Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents' H1N1 vaccination of their children

A prospective study of influenza vaccination and time to pregnancy

BACKGROUND

Although pregnancy planners are a priority group for influenza vaccination in the United States, little is known about the extent to which influenza vaccination affects fecundability.

METHODS

We analyzed data from Pregnancy Study Online (PRESTO), an ongoing preconception cohort study of North American pregnancy planners. During June 2013 to August 2019, 8654 female participants and 2137 of their male partners completed a baseline questionnaire and were followed until reported pregnancy, fertility treatment initiation, loss to follow-up, or 12 menstrual cycles of attempt time, whichever came first. At baseline, male and female participants reported whether they received an influenza vaccination in the past year and the date of vaccination. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI) comparing those who did and did not report influenza vaccination, adjusting for demographics, anthropometrics, behavioral factors, and medical history.

RESULTS

Influenza vaccination in the past year was more common among female participants than male participants (47% vs. 37%). FRs were 1.04 (95% CI: 0.98-1.10) for female vaccination and 1.03 (95% CI: 0.93-1.14) for male vaccination. Among the 2137 couples with complete data on both partners, for 40% neither partner was vaccinated, 23% had female-only vaccination, 9% had male-only vaccination, and in 28% both partners were vaccinated. Compared with couples in which neither participant was vaccinated, FRs were 1.13 for female-only vaccination (95% CI: 0.99-1.29), 0.94 for male-only vaccination (95% CI: 0.78-1.12), and 1.07 when both partners were vaccinated (95% CI: 0.94-1.21). When restricted to recent vaccination before peak influenza season, results were similar.

CONCLUSIONS

Our data indicate no adverse effect of influenza vaccination on fecundability.

Seasonal Influenza Vaccination among Saudi Children: Parental Barriers and Willingness to Vaccinate Their Children

Influenza is an acute respiratory infection. It is a contagious viral illness which can cause moderate to severe symptoms. However, high-risk groups, including children, can develop a severe condition requiring hospitalization that may, in severe cases, result in death. This study aimed to assess the knowledge and attitudes of Saudi parents toward the influenza vaccine and identify potential barriers to receiving the influenza vaccination. A cross-sectional survey was conducted using a questionnaire comprising 27 validated questions to assess parental awareness, knowledge, and attitudes toward the influenza vaccine. The overall attitude of the participants was positive (94.7%). However, their knowledge was generally poor (61.7%). Most participants were aware of the seasonal influenza vaccine (85.5%) and their children were up-to-date with the child national vaccination program vaccines (92.7%). Medical staff and awareness campaigns were the commonest sources of vaccine information. Significant predictors for knowledge about and attitudes toward the influenza vaccine included educational level, working in the medical field, monthly income, awareness of the seasonal influenza vaccine, having received the vaccine as parent, and having a child already vaccinated. Adherence to the influenza vaccination regimen for parents and their children was low. More educational campaigns are needed to increase knowledge about the vaccine.

Do previously held vaccine attitudes dictate the extent and influence of vaccine information-seeking behavior during pregnancy?

Pregnancy represents a high information need state, where uncertainty around medical intervention is common. As such, the pertussis vaccination given during pregnancy presents a unique opportunity to study the interaction between vaccine attitudes and vaccine information-seeking behavior. We surveyed a sample of pregnant women (N = 182) during early pregnancy and again during late pregnancy. The variables of vaccine confidence and risk perception of vaccination during pregnancy were measured across two questionnaires. Additional variables of decision conflict and intention to vaccinate were recorded during early pregnancy, while vaccine information-seeking behavior and vaccine uptake were recorded during late pregnancy. 88.8% of participants reported seeking additional information about the pertussis vaccine during pregnancy. Women that had a lower confidence in vaccination (p = .004) and those that saw the risk of pertussis disease as high compared to the risk of side effects from the pertussis vaccination during pregnancy (p = .004) spent significantly more time seeking information about the pertussis vaccination. Women's perception of risk related to vaccination during pregnancy significantly changed throughout the pregnancy (t(182) = 4.685 p< .001), with women perceiving the risk of pertussis disease higher as compared to the risk of side effects from the vaccine as the pregnancy progresses. The strength and influence of information found through seeking was predicted by intention to vaccinate (p = .011). As such, we suggest that intention to vaccinate during early pregnancy plays a role in whether the information found through seeking influences women towards or away from vaccination.

