Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States

HPV vaccine-related articles shared on Facebook from 2019 to 2021: Did COVID make a difference?

Objective

HPV vaccination is recommended for children beginning at age 9 to prevent several types of cancer. Many parents turn to Facebook for health information. This study describes changes in HPV vaccine-related articles shared on Facebook amidst the COVID-19 pandemic.

Methods

HPV-related articles shared on Facebook (2019-2021) were collected using Buzzsumo, a social media analytics tool and analyzed using content analysis. Articles were categorized by valence, misinformation, evidence types, persuasive tactics, and framing. We quantified these data and tested for difference by article year.

Results

Of the 138 included articles, 51% had positive valence towards the vaccine and 36% had negative valence. In 2021, there was a significant increase in positive messaging (72% vs. 44% in 2019/2020; p < 0.01) and misinformation decreased from 50% in 2019 to 24% in 2021 (p = 0.04). Persuasive strategies were more common in 2019 than in later years.

Conclusion

Despite decreased engagement in 2021, more positive HPV vaccine messaging was observed, although a quarter of articles still contained misinformation. Our results can inform strategies for communicating with parents about the HPV vaccine.

Innovation

Our study is the first to analyze HPV-related articles linked on Facebook and to assess for differences during the pandemic.

The impact of attitude toward COVID-19 vaccine on intention to receive influenza vaccination: a multi-group comparison based on the influence of presumed influence model and spillover effects

Introduction

Influenza vaccination is one of the most important strategies for preventing influenza. However, the influenza vaccination rate in China remains low. During the COVID-19 pandemic, people held different attitudes toward the COVID-19 vaccine. In the post-pandemic era, do the varying attitudes toward the COVID-19 vaccine affect the intention to receive influenza vaccination?

Methods

Based on the influence of presumed influence (IPI) model and spillover effects, this study employed structural equation modeling for multi-group comparison to analyze questionnaires from 613 participants, using instruments such as the Perceived Media Influence on Others Scale (PMIO), the Susceptibility to Influenza Scale (SI), and the Attitude toward Influenza Vaccine Scale (AIV).

Results

The key findings are as follows: (1) Information exposure to the influenza vaccine significantly influences perceived media influence on others. (2) Perceived media influence on others does not directly impact the intention to receive influenza vaccination but rather affects it through attitude toward the influenza vaccine. (3) Moreover, multi-group analyses revealed differences in the IPI model among audiences with different attitudes toward the COVID-19 vaccine. These differences demonstrated that prior attitudes toward the COVID-19 vaccine can influence attitudes toward similar influenza vaccines, thus demonstrating the existence of spillover effects.

Conclusion

Attitude toward the COVID-19 vaccine can influence the intention to receive the influenza vaccination. Those with a negative attitude toward the COVID-19 vaccine are significantly influenced by susceptibility to influenza. Perceived media influence affects the intention to receive the influenza vaccination among those with a positive attitude toward the COVID-19 vaccine.

Relationships among health-related social media use, knowledge, worry, and cervical cancer screening: A cross-sectional study of US females

OBJECTIVE

This study aimed to explore the relationship between health-related social media use and HPV-related health knowledge, attitudes, and practices (KAP).

METHOD

Data were derived from a subset of the national cohort from the 2022 Health Information National Trends Survey (HINTS 6), including only women aged 21 to 65 years old (n = 2013). Ordinary least squares regression and structural equation modeling were used to answer the research question and test hypotheses.

RESULTS

Participants with a family history of cancer, higher education, and White showed more HPV knowledge. Older females were associated with lower HPV knowledge, less worry and fewer timely cervical cancer screening. Additionally, HPV knowledge positively predicted worry and cervical cancer screening. Health-related social media use positively predicted HPV knowledge, worry, and cervical cancer screening.

CONCLUSION

This study identified populations with HPV knowledge and hesitated cervical cancer screening and tested hypothesized models that combine social media use with the KAP survey.

PRACTICE IMPLICATIONS

Future health interventions should strategically leverage the role of social media to enhance public awareness of HPV knowledge and cancer concerns. By promoting HPV knowledge and awareness, such interventions can subsequently encourage timely cervical cancer screening.

Facebook's shared articles on HPV vaccination: analysis of persuasive strategies

BACKGROUND

The current study analyzed articles shared on Facebook between 2019 and 2021 that discuss the HPV vaccine. Results address a gap in knowledge about the persuasive strategies used in HPV vaccine discourse on Facebook.

METHODS

Using Buzzsumo.com, we collected 138 articles, shared on Facebook between 2019 and 2021, with the highest "engagement scores," or total number of reactions, comments, and shares. Using a content analysis methodology, three independent coders were trained in using the study codebook, achieved acceptable inter-rater reliability (Krippendorf's alpha = 0.811), and coded each article in Atlas.ti.

RESULTS

Seventy-two articles had a positive valence toward the HPV vaccine, 48 had a negative valence, and 18 were mixed-valence or neutral. Pro-vaccine articles presented a variety of evidence types in support of benefits of HPV vaccination. Pro-vaccine articles primarily originated from national and local news sources. Anti-vaccine articles combined presentation of evidence with persuasive arguments and strategies, such as mistrust of institutions, fear appeals, ideological appeals, presenting a high number of arguments or detail, and minimizing the severity of HPV. Three sources were responsible for producing 62.5% of all anti-vaccine articles in the dataset. Mixed-valence or neutral articles mixed cancer prevention discourse with ideological appeals about protecting parental rights, and were mostly produced by local news outlets.

CONCLUSION

The results of this study can help health communicators anticipate the types of discourses that vaccine-hesitant parents may have encountered online. Implications and suggestions for practice are discussed.

Natural Language Processing-Powered Real-Time Monitoring Solution for Vaccine Sentiments and Hesitancy on Social Media: System Development and Validation

BACKGROUND

Vaccines serve as a crucial public health tool, although vaccine hesitancy continues to pose a significant threat to full vaccine uptake and, consequently, community health. Understanding and tracking vaccine hesitancy is essential for effective public health interventions; however, traditional survey methods present various limitations.

