of Public Health Building, 4200 Valley Drive, University of Maryland, College Park, MD, USA
| | - Sandra Crouse Quinn
- Center for Health Equity, 3302 School of Public Health Building, 4200 Valley Drive, University of Maryland, College Park, MD, USA; Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
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Quinn SC, Jamison AM, Freimuth VS. Measles outbreaks and public attitudes towards vaccine exemptions: some cautions and strategies for addressing vaccine hesitancy. Hum Vaccin Immunother 2019; 16:1050-1054. [PMID: 31403354 DOI: 10.1080/21645515.2019.1646578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Today, the United States and countries throughout the world are experiencing measles outbreaks that have sickened thousands of children. From the Disneyland outbreak in 2014 to today, some states have responded with changes in laws on vaccine requirements and exemptions. In this article, we examine the history of vaccine laws, and using our 2015 survey data, explore to what extent the news coverage of the Disneyland outbreak altered parents' attitudes toward required vaccination and non-medical exemptions. We explore those results in the context of today's increasing polarized and politicalized battle over vaccine laws, and consider how health care providers and policy makers can work to improve public attitudes about vaccines.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.,Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA
| | - A M Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA
| | - V S Freimuth
- Center for Health And Risk Communication (Emerita), University of Georgia, Athens, GA, USA
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Abstract
Social bots and other malicious actors have a significant presence on Twitter. It is increasingly clear that some of their activities can have a negative impact on public health. This guide provides an overview of the types of malicious actors currently active on Twitter by highlighting the characteristic behaviors and strategies employed. It covers both automated accounts (including traditional spambots, social spambots, content polluters, and fake followers) and human users (primarily trolls). It also addresses the unique threat of state-sponsored trolls. We utilize examples from our own research on vaccination to illustrate. The diversity of malicious actors and their multifarious goals adds complexity to research efforts that use Twitter. Bots are now part of the social media landscape, and although it may not be possible to stop their influence, it is vital that public health researchers and practitioners recognize the potential harms and develop strategies to address bot- and troll-driven messages.
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Affiliation(s)
- Amelia M Jamison
- Amelia M. Jamison is with the Center for Health Equity, School of Public Health, University of Maryland, College Park. David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC. Sandra Crouse Quinn is with the Department of Family Science and the Center for Health Equity, School of Public Health, University of Maryland
| | - David A Broniatowski
- Amelia M. Jamison is with the Center for Health Equity, School of Public Health, University of Maryland, College Park. David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC. Sandra Crouse Quinn is with the Department of Family Science and the Center for Health Equity, School of Public Health, University of Maryland
| | - Sandra Crouse Quinn
- Amelia M. Jamison is with the Center for Health Equity, School of Public Health, University of Maryland, College Park. David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC. Sandra Crouse Quinn is with the Department of Family Science and the Center for Health Equity, School of Public Health, University of Maryland
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Quinn SC, Jamison AM, An J, Hancock GR, Freimuth VS. Measuring vaccine hesitancy, confidence, trust and flu vaccine uptake: Results of a national survey of White and African American adults. Vaccine 2019; 37:1168-1173. [DOI: 10.1016/j.vaccine.2019.01.033] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
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Huang X, Smith MC, Jamison AM, Broniatowski DA, Dredze M, Quinn SC, Cai J, Paul MJ. Can online self-reports assist in real-time identification of influenza vaccination uptake? A cross-sectional study of influenza vaccine-related tweets in the USA, 2013-2017. BMJ Open 2019; 9:e024018. [PMID: 30647040 PMCID: PMC6340631 DOI: 10.1136/bmjopen-2018-024018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) spend significant time and resources to track influenza vaccination coverage each influenza season using national surveys. Emerging data from social media provide an alternative solution to surveillance at both national and local levels of influenza vaccination coverage in near real time. OBJECTIVES This study aimed to characterise and analyse the vaccinated population from temporal, demographical and geographical perspectives using automatic classification of vaccination-related Twitter data. METHODS In this cross-sectional study, we continuously collected tweets containing both influenza-related terms and vaccine-related terms covering four consecutive influenza seasons from 2013 to 2017. We created a machine learning classifier to identify relevant tweets, then evaluated the approach by comparing to data from the CDC's FluVaxView. We limited our analysis to tweets geolocated within the USA. RESULTS We assessed 1 124 839 tweets. We found strong correlations of 0.799 between monthly Twitter estimates and CDC, with correlations as high as 0.950 in individual influenza seasons. We also found that our approach obtained geographical correlations of 0.387 at the US state level and 0.467 at the regional level. Finally, we found a higher level of influenza vaccine tweets among female users than male users, also consistent with the results of CDC surveys on vaccine uptake. CONCLUSION Significant correlations between Twitter data and CDC data show the potential of using social media for vaccination surveillance. Temporal variability is captured better than geographical and demographical variability. We discuss potential paths forward for leveraging this approach.