Incorporating media data into a model of infectious disease transmission

Understanding the effect of media on disease spread can help improve epidemic forecasting and uncover preventive measures to slow the spread of disease. Most previously introduced models have approximated media effect through disease incidence, making media influence dependent on the size of epidemic. We propose an alternative approach, which relies on real data about disease coverage in the news, allowing us to model low incidence/high interest diseases, such as SARS, Ebola or H1N1. We introduce a network-based model, in which disease is transmitted through local interactions between individuals and the probability of transmission is affected by media coverage. We assume that media attention increases self-protection (e.g. hand washing and compliance with social distancing), which, in turn, decreases disease model. We apply the model to the case of H1N1 transmission in Mexico City in 2009 and show how media influence-measured by the time series of the weekly count of news articles published on the outbreak-helps to explain the observed transmission dynamics. We show that incorporating the media attention based on the observed media coverage of the outbreak better estimates the disease dynamics from what would be predicted by using media function that approximate the media impact using the number of cases and rate of spread. Finally, we apply the model to a typical influenza season in Washington, DC and estimate how the transmission pattern would have changed given different levels of media coverage.

Association between social capital and second dose of measles vaccination in Japan: Results from the A-CHILD study

BACKGROUND AND OBJECTIVES

Measles vaccination is important to prevent outbreak, and social capital can be an important preventive factor. However, there have been very few studies that investigated the association between social capital and measles vaccination, especially the second dose, which is more likely to be suboptimal. This study aimed to investigate the association between social capital and second dose of measles vaccine.

METHODS

Data were derived from a population-based study of first-grade elementary school children (6-7 years old) in Adachi City, Tokyo. Caregivers were asked to complete a questionnaire, and 4291 of them provided a valid response (response rate: 80.1%). Among these 4291 valid responses, 69 responses were excluded since variables for social capital measures were missing, which resulted in analytic sample size of 4222. We analyzed the association between measles vaccination and social capital including social ties, social trust and mutual aid by multilevel logistic regression analysis with a random intercept model.

RESULTS

About 8.9% of the children did not receive a second dose of measles-containing vaccines. After covariates adjustments, increase of one-standard-deviation of poor individual-level social ties showed 11% lower odds of receiving measles-containing vaccines (OR: 0.89, 95% CI: 0.80-0.99). By contrast, no significant association between community-level social ties and measles vaccination was found. Regarding social trust, no significant association between individual-level social trust and measles vaccination was found. However, increase of one-standard-deviation of poor community-level social trust showed 11% lower odds of receiving measles-containing vaccines (OR: 0.89, 95% CI: 0.79-0.998). There was no association between mutual aid and measles vaccination.

CONCLUSION

Social ties and social trust were associated with second dose of measles vaccination. Fostering social capital may be effective in raising the low rate of second dose of measles vaccine.

Community-level social capital, parental psychological distress, and child physical abuse: a multilevel mediation analysis

PURPOSE

The purpose of this study was to investigate the association between community-level social capital and physical abuse towards children, and the mediating effect of parental psychological distress by multilevel mediation analyses.

METHODS

We analyzed data from a population-based study of first-grade elementary school children (6-7 years old) in Adachi City, Tokyo, Japan. The caregivers of first-grade students from all elementary schools in Adachi City (N = 5355) were asked to respond to a questionnaire assessing parents' self-reported physical abuse (beating and hitting) and neighborhood social capital. Among them, 4291 parents returned valid responses (response rate 80.1%). We performed multilevel analyses to determine the relationships between community-level parental social capital and physical abuse, and further multilevel mediation analyses were performed to determine whether parental psychological distress mediated the association.

RESULTS

Low community-level social capital was positively associated with physical abuse (both beating and hitting) after adjustment for other individual covariates (beating: middle, OR = 1.54, 95% CI 1.11-2.13; low, OR = 1.33, 95% CI 0.94-1.88; and hitting: middle, OR = 1.35, 95% CI 1.02-1.80; low, OR = 1.16, 95% CI 0.86-1.57). Multilevel mediation analyses revealed that community-level parental psychological distress did not mediate the association (indirect effect ß = 0.10, 95% CI - 0.10 to 0.29, p = 0.34 for beating; ß = 0.03, 95% CI - 0.16 to 0.23, p = 0.74 for hitting).

CONCLUSIONS

Fostering community-level social capital might be important for developing a strategy to prevent child maltreatment, which may have a direct impact on abusive behavior towards children.