OBJECTIVE

This study aimed to create a real-time, natural language processing (NLP)-based tool to assess vaccine sentiment and hesitancy across 3 prominent social media platforms.

METHODS

We mined and curated discussions in English from Twitter (subsequently rebranded as X), Reddit, and YouTube social media platforms posted between January 1, 2011, and October 31, 2021, concerning human papillomavirus; measles, mumps, and rubella; and unspecified vaccines. We tested multiple NLP algorithms to classify vaccine sentiment into positive, neutral, or negative and to classify vaccine hesitancy using the World Health Organization's (WHO) 3Cs (confidence, complacency, and convenience) hesitancy model, conceptualizing an online dashboard to illustrate and contextualize trends.

RESULTS

We compiled over 86 million discussions. Our top-performing NLP models displayed accuracies ranging from 0.51 to 0.78 for sentiment classification and from 0.69 to 0.91 for hesitancy classification. Explorative analysis on our platform highlighted variations in online activity about vaccine sentiment and hesitancy, suggesting unique patterns for different vaccines.

CONCLUSIONS

Our innovative system performs real-time analysis of sentiment and hesitancy on 3 vaccine topics across major social networks, providing crucial trend insights to assist campaigns aimed at enhancing vaccine uptake and public health.

Accuracy of a large language model in distinguishing anti- and pro-vaccination messages on social media: The case of human papillomavirus vaccination

Objective

Vaccination has engendered a spectrum of public opinions, with social media acting as a crucial platform for health-related discussions. The emergence of artificial intelligence technologies, such as large language models (LLMs), offers a novel opportunity to efficiently investigate public discourses. This research assesses the accuracy of ChatGPT, a widely used and freely available service built upon an LLM, for sentiment analysis to discern different stances toward Human Papillomavirus (HPV) vaccination.

Methods

Messages related to HPV vaccination were collected from social media supporting different message formats: Facebook (long format) and Twitter (short format). A selection of 1,000 human-evaluated messages was input into the LLM, which generated multiple response instances containing its classification results. Accuracy was measured for each message as the level of concurrence between human and machine decisions, ranging between 0 and 1.

Results

Average accuracy was notably high when 20 response instances were used to determine the machine decision of each message: .882 (SE = .021) and .750 (SE = .029) for anti- and pro-vaccination long-form; .773 (SE = .027) and .723 (SE = .029) for anti- and pro-vaccination short-form, respectively. Using only three or even one instance did not lead to a severe decrease in accuracy. However, for long-form messages, the language model exhibited significantly lower accuracy in categorizing pro-vaccination messages than anti-vaccination ones.

Conclusions

ChatGPT shows potential in analyzing public opinions on HPV vaccination using social media content. However, understanding the characteristics and limitations of a language model within specific public health contexts remains imperative.

The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis

BACKGROUND

Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy.

OBJECTIVE

In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities.

METHODS

To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities.

RESULTS

We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community.

CONCLUSIONS

Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study

BACKGROUND

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions.

OBJECTIVE

The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada.

METHODS

Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results.

RESULTS

The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots.

CONCLUSIONS

Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context

BACKGROUND

Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known.

OBJECTIVE

We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics.

METHODS

We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms "HPV" and "HPV vaccine" on YouTube.

RESULTS

In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term "HPV" was more frequently searched on YouTube compared with "HPV vaccine." Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine.

CONCLUSIONS

The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics.

Why did Brazil fail to vaccinate children against COVID-19 during the pandemic? An assessment of attitudinal and behavioral determinants

The objective of this study is to identify the determining attitudinal, behavioral, and sociodemographic factors behind the vaccination decision of parents and guardians in Brazil regarding immunization of children against COVID-19. Our data is obtained from a national online survey of 1,872 parents or guardians of children between 5 and 11 years of age, conducted from May 16 to 25, 2022. Our results show that, in Brazil, the decision to vaccinate children against COVID-19 is better explained by attitudinal and behavioral factors than sociodemographic ones. More precisely, the choice to immunize children against COVID-19 is strongly associated with the parents or guardians' own COVID-19 vaccination status, their ambivalence regarding this decision, their political preferences, and media use. In particular, parents and guardians who did not vaccinate against SARSCov2 and who supported former president Jair Bolsonaro (the main anti-vaccine political leader in the country during the COVID-19 pandemic) were substantially less likely to vaccinate their children. Parents and guardians with greater exposure to the country's major TV news program (Jornal Nacional/TV Globo), however, were more likely to do so. Other findings show that evangelicals - whose religious leaders strongly supported the former president -, young parents and guardians, and those from lower economic status were also less likely to vaccinate their children.

Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations

RATIONALE

Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes.

OBJECTIVE

The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations.

METHOD

We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles.

RESULTS

The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions.

CONCLUSIONS

While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.

Attitudes towards Receiving Monkeypox Vaccination: A Systematic Review and Meta-Analysis

BACKGROUND

The public's attitude towards Mpox vaccination is a critical factor in the success of immunisation programmes. Understanding the factors contributing to vaccine acceptance or hesitancy is critical for developing effective health communication strategies. This systematic review and meta-analysis aims to bring together evidence from observational studies on attitudes towards Mpox vaccination, including willingness and rejection.

METHODS

From this review's inception until June 2023, a comprehensive search was conducted across four major electronic databases: PubMed, Web of Science, Scopus, and EBSCO. The inclusion criteria included studies investigating public attitudes towards Mpox vaccination, as defined by acceptance and willingness to be vaccinated versus rejection and unwillingness.