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Affiliation(s)
- Xiaolei Huang
- Department of Information Science, University of Colorado, Boulder, Colorado, USA
| | - Michael C Smith
- Department of Engineering Management and Systems Engineering, George Washington University, Washington, District of Columbia, USA
| | - Amelia M Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, George Washington University, Washington, District of Columbia, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sandra Crouse Quinn
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Justin Cai
- Department of Computer Science, University of Colorado, Boulder, Colorado, USA
| | - Michael J Paul
- Department of Information Science, University of Colorado, Boulder, Colorado, USA
- Department of Computer Science, University of Colorado, Boulder, Colorado, USA
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27
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Jamison AM, Quinn SC, Freimuth VS. "You don't trust a government vaccine": Narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med 2018; 221:87-94. [PMID: 30576982 DOI: 10.1016/j.socscimed.2018.12.020] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 01/21/2023]
Abstract
Vaccine confidence depends on trust in vaccines as products and trust in the system that produces them. In the US, this system consists of a complex network connecting pharmaceutical companies, government agencies, and the healthcare system. We explore narratives from White and African American adults describing their trust in these institutions, with a focus on influenza vaccine. Our data were collected between 2012 and 2014 as part of a mixed-methods investigation of racial disparities in influenza immunization. We interviewed 119 adults, primarily in Maryland and Washington, DC, in three stages utilizing semi-structured interviews (12), focus groups (9, n = 91), and in-depth interviews (16). Analysis was guided by grounded theory. Trust in institutions emerged as a significant theme, with marked differences by race. In 2018, we contextualized these findings within the growing scholarship on trust and vaccines. Most participants distrusted pharmaceutical companies, which were viewed to be motivated by profit. Trust in government varied. Whites described implicit trust of federal institutions but questioned their competency. African Americans were less trusting of the government and were more likely to doubt its motives. Trust in institutions may be fragile, and once damaged, may take considerable time and effort to repair.
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Affiliation(s)
- Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Sandra Crouse Quinn
- Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA; Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, 107 Paul Coverdell Center, Athens, GA, 30602, USA.
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Broniatowski DA, Jamison AM, Qi S, AlKulaib L, Chen T, Benton A, Quinn SC, Dredze M. Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate. Am J Public Health 2018; 108:1378-1384. [PMID: 30138075 DOI: 10.2105/ajph.2018.304567] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To understand how Twitter bots and trolls ("bots") promote online health content. METHODS We compared bots' to average users' rates of vaccine-relevant messages, which we collected online from July 2014 through September 2017. We estimated the likelihood that users were bots, comparing proportions of polarized and antivaccine tweets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity. RESULTS Compared with average users, Russian trolls (χ2(1) = 102.0; P < .001), sophisticated bots (χ2(1) = 28.6; P < .001), and "content polluters" (χ2(1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ2(1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ2(1) = 12.1; P < .001) and antivaccine (χ2(1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive. CONCLUSIONS Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination. Public Health Implications. Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.
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Affiliation(s)
- David A Broniatowski
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Amelia M Jamison
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - SiHua Qi
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Lulwah AlKulaib
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Tao Chen
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Adrian Benton
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Sandra C Quinn
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Mark Dredze
- David A. Broniatowski is with the Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC. Amelia M. Jamison and Sandra C. Quinn are with the Department of Family Science, School of Public Health, University of Maryland, College Park. Sihua Qi and Lulwah Alkulaib are with the Department of Computer Science, School of Engineering and Applied Science, The George Washington University. Tao Chen, Adrian Benton, and Mark Dredze are with the Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
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Quinn SC, Hilyard KM, Jamison AM, An J, Hancock GR, Musa D, Freimuth VS. The influence of social norms on flu vaccination among African American and White adults. Health Educ Res 2017; 32:473-486. [PMID: 29220514 PMCID: PMC5914409 DOI: 10.1093/her/cyx070] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/17/2017] [Indexed: 05/14/2023]
Abstract
Adult influenza vaccination rates remain suboptimal, particularly among African Americans. Social norms may influence vaccination behavior, but little research has focused on influenza vaccine and almost no research has focused on racially-specific norms. This mixed methods investigation utilizes qualitative interviews and focus groups (n = 118) and national survey results (n = 1643) to assess both descriptive and subjective norms surrounding influenza vaccination. Qualitative results suggest a perceived descriptive norm that 'about half' of the population gets vaccinated. Participants describe differing norms by race and vaccine behavior. Quantitative results confirm a perceived descriptive norm that 40-60% of the population gets vaccinated. Both African Americans and Whites accurately identified race-specific vaccination rates relative to the general population. Individuals who report that a majority of people around them want them to be vaccinated were significantly more likely to be vaccinated, suggesting subjective norms are influential for both White and African American adults. While perceived descriptive norms are somewhat accurate (mirroring the actual influenza vaccination rate), emphasizing a suboptimal vaccination rate may not be beneficial. Health promotion efforts, particularly those targeting African Americans, may benefit from focusing on subjective norms and encouraging friends and family members to talk about the benefits of influenza vaccination.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, 1142 School of Public Health Building, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