Communicating Online Diet-Nutrition Information and Influencing Health Behavioral Intention: The Role of Risk Perceptions, Problem Recognition, and Situational Motivation

Despite the concerns raised about the impact of online health information on users, research has not specifically explored different types of information behaviors people exhibit during the communicative process. In this article, we address this research gap by combining the Situational Theory of Problem Solving with considerations of multiple dimensions of risk perception, such as affective and deliberative. This study constructs a hypothetical model to explore how online users' risk perceptions and information behaviors (information seeking, forefending, and forwarding) influence their health behavioral intention. A survey collected data from 1,463 participants at two healthcare centers in China. Based on the structural equation modeling, multiple dimensions of risk perception play a distinctive role in communicating online health information and forming health behavioral intention. Furthermore, information forwarding, an essential information behavior, influences deliberative risk perception more than information forefending, and it is a much better predictor of individuals' health intention than information seeking. Implications and suggestions for health communication research are discussed.

The effect of maternal decisional authority on children's vaccination in East Asia

Even though they are important determinants for increasing vaccination rates in advanced and developing nations alike, maternal capacity and decisional authority have not been fully elucidated in diverse countries and cultural spheres. This study examined the effects of South Korean, Chinese, and Japanese mothers' health literacy, self-efficacy, mass media use, and decisional authority on their children's vaccination after adjustment for their socioeconomic statuses. Computer-assisted web interviews were conducted with married women in their 20s-40s of South Korean, Chinese, or Japanese nationality (n = 1,571). Dependent variables were generated for the following four vaccinations: BCG, diphtheria+pertussis+tetanus (DPT), poliomyelitis (polio), and measles. For statistical processing, cases where all four types of vaccines had been recorded were scored as 1 and other cases were processed as 0. According to the results of the pooled model, we found that for East Asian mothers, decisional authority, self-efficacy, and health literacy all increased the likelihood that they would vaccinate their children. Furthermore, women who searched for health information through media such as the radio were more likely to vaccinate their children. However, when elaborate analyses were conducted by country, there were considerable differences in those characteristics by country. Therefore, this study showed that it is necessary to establish locally tailored strategies in order to raise vaccination rates in the Global Vaccine Action Plan. This study also showed that social contexts must be taken into consideration in order to raise vaccination rates.

Parents' attitude, awareness and behaviour towards influenza vaccination in Pakistan

National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was 'immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.

Associations between media use and health information-seeking behavior on vaccinations in South Korea

BACKGROUND

Although vaccinations are critical for preventing emerging infectious diseases, scant research has been conducted on risk communication. With socio-economic characteristics, health behavior, and underlying diseases under control, we investigated associations between media use, health information-seeking behavior, health information type, and vaccination in the population.

METHODS

This study relied on a national survey of Korean adults (n = 1367). Participants were adult males and females age 20 and older. Web and face-to-face surveys were conducted throughout July 2014. The main outcome was vaccination (categorized as yes or no). Independent variables were time spent on media, frequency of health information-seeking behavior, and types of health information sought.

RESULTS

Controlling for co-variates, logistic regression analysis was conducted to identify factors that influence Korean adults being vaccinated. Results revealed that accessible information about emerging infectious diseases, listening to the radio, and reading the newspaper were associated with increased odds of being vaccinated. Active seeking health information as well as being female and of higher socio-economic status were positively correlated with Korean adults being vaccinated.

CONCLUSION

It is critical to promote health information-seeking behavior and use diverse media channels to increase acceptance and awareness of emerging infectious diseases and vaccinations. Because there are differences in vaccination awareness depending on social class, it is critical to reduce communication inequality, strengthen accessibility to vaccinations, and devise appropriate risk communication strategies that ensure Korean adults receive vaccinations.

Perceived Neighborhood Social Cohesion and Preventive Healthcare Use

INTRODUCTION

Neighborhood social cohesion has been linked with better health and health behaviors, but its association with patterns of preventive healthcare use remains understudied. The hypothesis was that people with higher perceived neighborhood social cohesion would display increased use of preventive healthcare services.

METHODS

Participants (N=7,168) were drawn from the 2006 wave of the Health and Retirement Study-a prospective and nationally representative panel study of American adults aged >50 years-and tracked for one wave (2 years). Analyses were conducted in 2016.