RESULTS

Thirty studies met the inclusion criteria among the screened literature. An analysis of 27 studies involving 81,792 participants revealed that 45,926 (56.14%) were willing to receive the Mpox vaccination. In contrast, ten studies involving 7448 participants revealed that 2156 people (28.94%) were unwilling to receive the Mpox vaccination. Females were less willing to receive the vaccine than males, with an odds ratio (OR) of 0.61 (95% CI, 0.43-0.86). Furthermore, homosexuals were found to be more willing than heterosexuals, with an OR of 1.44 (95% CI, 1.14-1.80).

CONCLUSION

Vaccination is emerging as a critical strategy for preventing Mpox infection and fostering herd immunity against potential outbreaks. Improving public awareness and acceptance of vaccination is critical to avoiding a situation similar to the COVID-19 pandemic. Targeted educational and outreach programmes could explain the benefits of vaccination, bridging the information gap and encouraging a proactive public health approach to emerging infectious diseases.

Trust in information sources as a moderator of the impact of COVID-19 anxiety and exposure to information on conspiracy thinking and misinformation beliefs: a multilevel study

This study investigates the intricate relationship between exposure to information sources, trust in these sources, conspiracy and misinformation beliefs, and COVID-19 anxiety among 509 Omani citizens aged 11 to 50, representing 11 governorates. Employing structural equation modeling, we not only examine these associations but also explore how trust and COVID-19 anxiety act as moderating variables in this context. Additionally, we delve into demographic factors such as age group, educational level, gender, and place of residence (governorate) to discern potential variations.Our findings reveal that trust in health experts is inversely related to belief in conspiracy theories, while trust in health experts negatively correlates with exposure to conspiracy and misinformation. Intriguingly, trust in health experts exhibits divergent effects across governorates: it diminishes conspiracy and misinformation beliefs in some regions but not in others. Exposure to personal contacts and digital media, on the other hand, is associated with heightened beliefs in misinformation and conspiracy theories, respectively, in select governorates. These distinctions may be attributed to proximity to Muscat, the capital city of Oman, where various media outlets and policy-making institutions are situated. Furthermore, lower educational attainment is linked to greater belief in conspiracy and misinformation. Females reported higher levels of conspiracy theory beliefs and COVID-19 anxiety while no significant differences were detected in misinformation beliefs.This study sheds light on the intricate dynamics of misinformation and conspiracy theories in the context of COVID-19 in Oman, highlighting the pivotal roles of trust and COVID-19 anxiety as moderating factors. These findings offer valuable insights into understanding and addressing the spread of misinformation and conspiracy theories during a public health crisis.

A review of HPV and HBV vaccine hesitancy, intention, and uptake in the era of social media and COVID-19

Prior to the COVID-19 pandemic, the World Health Organization named vaccine hesitancy as one of the top 10 threats to global health. The impact of hesitancy on the uptake of human papillomavirus (HPV) vaccines was of particular concern, given the markedly lower uptake compared to other adolescent vaccines in some countries, notably the United States. With the recent approval of COVID-19 vaccines, coupled with the widespread use of social media, concerns regarding vaccine hesitancy have grown. However, the association between COVID-related vaccine hesitancy and cancer vaccines such as HPV is unclear. To examine the potential association, we performed two reviews using Ovid Medline and APA PsychInfo. Our aim was to answer two questions: (1) Is COVID-19 vaccine hesitancy, intention, or uptake associated with HPV or hepatitis B (HBV) vaccine hesitancy, intention, or uptake? and (2) Is exposure to COVID-19 vaccine misinformation on social media associated with HPV or HBV vaccine hesitancy, intention, or uptake? Our review identified few published empirical studies that addressed these questions. Our results highlight the urgent need for studies that can shift through the vast quantities of social media data to better understand the link between COVID-19 vaccine misinformation and disinformation and its impact on uptake of cancer vaccines.

Exploring public sentiment and vaccination uptake of COVID-19 vaccines in England: a spatiotemporal and sociodemographic analysis of Twitter data

Objectives

Vaccination is widely regarded as the paramount approach for safeguarding individuals against the repercussions of COVID-19. Nonetheless, concerns surrounding the efficacy and potential adverse effects of these vaccines have become prevalent among the public. To date, there has been a paucity of research investigating public perceptions and the adoption of COVID-19 vaccines. Therefore, the present study endeavours to address this lacuna by undertaking a spatiotemporal analysis of sentiments towards vaccination and its uptake in England at the local authority level, while concurrently examining the sociodemographic attributes at the national level.

Methods

A sentiment analysis of Twitter data was undertaken to delineate the distribution of positive sentiments and their demographic correlates. Positive sentiments were categorized into clusters to streamline comparison across different age and gender demographics. The relationship between positive sentiment and vaccination uptake was evaluated using Spearman's correlation coefficient. Additionally, a bivariate analysis was carried out to further probe public sentiment towards COVID-19 vaccines and their local adoption rates.

Result

The results indicated that the majority of positive tweets were posted by males, although females expressed higher levels of positive sentiment. The age group over 40 dominated the positive tweets and exhibited the highest sentiment polarity. Additionally, vaccination uptake was positively correlated with the number of positive tweets and the age group at the local authority level.

Conclusion

Overall, public opinions on COVID-19 vaccines are predominantly positive. The number of individuals receiving vaccinations at the local authority level is positively correlated with the prevalence of positive attitudes towards vaccines, particularly among the population aged over 40. These findings suggest that targeted efforts to increase vaccination uptake among younger populations, particularly males, are necessary to achieve widespread vaccination coverage.

The Influence of Social Media and Institutional Trust on Vaccine Hesitancy in France: Examining Direct and Mediating Processes

Vaccine hesitancy (VH) remains an ongoing challenge in French society. This project explored how institutional trust and preference for information via social media (PISM) drive hesitancy. Across a large, nationally represented population, our findings show that PISM and trust are strongly correlated measures, with both independently predicting VH. Subsequent mediation tests show that social media operates as primarily an indirect contributor to VH through trust. Additional tests involving VH and non-VH typologies revealed that institutional trust consistently predicts greater general support for vaccines and reduced distrust in vaccination. Conversely, PISM directly drives vaccine distrust, with its impact on non-hesitancy fully mediated by institutional trust. Overall, these findings point to the relevance for researchers and public health deciders to address the nature by which people utilize social media information resources and how that interacts with levels of trust for national institutions.