- Maryland Center for Health Equity, 3302 School of Public Health Building, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
- Correspondence to: S. C. Quinn. E-mail:
| | - Karen M Hilyard
- FHI 360, Social Marketing and Communication Division, 13 Corporate Boulevard, Suite 250, Atlanta, GA 30329, USA
| | - Amelia M Jamison
- Maryland Center for Health Equity, 3302 School of Public Health Building, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Ji An
- Department of Human Development and Quantitative Methodology, College of Education, University of Maryland, 3119 Benjamin Building, College Park, MD 20742, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, College of Education, University of Maryland, 3119 Benjamin Building, College Park, MD 20742, USA
| | - Donald Musa
- Center for Social and Urban Research, University of Pittsburgh, 3343 Forbes Avenue, Pittsburgh, PA 15260, USA
| | - Vicki S Freimuth
- Center for Health Risk and Communication, Department of Communication Studies, University of Georgia, 617 Caldwell Hall, Athens, GA 30602, USA
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Crouse Quinn S, Jamison AM, Freimuth VS, An J, Hancock GR. Determinants of influenza vaccination among high-risk Black and White adults. Vaccine 2017; 35:7154-7159. [PMID: 29126805 DOI: 10.1016/j.vaccine.2017.10.083] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. METHODS We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (≥18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. RESULTS 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never.ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. CONCLUSIONS This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake.We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742-2611, United States.
| | - Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, College Park, MD, United States
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States
| | - Ji An
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
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Freimuth VS, Jamison AM, An J, Hancock GR, Quinn SC. Determinants of trust in the flu vaccine for African Americans and Whites. Soc Sci Med 2017; 193:70-79. [PMID: 29028558 DOI: 10.1016/j.socscimed.2017.10.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/22/2023]
Abstract
Trust is thought to be a major factor in vaccine decisions, but few studies have empirically tested the role of trust in adult immunization. Utilizing a 2015 national survey of African American and White adults (n = 1630), we explore multiple dimensions of trust related to influenza immunization, including generalized trust, trust in the flu vaccine, and trust in the vaccine production process. We find African Americans report lower trust than Whites across all trust measures. When considering demographic, racial, and ideological predictors, generalized trust shows statistically significant effects on both trust in the flu vaccine and trust in the vaccine process. When controlling for demographic, racial, and ideological variables, higher generalized trust was significantly associated with higher trust in the flu vaccine and the vaccine process. When controlling for generalized trust, in addition to the baseline covariates, psychosocial predictors (i.e. risk perception, social norms, knowledge) are significant predictors of trust in flu vaccine and trust in the vaccine process, with significant differences by race. These findings suggest that trust in vaccination is complex, and that significant differences in trust between White and African American adults may be contributing to disparities in influenza immunization.
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Affiliation(s)
- Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, USA
| | - Amelia M Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ji An
- Department of Human Development and Quantitative Methodology, College of Education, University of Maryland, College Park, MD, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, College of Education, University of Maryland, College Park, MD, USA
| | - Sandra Crouse Quinn
- Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA; Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.
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Sangaramoorthy T, Jamison AM, Boyle MD, Payne-Sturges DC, Sapkota A, Milton DK, Wilson SM. Place-based perceptions of the impacts of fracking along the Marcellus Shale. Soc Sci Med 2016; 151:27-37. [PMID: 26773295 DOI: 10.1016/j.socscimed.2016.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/22/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Abstract
We examined community perspectives and experiences with fracking in Doddridge County, West Virginia, USA as part of a larger assessment to investigate the potential health impacts associated with fracking in neighboring Maryland, USA. In November 2013, we held two focus groups with community residents who had been impacted by fracking operations and conducted field observations in the impacted areas. Employing grounded theory, we conducted qualitative analysis to explore emergent themes related to direct and indirect health impacts of fracking. Three components of experience were identified, including (a) meanings of place and identity, (b) transforming relationships, and (c) perceptions of environmental and health impacts. Our findings indicate that fracking contributes to a disruption in residents' sense of place and social identity, generating widespread social stress. Although community residents acknowledged the potential for economic growth brought about by fracking, rapid transformations in meanings of place and social identity influenced residents' perceptions of environmental and health impacts. Our findings suggest that in order to have a more complete understanding of the health impacts of fracking, future work must consider the complex linkages between social disruption, environmental impacts, and health outcomes through critical engagements with communities undergoing energy development.
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Affiliation(s)
- Thurka Sangaramoorthy
- Department of Anthropology, University of Maryland, 1111 Woods Hall, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Amelia M Jamison
- Department of Epidemiology and Biostatistics, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Meleah D Boyle
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Devon C Payne-Sturges
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Sacoby M Wilson
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
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