RESULTS

After adjusting for sociodemographic factors and baseline health, each SD increase in neighborhood social cohesion was associated with a higher likelihood that people would obtain influenza vaccinations (OR=1.09, 95% CI=1.04, 1.15) or cholesterol tests (OR=1.10, 95% CI=1.02, 1.19). Further, women were more likely to receive mammograms/x-rays (OR=1.10, 95% CI=1.01, 1.19) or Pap tests (OR=1.08, 95% CI=1.00, 1.17). However, men were not more likely to receive prostate exams (OR=1.06, 95% CI=0.96, 1.17).

CONCLUSIONS

With additional research, findings from this study may inform the development of new strategies that increase the use of preventive healthcare services and enhance the quality of life among people moving through the ranks of this aging society.

Effect of Viewing Smoking Scenes in Motion Pictures on Subsequent Smoking Desire in Audiences in South Korea

Background

In the modern era of heightened awareness of public health, smoking scenes in movies remain relatively free from public monitoring. The effect of smoking scenes in movies on the promotion of viewers’ smoking desire remains unknown.

Objective

The study aimed to explore whether exposure of adolescent smokers to images of smoking in fılms could stimulate smoking behavior.

Methods

Data were derived from a national Web-based sample survey of 748 Korean high-school students. Participants aged 16-18 years were randomly assigned to watch three short video clips with or without smoking scenes. After adjusting covariates using propensity score matching, paired sample t test and logistic regression analyses compared the difference in smoking desire before and after exposure of participants to smoking scenes.

Results

For male adolescents, cigarette craving was significantly higher in those who watched movies with smoking scenes than in the control group who did not view smoking scenes (t_307.96=2.066, P<.05). In the experimental group, too, cigarette cravings of adolescents after viewing smoking scenes were significantly higher than they were before watching smoking scenes (t_161.00=2.867, P<.01). After adjusting for covariates, more impulsive adolescents, particularly males, had significantly higher cigarette cravings: adjusted odds ratio (aOR) 3.40 (95% CI 1.40-8.23). However, those who actively sought health information had considerably lower cigarette cravings than those who did not engage in information-seeking: aOR 0.08 (95% CI 0.01-0.88).

Conclusions

Smoking scenes in motion pictures may increase male adolescent smoking desire. Establishing a standard that restricts the frequency of smoking scenes in films and assigning a smoking-related screening grade to films is warranted.

Consumer Health Informatics: Promoting Patient Self-care Management of Illnesses and Health

Consumer health informatics (CHI) is propelling important changes for medical providers and the lives of patients through information and communications technology. Independently, medical consumers seek, collect, and use health information for decision making. However, when constructing a CHI-based medical platform, high technology must be applied in a fully understandable and usable format for both health care providers and consumers. This study examines the present status of CHI and its effect on medical consumers. For the development of CHI, we discuss the need for tailored health communications and capacity building with chronic patients at the medical center. First, empowerment is a key characteristic needed for medical consumer health care management. However, promoting patient self-care management of illnesses and health is necessary to create conjugation where cooperation with medical service providers is possible. Also, establishing a health care delivery system that will support cooperation is necessary. Second, tailored health communications can uniquely construct the health information of patients, which prevents unnecessary or excessive information from leading patients to confused and inappropriate decisions. Ultimately, through the present environment of health communication, the innovation of a consumer health care information system has become the tide of the times and the positive effect of improved health can be expected.

Predictors of self and parental vaccination decisions in England during the 2009 H1N1 pandemic: Analysis of the Flu Watch pandemic cohort data

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To our knowledge, this is a first joint examination of general UK H1N1 self and parental vaccination.

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Data collected during the Flu Watch study (798 adults, 85 children) were analysed.

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Vaccine concerns and perceived H1N1 risk predicted self and parental vaccination.

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Addressing these issues in future could influence self and parental vaccination.

During the 2009 H1N1 pandemic, UK uptake of the pandemic influenza vaccine was very low. Furthermore, attitudes governing UK vaccination uptake during a pandemic are poorly characterised. To the best of our knowledge, there is no published research explicitly considering predictors of both adult self-vaccination and decisions regarding whether or not to vaccinate one’s children among the UK population during the H1N1 pandemic. We therefore aimed to identify predictors of both self-vaccination decisions and parental vaccination decisions using data collected during the H1N1 pandemic as part of the Flu Watch cohort study.