Vaccination, information and parental confidence in the digital age in England

Background

Immunisation programmes have led to substantial reductions in vaccine-preventable infectious diseases globally. A variety of factors have been shown to impact parental confidence and uptake of childhood vaccines, from concerns about vaccine safety to a lack of perceived need. Determinants of vaccine decision making include information, risk perceptions, and modifying factors such as attitude, identity, norms, habit and barriers. With the rise of the internet and social media, there has been a vast increase in information available about vaccines, not all scientifically-based and well-informed.

Methods

285 locations in England were randomly selected to survey a nationally representative sample of the English population. 1735 primary care givers of children aged between 2 months and <5 years old from England were randomly selected and surveyed via face-to-face interviews between January and March 2019.

Results

A much higher percentage of parents surveyed trust health care workers, the NHS, pharmacists and government for advice about immunisation, in comparison to media, the internet and social media. Most parents use official sources to obtain information on vaccines including parents who use the internet. The small proportion of parents who reported having seen negative information about vaccines were more likely to find it on the internet. Parents who felt they did not have enough information were more likely to have delayed or refused a vaccine for their child.

Interpretation

This study showed that for parents of young children in England, vaccination continues to be the social norm but this can rapidly change and clear, consistent messaging from trusted sources continues to be important. Although a proportion do seek vaccine information on the internet, the majority use official sources. Representative attitudinal surveys continue to be key in identifying any emerging threats to parental vaccine confidence.

Public perception of COVID-19 vaccines through analysis of Twitter content and users

BACKGROUND

With the global continuation of the COVID-19 pandemic, the large-scale administration of a SARS-CoV-2 vaccine is crucial to achieve herd immunity and curtail further spread of the virus, but success is contingent on public understanding and vaccine uptake. We aim to understand public perception about vaccines for COVID-19 through the wide-scale, organic discussion on Twitter.

METHODS

This cross-sectional observational study included Twitter posts matching the search criteria (('covid*' OR 'coronavirus') AND 'vaccine') posted during vaccine development from February 1st through December 11th, 2020. These COVID-19 vaccine related posts were analyzed with topic modeling, sentiment and emotion analysis, and demographic inference of users to provide insight into the evolution of public attitudes throughout the study period.

FINDINGS

We evaluated 2,287,344 English tweets from 948,666 user accounts. Individuals represented 87.9 % (n = 834,224) of user accounts. Of individuals, men (n = 560,824) outnumbered women (n = 273,400) by 2:1 and 39.5 % (n = 329,776) of individuals were ≥40 years old. Daily mean sentiment fluctuated congruent with news events, but overall trended positively. Trust, anticipation, and fear were the three most predominant emotions; while fear was the most predominant emotion early in the study period, trust outpaced fear from April 2020 onward. Fear was more prevalent in tweets by individuals (26.3 % vs. organizations 19.4 %; p < 0.001), specifically among women (28.4 % vs. males 25.4 %; p < 0.001). Multiple topics had a monthly trend towards more positive sentiment. Tweets comparing COVID-19 to the influenza vaccine had strongly negative early sentiment but improved over time.

INTERPRETATION

This study successfully explores sentiment, emotion, topics, and user demographics to elucidate important trends in public perception about COVID-19 vaccines. While public perception trended positively over the study period, some trends, especially within certain topic and demographic clusters, are concerning for COVID-19 vaccine hesitancy. These insights can provide targets for educational interventions and opportunity for continued real-time monitoring.

Examining thematic and emotional differences across Twitter, Reddit, and YouTube: The case of COVID-19 vaccine side effects

Social media discourse has become a key data source for understanding the public's perception of, and sentiments during a public health crisis. However, given the different niches which platforms occupy in terms of information exchange, reliance on a single platform would provide an incomplete picture of public opinions. Based on the schema theory, this study suggests a 'social media platform schema' to indicate users' different expectations based on previous usages of platform and argues that a platform's distinct characteristics foster distinct platform schema and, in turn, distinct nature of information. We analyzed COVID-19 vaccine side effect-related discussions from Twitter, Reddit, and YouTube, each of which represents a different type of the platform, and found thematic and emotional differences across platforms. Thematic analysis using k-means clustering algorithm identified seven clusters in each platform. To computationally group and contrast thematic clusters across platforms, we employed modularity analysis using the Louvain algorithm to determine a semantic network structure based on themes. We also observed differences in emotional contexts across platforms. Theoretical and public health implications are then discussed.

Using the increasing vaccination model and the moderating roles of chronic medical conditions and education to understand COVID-19 vaccination uptake in Singapore

COVID-19 vaccination programmes have helped reduce deaths and morbidity from the pandemic and allowed for the resumption of normal life. However, vaccine hesitancy remains an issue even with recurrent surges in COVID-19 cases due to new SARS-CoV-2 variants. Purpose: To elucidate psychosocial factors that contribute to our understanding of vaccine hesitancy. 676 Participants in Singapore took part in an online survey on vaccine hesitancy and uptake between May and June 2021. Data on demographics, perception of the COVID-19 pandemic, and vaccine willingness and hesitancy factors were collected. The responses were analyzed using structural equation modeling (SEM). The study found that confidence in the COVID-19 vaccines and risk perception of the COVID-19 situation are significantly associated with vaccination intention, while vaccination intention is also significantly associated with reported vaccination status. Additionally, certain chronic medical conditions moderate the relationship between vaccine confidence/risk perception and vaccine intention. This study contributes to our understanding of factors behind vaccination uptake which can help anticipate challenges to future vaccination campaigns for the next pandemic.