Data were analysed separately for 798 adults and 85 children: exploratory factor analysis facilitated reduction of 16 items on attitudes to pandemic vaccine into a smaller number of factors. Single variable analyses with vaccine uptake as the outcome were used to identify variables that were predictive of vaccination in children and adults. Potential predictors were: attitudinal factors created by data reduction, age group, sex, region, deprivation, ethnicity, chronic condition, vocation, healthcare-related occupation and previous influenza vaccination.

Consistent with previous literature concerning adult self-vaccination decisions, we found that vaccine efficacy/safety and perceived risk of pandemic influenza were significant predictors of both self-vaccination decisions and parental vaccination decisions. This study provides the first systematic attempt to understand both the predictors of self and parental vaccination uptake among the UK general population during the H1N1 pandemic. Our findings indicate that concerns about vaccine safety, and vaccine effectiveness may be a barrier to increased uptake for both self and parental vaccination.

Facing a Health Threat in a Complex Information Environment: A National Representative Survey Examining American Adults' Behavioral Responses to the 2009/2010 A(H1N1) Pandemic

Background. Recent A(H1N1) studies suggest that intrapersonal and interpersonal factors may exert influence on people’s preventive behaviors for avoiding the flu during pandemics. Aims. Nonpharmaceutical interventions (NPIs) and vaccinations play key roles in containing disease transmission during a pandemic. We examined how intrapersonal and interpersonal factors influenced adoption of NPIs and vaccine uptake during the A(H1N1) pandemic of 2009. Method. The data come from a nationally representative sample survey of 1,569 American adults. Hierarchical multivariable logistic regression was conducted to investigate the association between socioeconomic position, concern and knowledge about the threat, social networks for health advice or health care seeking, health consultations with doctors, and NPIs (including individual’s social distancing behaviors and hygiene practices) and vaccine acceptance. Results. People with higher scores on health-related social networks, more knowledge or concern about A(H1N1), and those who have consulted their doctor were more likely than others to adopt NPIs. There was a significant association between being concerned about A(H1N1), having consulted a doctor, and seeking a vaccine. Conclusions. These findings suggest that interpersonal communication factors, such as health-related social networks and consultations with doctors, and intrapersonal factors, such as concern and knowledge, play a critical role in NPIs and vaccine uptake during pandemics and offer avenues for intervention.

Who's Responsible? Media Framing of Pediatric Environmental Health and Mothers' Perceptions of Accountability

How the media frames issues of environmental health may affect mothers' views of who is responsible for addressing environmental risks to pediatric health and, ultimately, their protective behaviors. This article describes how information-oriented media sources attribute responsibility for such risks and examines associations between mothers' routine media exposure, or scanning, and perceptions of responsibility. First, a content analysis was conducted on a sample of 474 media stories (i.e., Associated Press, parenting magazines, and websites) about childhood exposure to environmental chemicals over a 6-month period (September 2012-February 2013). We found that media stories attributed responsibility most frequently to parents, though significant differences were observed across media sources, such that websites focused more on parents and general news more on government agencies and manufacturers. Next, we conducted an online survey of mothers (N = 819) and revealed that website scanning during the prior 6 months was significantly associated with perceived personal responsibility, even after we adjusted for potential confounders. Scanning general news was also significantly associated with perceived government and manufacturer responsibility. Understanding media framing of these issues highlights opportunities for health communicators to offset pressure placed on mothers by encouraging greater social and policy support in and exposure to certain media.

Contextual generalized trust and immunization against the 2009 A(H1N1) pandemic in the American states: A multilevel approach

The aim of the study was to investigate the association between contextual generalized trust and individual-level 2009 A(H1N1) pandemic immunization acceptance. A second aim was to investigate whether knowledge about the A(H1N1) pandemic mediated the association between contextual generalized trust and A(H1N1) immunization acceptance. Data from the National 2009 H1N1 Flu Survey was used. To capture contextual generalized trust, data comes from an aggregation of surveys measuring generalized trust in the American states. To investigate the association between contextual generalized trust and immunization acceptance, while taking potential individual-level confounders into account, multilevel logistic regression was used. The investigation showed contextual generalized trust to be significantly associated with immunization acceptance. However, controlling for knowledge about the A(H1N1) pandemic did not substantially affect the association between contextual generalized trust and immunization acceptance. In conclusion, contextual state-level generalized trust was associated with A(H1N1) immunization, but knowledge about A(H1N1) was not mediating this association.

Media Use and the Cancer Communication Strategies of Cancer Survivors

Communication related to health not only substantially affects perceptions and behaviors related to health but is also positively associated with the extent of health-information seeking and the practice of preventive behavior. Despite the fact that the number of cancer survivors has increased dramatically, there are few studies of the lack of health information, factors which act as barriers, and the difficulties in follow-up care experienced by cancer survivors. Therefore, we reviewed media utilization and the types of media used by cancer survivors with regard to risk communication and suggested appropriate strategies for cancer communication. According to the results, health communication contributed to health promotion by providing health-related information, consolidating social support factors such as social solidarity and trust, and reducing anxiety. In particular, participatory health communication may establish preventive programs which reflect the needs of communities, expand accessibility to better quality healthcare, and intensify healthy living by reducing health inequalities. Therefore, when people do not have an intention to obtain cancer screening, we need to intervene to change their behavior, norms, and degrees of self-efficacy. The findings of this study may help those involved in building partnerships by assisting in their efforts to understand and communicate with the public.

Influence of sources of information about influenza vaccine on parental attitudes and adolescent vaccine receipt

In 2011-2012, only 34% of 13-17 years olds in the United States (US) received seasonal influenza vaccine. Little is known about the link between parents' sources of health information, their vaccine-related attitudes, and vaccination of their adolescent against influenza. This study seeks to determine the relationship between number of sources of information on influenza vaccine, parental attitudes toward influenza vaccine, and influenza vaccine uptake in adolescents. We conducted a telephone and web-based survey among US parents of students enrolled in 6 middle and 5 high schools in Georgia. Bivariate and multivariable analyses were conducted to examine associations between the number of information sources about influenza vaccine and vaccine receipt and whether parent vaccine-related attitudes act as a mediator. The most commonly reported sources of information were: a physician/medical professional (95.0%), a family member or friend (80.6%), and television (77.2%). Parents who had higher attitude scores toward influenza vaccine were 5 times as likely to report their adolescent had ever received influenza vaccine compared to parents who had lower attitude scores (adjusted odds ratio (aOR) 5.1; 95% confidence intervals (CI) 3.1-8.4; P < 0.01). Parent vaccine-related attitudes were a significant mediator of the relationship between sources of information and vaccine receipt. In light of the low response rate and participation in an adolescent vaccination intervention, findings may not be generalizable to other populations. This study shows the importance of multiple sources of information in influencing parental decision-making about influenza vaccine for adolescents. Harnessing the power of mass media and family members and friends as health advocates for influenza vaccination can potentially help increase vaccination coverage of adolescents.

Emerging infectious disease (EID) communication during the 2009 H1N1 influenza outbreak: literature review (2009-2013) of the methodology used for EID communication analysis

OBJECTIVE

This year alone has seen outbreaks of epidemics such as Ebola, Chikungunya, and many other emerging infectious diseases (EIDs). We must look to the responses of recent outbreaks to help guide our strategies in current and future outbreaks or we risk repeating the same mistakes. The objective of this paper was to conduct a systematic literature review of the methodology used by studies that examined EID communication during the 2009 H1N1 pandemic outbreak through different communication channels or by analyzing contents and strategies.

METHODS

This was a systematic review of the literature (n=61) studying risk communication strategies of H1N1 influenza, published between 2009 and 2013, and retrieved from searches of computerized databases, hand searches, and authoritative texts by use of specific search criteria. Searches were followed by review, categorization, and mixed qualitative and quantitative content analysis.

RESULTS

Of 41 articles that used quantitative methods, most used surveys (n=35); some employed content analyses (n=4) and controlled trials (n=2). The 16 articles that employed qualitative methods relied on content analyses (n=10), semi-structured interviews (n=2) and focus groups (n=4). Four more articles used mixed-methods or nonstandard methods. Seven different topic categories were found: risk perception and effects on behaviors, framing the risk in the media, public concerns, trust, optimistic bias, uncertainty, and evaluating risk communication.

CONCLUSIONS

Up until 2013, studies tended to be descriptive and quantitative rather than discursive and qualitative and to focus on the role of the media as representing information and not as a medium for actual communication with the public. Several studies from 2012, and increasingly more in 2013, addressed issues of discourse and framing and the complexity of risk communication with the public. Formative evaluations that use recommendations from past research when designing communication campaigns from the first stages of crises are recommended. Research should employ diverse triangulation processes based on representatives from different stakeholders. Further studies should address the potential offered by social media to create dialogue with individuals and the public at large.