Measuring the burden of infodemics with a research toolkit for connecting information exposure, trust, and health behaviours

BACKGROUND

During a public health emergency, accurate and useful information can be drowned out by questions, concerns, information voids, conflicting information, and misinformation. Very few studies connect information exposure and trust to health behaviours, which limits available evidence to inform when and where to act to mitigate the burden of infodemics, especially in low resource settings. This research describes the features of a toolkit that can support studies linking information exposure to health behaviours at the individual level.

METHODS

To meet the needs of the research community, we determined the functional and non-functional requirements of a research toolkit that can be used in studies measuring topic-specific information exposure and health behaviours. Most data-driven infodemiology research is designed to characterise content rather than measure associations between information exposure and health behaviours. Studies also tend to be limited to specific social media platforms, are unable to capture the breadth of individual information exposure that occur online and offline, and cannot measure differences in trust by information source or content. Studies are also designed very differently, limiting synthesis of results.

RESULTS

We demonstrate a way to address these requirements via a web-based study platform that includes an app that participants use to record topic-specific information exposure, a browser plugin for tracking access to relevant webpages, questionnaires that can be delivered at any time during a study, and app-based incentives for participation such as visual analytics to compare trust levels with other participants. Other features of the platform include the ability to tailor studies to local contexts, ease of use for participants, and frictionless sharing of de-identified data for aggregating individual participant data in international meta-analyses.

CONCLUSIONS

Our proposed solution will be able to capture detailed data about information exposure and health behaviour data, standardise study design while simultaneously supporting localisation, and make it easy to synthesise individual participant data across studies. Future research will need to evaluate the toolkit in realistic scenarios to understand the usability of the toolkit for both participants and investigators.

Social Media Communication about HPV Vaccine in China: A Study Using Topic Modeling and Survey

The human papillomavirus (HPV) vaccine is relatively novel to people in China. Social media is becoming an important channel for learning new health information. However, limited is known about what HPV vaccine information has been disseminated on social media, and how such online information is associated with health-related behaviors in China. Based on Longo et al.'s model of patient use of healthcare information for healthcare decision, and Longo's model of health information seeking behaviors, this study examined HPV vaccine-related information type and information acquisition pattern. Following the mixed-methods approach, we first crawled 67,773 postings about HPV vaccine on Weibo, the largest microblogging website in China, and performed topic modeling to identify HPV vaccine-related topics that are prevalent on Weibo. The results showed six major topics about HPV vaccine, namely policy, guidance information, advertising, scandals, personal experience sharing, and HPV risks. Second, we conducted an online survey (n = 1,982) to investigate how scanning, seeking, and discussing the six HPV vaccine topics identified from big data analytics can affect HPV vaccine knowledge, safety concern, and vaccination intention. We documented significant impacts of social media health communication on users' health knowledge, attitude and behavioral intention.

Impact of social media news on COVID-19 vaccine hesitancy and vaccination behavior

In order to take advantage of the power of social media to promote vaccination, this study reveals the mechanisms of positive and negative impacts of social media news on vaccine hesitancy and vaccination behavior. Based on the stimulus-organism-response (S-O-R) framework, we developed a research model to understand the effects of vaccine safety news and risk news from social media (external stimuli) on individuals' psychological organism (i.e., safety perception and risk perception) and consequent behavioral response, vaccine hesitancy and vaccination behavior. The proposed model was tested by partial least square structural equation modeling (PLS-SEM) on a sample gathered in China from September 2021 to November 2021 and from February 2022 to April 2022 (valid responses = 1579). The results found that the relationship between vaccine risk news from social media and risk perception was higher than the relationship between vaccine safety news from social media and safety perception. Individuals are more sensitive to vaccine risk news than safety news on social media. Moreover, both safety perception and risk perception explained the critical psychological mechanisms behind vaccine hesitancy. Interestingly, ego network density mitigated the effect of safety news on safety perception and the effect of risk news on risk perception. The findings contribute to the S-O-R model, the research on social media effects, and the literature on vaccination attitudes and behaviors. This study also informs public health officials about leveraging the power of social media to motivate the public to accept the COVID-19 vaccines.

HPV vaccine narratives on Twitter during the COVID-19 pandemic: a social network, thematic, and sentiment analysis

INTRODUCTION

The COVID-19 pandemic has increased online interactions and the spread of misinformation. Some researchers anticipate benefits stemming from improved public awareness of the value of vaccines while others worry concerns around vaccine development and public health mandates may have damaged public trust. There is a need to understand whether the COVID-19 pandemic, vaccine development, and vaccine mandates have influenced HPV vaccine attitudes and sentiments to inform health communication strategies.

METHODS

We collected 596,987 global English-language tweets from January 2019-May 2021 using Twitter's Academic Research Product track. We determined vaccine confident and hesitant networks discussing HPV immunization using social network analysis. Then, we used a neural network approach to natural language processing to measure narratives and sentiment pertaining to HPV immunization.

RESULTS

Most of the tweets in the vaccine hesitant network were negative in tone (54.9%) and focused on safety concerns surrounding the HPV vaccine while most of the tweets in the vaccine confident network were neutral (51.6%) and emphasized the health benefits of vaccination. Growth in negative sentiment among the vaccine hesitant network corresponded with legislative efforts in the State of New York to mandate HPV vaccination for public school students in 2019 and the WHO declaration of COVID-19 as a Global Health Emergency in 2020. In the vaccine confident network, the number of tweets concerning the HPV vaccine decreased during the COVID-19 pandemic but in both vaccine hesitant and confident networks, the sentiments, and themes of tweets about HPV vaccine were unchanged.

CONCLUSIONS

Although we did not observe a difference in narratives or sentiments surrounding the HPV vaccine during the COVID-19 pandemic, we observed a decreased focus on the HPV vaccine among vaccine confident groups. As routine vaccine catch-up programs restart, there is a need to invest in health communication online to raise awareness about the benefits and safety of the HPV vaccine.