Assessing opinions in community leadership networks to address health inequalities: a case study from Project IMPACT

This study demonstrates a novel approach that those engaged in promoting social change in health can use to analyze community power, mobilize it and enhance community capacity to reduce health inequalities. We used community reconnaissance methods to select and interview 33 participants from six leadership sectors in 'Milltown', the New England city where the study was conducted. We used UCINET network analysis software to assess the structure of local leadership and NVivo qualitative software to analyze leaders' views on public health and health inequalities. Our main analyses showed that community power is distributed unequally in Milltown, with our network of 33 divided into an older, largely male and more powerful group, and a younger, largely female group with many 'grassroots' sector leaders who focus on reducing health inequalities. Ancillary network analyses showed that grassroots leaders comprise a self-referential cluster that could benefit from greater affiliation with leaders from other sectors and identified leaders who may serve as leverage points in our overall program of public agenda change to address health inequalities. Our innovative approach provides public health practitioners with a method for assessing community leaders' views, understanding subgroup divides and mobilizing leaders who may be helpful in reducing health inequalities.

Does Social Capital Explain Community-Level Differences in Organ Donor Designation?

POLICY POINTS

The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention.

CONTEXT

The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts.

METHODS

We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates.

FINDINGS

Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52).

CONCLUSIONS

The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.

The Effects of Media Reports on Disease Spread and Important Public Health Measurements

Controlling the spread of influenza to reduce the effects of infection on a population is an important mandate of public health. Mass media reports on an epidemic or pandemic can provide important information to the public, and in turn, can induce positive healthy behaviour practices (i.e., handwashing, social distancing) in the individuals, that will reduce the probability of contracting the disease. Mass media fatigue, however, can dampen these effects. Mathematical models can be used to study the effects of mass media reports on epidemic/pandemic outcomes. In this study we employ a stochastic agent based model to provide a quantification of mass media reports on the variability in important public health measurements. We also include mass media report data compiled by the Global Public Health Intelligence Network, to study the effects of mass media reports in the 2009 H1N1 pandemic. We find that the report rate and the rate at which individuals relax their healthy behaviours (media fatigue) greatly affect the variability in important public health measurements. When the mass media reporting data is included in the model, two peaks of infection result.

Social capital and health-protective behavior intentions in an influenza pandemic

Health-protective behaviors, such as receiving a vaccine, wearing a face mask, and washing hands frequently, can reduce the risk of contracting influenza. However, little is known about how social capital may influence health-protective behavior in the general population. This study examined whether each of the social capital dimensions (bonding, bridging, and linking) contributed to the intention to adopt any of the health-protective behaviors in an influenza pandemic. The data of this study were from the 2014 Taiwan Social Change Survey. A stratified, three-stage probability proportional-to-size sampling from across the nation, was conducted to select adults aged 20 years and older (N = 1,745). Bonding social capital was measured by the frequency of neighborly contact and support. Bridging social capital was measured based on association membership. Linking social capital was measured according to general government trust and trust in the government's capacity to counter an influenza pandemic. Binary logistic regressions were used to assess the multivariate associations between social capital and behavioral intention. The study results indicate that social capital may influence the response to influenza pandemic. Specifically, the intention to receive a vaccine and to wash hands more frequently were associated with the linking dimension and the bonding dimension of social capital, while the intention to wear a face mask was associated with all forms of social capital. The findings of this study suggest that government credibility and interpersonal networks may play a crucial role in health-protective behavior. This study provides new insights into how to improve the effectiveness of influenza prevention campaigns.

Identifying social characteristics of health-related information seeker: a gender-specific approach for cancer survivors

While health information-seeking behavior as an indicator of health communication of patients including cancer survivors has been researched, few studies have focused on how socioeconomic position and media use combine to influence health-related information seekers. This study examined social characteristics of health information-seeking behavior taking into account an individual's socioeconomic position and their media use in Korea, a developed country. The data for this study came from a survey of 1,010 respondents drawn from a nationally representative sample in the Republic of Korea. We conducted multivariate logistic regression analyses for gender-specific effects. We found that men who reported high household income were one and half times more likely to seek health information than those with low income status. We also found that women who performed Internet searches by computer at home were almost two times more likely to seek health information than those who did not. Similar results were found for men as well. Our analyses revealed that socioeconomic position and media use are associated with health information-seeking behavior by gender. Studies on information seekers may bring us more effective health promotion and relevant intervention for people with chronic conditions including cancer survivors.