Scaling up the discovery of hesitancy profiles by identifying the framing of beliefs towards vaccine confidence in Twitter discourse

Our study focused on the discovery of how vaccine hesitancy is framed in Twitter discourse, allowing us to recognize at-scale all tweets that evoke any of the hesitancy framings as well as the stance of the tweet authors towards the frame. By categorizing the hesitancy framings that propagate misinformation, address issues of trust in vaccines, or highlight moral issues or civil rights, we were able to empirically recognize their ontological commitments. Ontological commitments of vaccine hesitancy framings couples with the stance of tweet authors allowed us to identify hesitancy profiles for two most controversial yet effective and underutilized vaccines for which there remains substantial reluctance among the public: the Human Papillomavirus and the COVID-19 vaccines. The discovered hesitancy profiles inform public health messaging approaches to effectively reach Twitter users with promise to shift or bolster vaccine attitudes.

Parental Factors Affecting Decision to Vaccinate Their Daughters against Human Papillomavirus

ABSTRACT

Human papillomavirus (HPV) vaccination was introduced in the National Immunization Program (NIP) in Korea targeting girls aged 12 years to receive two doses of HPV vaccine to prevent cervical cancer. This study aimed to evaluate the factors that may influence parental decision to inoculate their daughters in Korea. A cross-sectional survey was conducted in 2020 by interviewing the parents of 2,000 nationally representative girls eligible for HPV NIP. By the daughters' status of HPV vaccination, the probabilities for each variable were compared with evaluate the factors that could affect parents' decision to inoculate their daughters with HPV vaccines. Compared with parents who were not vaccinated with HPV, parents who were vaccinated with HPV were 2.40 times more likely to decide to vaccinate their daughters with HPV. Parents who regularly undergo cervical cancer screening were 1.39 times more likely to decide to vaccinate their daughters with HPV than parents who do not receive regular checkups. Parents' perceived knowledge and perceived risk had a significant impact on their decision to vaccinate their daughters with HPV vaccines. Parents who had strong belief that HPV vaccine is safe in terms of adverse effects were 10 times more likely to decide to vaccinate their daughters against HPV. Parental factors including HPV-related health behavior and awareness were found to be associated with parental decision to vaccinate their daughters against HPV. To improve HPV vaccine uptake at 12 years, it is required to improve parental awareness on HPV through public communication supported by scientific-based evidence.

PREVENTION RELEVANCE

Parental HPV vaccination and maternal regular cervical cancer screening were positively associated with parental decision to vaccinate their daughters against HPV. Parents' perceived knowledge of HPV vaccination and perceived risk of cervical cancer play an important role in determining whether their 12-year-old daughters will be vaccinated against HPV.

Anti-vaccination attitude trends during the COVID-19 pandemic: A machine learning-based analysis of tweets

Objective

Vaccine hesitancy has been ranked by the World Health Organization among the top 10 threats to global health. With a surge in misinformation and conspiracy theories against vaccination observed during the COVID-19 pandemic, attitudes toward vaccination may be worsening. This study investigates trends in anti-vaccination attitudes during the COVID-19 pandemic and within the United States, Canada, the United Kingdom, and Australia.

Methods

Vaccine-related English tweets published between 1 January 2020 and 27 June 2021 were used. A deep learning model using a dynamic word embedding method, Bidirectional Encoder Representations from Transformers (BERTs), was developed to identify anti-vaccination tweets. The classifier achieved a micro F1 score of 0.92. Time series plots and country maps were used to examine vaccination attitudes globally and within countries.

Results

Among 9,352,509 tweets, 232,975 (2.49%) were identified as anti-vaccination tweets. The overall number of vaccine-related tweets increased sharply after the implementation of the first vaccination round since November 2020 (daily average of 6967 before vs. 31,757 tweets after 9/11/2020). The number of anti-vaccination tweets increased after conspiracy theories spread on social media. Percentages of anti-vaccination tweets were 3.45%, 2.74%, 2.46%, and 1.86% for the United States, the United Kingdom, Australia, and Canada, respectively.

Conclusions

Strategies and information campaigns targeting vaccination misinformation may need to be specifically designed for regions with the highest anti-vaccination Twitter activity and when new vaccination campaigns are initiated.

Health Literacy Correlates to HPV Vaccination Among US Adults Ages 27-45

Human papillomavirus (HPV) vaccination is now available for adults aged 27-45 as a shared clinical decision. Health literacy skills (i.e., accessing, understanding, appraising, applying information) may facilitate vaccine decision-making for adults with a provider recommendation. This study assessed associations between health literacy skills and willingness to get a provider-recommended HPV vaccine among newly eligible US adults. In 2020, US participants (51% women), aged 27-45 years, were surveyed online (n = 691). The outcome was willingness (willing/not willing) to get the HPV vaccine with provider recommendation. Measures were adapted from Sørensen's multidimensional European Health Literacy Scale, which assesses health literacy among four domains (i.e., access, understanding, appraisal, application). Adjusted odds ratios were calculated for the outcome and each health literacy domain, adjusting for personal health determinants (e.g., age, sex). The sample consisted of primarily non-Hispanic (91.2%), White (74.4%), and married (60.7%) adults. Approximately 65% of participants were willing to get a provider-recommended HPV vaccine. Higher willingness to vaccinate with provider recommendation was significantly associated with increased HPV knowledge (understanding; aOR = 1.13, 95% CI 1.04, 1.24), ability to understand HPV information (understanding; aOR = 1.96, 95% CI 1.09, 3.52), increased perceived vulnerability to HPV-related cancer (appraising; aOR = 3.22, 95% CI 1.83, 5.69), and the need for more information on vaccine safety to seek vaccination (applying; aOR = 3.25; 95% CI 2.05, 5.16). Utilizing a multidimensional health literacy framework to evaluate facilitators to HPV vaccination uptake among adults aged 27-45 can help guide future interventions by targeting accurate, easy-to-understand HPV information that connects vaccination efficacy to reduction in HPV cancer risk.