Geospatial patterns in influenza vaccination: evidence from uninsured and publicly insured children in North Carolina

BACKGROUND

The purpose of this study was to explore geospatial patterns in influenza vaccination.

METHODS

We conducted an ecological analysis of publicly funded influenza vaccinations at the ZIP code tabulation area (ZCTA) level using secondary data for publicly funded influenza vaccinations among eligible school-aged children (age range, 5-17 years) for the 2010-2011 and 2011-2012 influenza seasons from the North Carolina Immunization Registry (NCIR). NCIR data were merged by ZCTA with other publicly available data. We tested for spatial autocorrelation in unadjusted influenza vaccination rates using choropleth maps and Moran's I. We estimated nonspatial and spatial negative binomial models with spatially correlated random effects adjusted for demographic, economic, and health care variables. The study was conducted at the University of North Carolina at Chapel Hill in the spring of 2014.

RESULTS

The NCIR demonstrated spatial autocorrelation in publicly funded influenza vaccinations among uninsured and means-tested, publicly insured school-aged children; ZCTAs tended to have influenza vaccination rates that were similar to their neighbors. This result was partially explained by included ZCTA characteristics, but not wholly.

CONCLUSION

To the extent that the geospatial clustering of vaccination rates is the result of social influences, targeting interventions to increase influenza vaccination among school-aged children in one area could also lead to increases in neighboring areas.

Media use and communication inequalities in a public health emergency: a case study of 2009-2010 pandemic influenza A virus subtype H1N1

OBJECTIVES

Studies have shown that differences among individuals and social groups in accessing and using information on health and specific threats have an impact on their knowledge and behaviors. These differences, characterized as communication inequalities, may hamper the strength of a society's response to a public health emergency. Such inequalities not only make vulnerable populations subject to a disproportionate burden of adversity, but also compromise the public health system's efforts to prevent and respond to pandemic influenza outbreaks. We investigated the effect of socioeconomic status (SES) and health communication behaviors (including barriers) on people's knowledge and misconceptions about pandemic influenza A(H1N1) (pH1N1) and adoption of prevention behaviors.

METHODS

The data for this study came from a survey of 1,569 respondents drawn from a nationally representative sample of American adults during pH1N1. We conducted logistic regression analyses when appropriate.

RESULTS

We found that (1) SES has a significant association with barriers to information access and processing, levels of pH1N1-related knowledge, and misconceptions; (2) levels of pH1N1-related knowledge are associated positively with the adoption of recommended prevention measures and negatively with the adoption of incorrect protective behaviors; and (3) people with higher SES, higher news exposure, and higher levels of pH1N1-related knowledge, as well as those who actively seek information, are less likely than their counterparts to adopt incorrect prevention behaviors.

CONCLUSION

Strategic public health communication efforts in public health preparedness and during emergencies should take into account potential communication inequalities and develop campaigns that reach across different social groups.

What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature

Background

During public health emergencies, public officials are busy in developing communication strategies to protect the population from existing or potential threats. However, a population’s social and individual determinants (i.e. education, income, race/ethnicity) may lead to inequalities in individual or group-specific exposure to public health communication messages, and in the capacity to access, process, and act upon the information received by specific sub-groups- a concept defined as communication inequalities.

The aims of this literature review are to: 1) characterize the scientific literature that examined issues related to communication to the public during the H1N1 pandemic, and 2) summarize the knowledge gained in our understanding of social determinants and their association with communication inequalities in the preparedness and response to an influenza pandemic.

Methods

Articles were searched in eight major communication, social sciences, and health and medical databases of scientific literature and reviewed by two independent reviewers by following the PRISMA guidelines. The selected articles were classified and analyzed in accordance with the Structural Influence Model of Public Health Emergency Preparedness Communications.

Results

A total of 118 empirical studies were included for final review. Among them, 78% were population-based studies and 22% were articles that employed information environment analyses techniques. Consistent results were reported on the association between social determinants of communication inequalities and emergency preparedness outcomes. Trust in public officials and source of information, worry and levels of knowledge about the disease, and routine media exposure as well as information-seeking behaviors, were related to greater likelihood of adoption of recommended infection prevention practices. When addressed in communication interventions, these factors can increase the effectiveness of the response to pandemics.

Conclusions

Consistently across studies, a number of potential predictors of behavioral compliance to preventive recommendations during a pandemic were identified. Our findings show the need to include such evidence found in the development of future communication campaigns to ensure the highest rates of compliance with recommended protection measures and reduce communication inequalities during future emergencies.