How was the coronavirus vaccine accepted on Twitter? A computational analysis using big data in Japan

Purpose

This study aims to reveal how the COVID-19 vaccine was accepted in the Japanese Twitter-sphere. This study explores how the topics related to the vaccine promotion project changed on Twitter and how the topics that were likely to spread changed during the vaccine promotion project.

Design/methodology/approach

The computational social science methodology was adopted. This study collected all tweets containing the word “vaccine” using the Twitter API from March to October 2021 and conducted the following analysis: analyzing frequent words and identifying topics likely to spread through the cosine similarity and Tobit model.

Findings

First, vaccine hesitancy–related words were frequently mentioned during the vaccine introduction and dissemination periods and had diffusing power only during the former period. Second, vaccine administration–related words were frequently mentioned and diffused through April to May and had diffusing power throughout the period. The background to these findings is that the sentiment of longing for vaccines outweighed that of hesitancy toward vaccines during this period.

Originality/value

This study finds that the timing of the rise in vaccine hesitation sentiment and the timing of the start of vaccine supply were misaligned. This is one of the reasons that Japan, which originally exhibited strong vaccine hesitancy, did not face vaccine hesitancy in the COVID-19 vaccine promotion project.

Sociocultural-psychological predictors influencing parents' decision-making regarding HPV vaccination for their adolescent daughters in mainland China: An extended TPB model

Introduction

Enhancing human papillomavirus (HPV) vaccine uptake rates to protect women's health is an important public health issue worldwide. China has taken a series of measures in recent years to promote HPV vaccination among school-aged girls, but the vaccine uptake rate remains low. Investigating the factors influencing vaccination-related decision-making of adolescent girls' parents is key to solving the problem. This study aimed to examine the influence of sociocultural-psychological predictors, including exposure to HPV-related stories (positive/negative), affective reactions (pride/regret), injunctive norms on the Internet and perceived moral obligation, on parents' HPV vaccination-related decision-making for girls aged 13-15 years in mainland China.

Methods

A cross-sectional online survey using quota sampling was conducted in February 2022. Four hundred and five valid and qualified questionnaires were obtained. Partial least squares structural equation modeling was performed by SmartPLS 3 (i) to evaluate the reliability and validity of the measurement models of 11 constructs, and (ii) to test the effect relationships of the sociocultural-psychological predictors on parents' intention to vaccinate their daughters.

Results

The study findings showed that parental decision-making regarding HPV vaccination was influenced by sociocultural and psychological factors. At the level of individual psychological factors, exposure to positive stories was significantly associated with perceived vaccine effectiveness (β = 0.331, t = 8.448, p < 0.001), which strongly predicted the attitude toward vaccination (β = 0.521, t = 8.133, p < 0.001); anticipated pride had more positive influence on vaccination-related decision-making (β = 0.156, t = 2.176, p < 0.05) than anticipated regret. In terms of social influence, injunctive norms on the Internet had a significantly positive influence on vaccination intention (β = 0.127, t = 2.382, p < 0.05), similar to descriptive norms (β = 0.135, t = 3.358, p < 0.01). Perceived moral obligation at the cultural level was the strongest predictor of parental decision-making regarding HPV vaccination (β = 0.193, t = 2.139, p < 0.05).

Discussion

This study is the first in mainland China to systematically examine the sociocultural-psychological predictors of parents' decision-making to vaccinate their 13-15-year-old daughters against HPV. A new extended TPB model with a sociocultural-psychological approach was developed. This model can support the investigation of factors affecting HPV vaccine uptake rates in the mainland Chinese population and similar populations and help to understand the differences in vaccination-related decision-making between Eastern and Western cultures. Furthermore, the study provided some suggestions for HPV vaccination communication campaigns targeting adolescent girls' parents.

Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic

BACKGROUND

Vaccine hesitancy presents an obstacle to the campaign to control COVID-19. It has previously been found to be associated with youth, female gender, low income, low education, low medical trust, minority ethnic group membership, low perceived risk from COVID-19, use of certain social media platforms and conspiracy beliefs. However, it is unclear which of these predictors might explain variance associated with others.

METHODS

An online survey was conducted with a representative sample of 4343 UK residents, aged 18-75, between 21 November and 21 December 2020. Predictors of vaccine hesitancy were assessed using linear rank-order models.

RESULTS

Coronavirus vaccine hesitancy is associated with youth, female gender, low income, low education, high informational reliance on social media, low informational reliance on print and broadcast media, membership of other than white ethnic groups, low perceived risk from COVID-19 and low trust in scientists and medics, as well as (to a much lesser extent) low trust in government. Coronavirus conspiracy suspicions and general vaccine attitudes appear uniquely predictive, jointly explaining 35% of variance. Following controls for these variables, effects associated with trust, ethnicity and social media reliance largely or completely disappear, whereas the effect associated with education is reversed.

CONCLUSIONS

Strengthening positive attitudes to vaccination and reducing conspiracy suspicions with regards to the coronavirus may have a positive effect on vaccine uptake, especially among ethnic groups with heightened vaccine hesitancy. However, vaccine hesitancy associated with age and gender does not appear to be explained by other predictor variables tested here.

The spread of COVID-19 vaccine information in Arabic on YouTube: A network exposure study

Objective

The Arabic-speaking world had the lowest vaccine rates worldwide. The region's increasing reliance on social media as a source of COVID-19 information coupled with the increasing popularity of YouTube in the Middle East and North Africa region begs the question of what COVID-19 vaccine content is available in Arabic on YouTube. Given the platform's reputation for being a hotbed for vaccine-related misinformation in English, this study explored the COVID-19 vaccine-related content an individual is likely to be exposed to on YouTube when using keyword-based search or redirected to YouTube from another platform from an anti-vaccine seed video in Arabic.

Methods

Only using the Arabic language, four networks of videos based on YouTube's recommendations were created in April 2021. Two search networks were created based on Arabic pro-vaccine and anti-vaccine keywords, and two seed networks were created from conspiracy theory and anti-vaccine expert seed videos. The network exposure model was used to examine the video contents and network structures.

Results

Results show that users had a low chance of being exposed to anti-vaccine content in Arabic compared to the results of a previous study of YouTube content in English. Of the four networks, only the anti-vaccine expert network had a significant likelihood of exposing the user to more anti-vaccine videos. Implications were discussed.

Conclusion

YouTube deserves credit for its efforts to clean up and limit anti-vaccine content exposure in Arabic on its platform, but continuous evaluations of the algorithm functionality are warranted.

Social media in health communication: A literature review of information quality

BACKGROUND

Social media is used in health communication by individuals, health professionals, disease centres and other health regulatory bodies. However, varying degrees of information quality are churned out daily on social media. This review is concerned with the quality of Social Media Health Information (SMHI).

OBJECTIVE

The review sought to understand how SMHI quality issues have been framed and addressed in the literature. Health topics, users and social media platforms that have raised health information quality concerns are reviewed. The review also looked at the suitability of existing criteria and instruments used in evaluating SMHI and identified gaps for future research.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the forward chaining strategy were used in the document search. Data were sourced according to inclusion criteria from five academic databases, namely Scopus, Web of Science, Cochrane Library, PubMed and MEDLINE.

RESULTS

A total of 93 articles published between 2000 and 2019 were used in the review. The review revealed a worrying trend of health content and communication on social media, especially of cancer, dental care and diabetes information on YouTube. The review further discovered that the Journal of the American Medical Association, the DISCERN and the Health on the Net Foundation, which were designed before the advent of social media, continue to be used as quality evaluation instruments for SMHI, even though technical and user characteristics of social media differ from traditional portals such as websites.

CONCLUSION

The study synthesises varied opinions on SMHI quality in the literature and recommends that future research proposes quality evaluation criteria and instruments specifically for SMHI.

Polarization and trust in the evolution of vaccine discourse on Twitter during COVID-19

Trust in vaccination is eroding, and attitudes about vaccination have become more polarized. This is an observational study of Twitter analyzing the impact that COVID-19 had on vaccine discourse. We identify the actors, the language they use, how their language changed, and what can explain this change. First, we find that authors cluster into several large, interpretable groups, and that the discourse was greatly affected by American partisan politics. Over the course of our study, both Republicans and Democrats entered the vaccine conversation in large numbers, forming coalitions with Antivaxxers and public health organizations, respectively. After the pandemic was officially declared, the interactions between these groups increased. Second, we show that the moral and non-moral language used by the various communities converged in interesting and informative ways. Finally, vector autoregression analysis indicates that differential responses to public health measures are likely part of what drove this convergence. Taken together, our results suggest that polarization around vaccination discourse in the context of COVID-19 was ultimately driven by a trust-first dynamic of political engagement.

Countering Antivax Misinformation via Social Media: Message-Testing Randomized Experiment for Human Papillomavirus Vaccination Uptake

BACKGROUND

Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of the HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified.

OBJECTIVE

We aimed to test message effectiveness in changing parents' attitudes and behavioral intentions toward HPV vaccination.

METHODS

We conducted a web-based message-testing experiment with 6 control messages and 25 experimental messages and 5 from each of the 5 salient themes about HPV vaccination (theme 1: safety, side effects, risk, and ingredient concerns and long-term or major adverse events; theme 2: distrust of the health care system; theme 3: HPV vaccine effectiveness concerns; theme 4: connection to sexual activity; and theme 5: misinformation about HPV or HPV vaccine). Themes were identified from previous web-based focus group research with parents, and specific messages were developed by the study team using content from credible scientific sources. Through an iterative process of message development, the messages were crafted to be appropriate for presentation on a social media platform. Among the 1713 participants recruited via social media and crowdsourcing sites, 1043 eligible parents completed a pretest survey questionnaire. Participants were then randomly assigned to 1 of the 31 messages and asked to complete a posttest survey questionnaire that assessed attitudes toward the vaccine and perceived effectiveness of the viewed message. A subgroup of participants (189/995, 19%) with unvaccinated children aged 9 to 14 years was also assessed for their behavioral intention to vaccinate their children against HPV.

RESULTS

Parents in the experimental group had increased positive attitudes toward HPV vaccination compared with those in the control group (t969=3.03, P=.003), which was associated with increased intention to vaccinate among parents of unvaccinated children aged 9 to 14 years (r=1.14, P=.05). At the thematic level, we identified 4 themes (themes 2-5) that were relatively effective in increasing behavioral intentions by positively influencing attitudes toward the HPV vaccine (χ25=5.97, P=.31, root mean square error of approximation [RMSEA]=0.014, comparative fit index [CFI]=0.91, standardized root mean square residual [SRMR]=0.031). On the message level, messages that provided scientific evidence from government-related sources (eg, the Centers for Disease Control and Prevention) and corrected misinformation (eg, "vaccines like the HPV vaccine are simply a way for pharmaceutical companies to make money. That isn't true") were effective in forming positive perceptions toward the HPV vaccination messages.

CONCLUSIONS

Evidence-based messages directly countering misinformation and promoting HPV vaccination in social media environments can positively influence parents' attitudes and behavioral intentions to vaccinate their children against HPV.

One Vax Two Lives: a social media campaign and research program to address COVID-19 vaccine hesitancy in pregnancy

The COVID-19 pandemic has disproportionately affected pregnant people by increasing health risks of maternal morbidity and mortality, stillbirth, and preterm birth. Although numerous studies have supported the safety and efficacy of COVID-19 vaccination in pregnancy in preventing or mitigating the risk for these adverse outcomes, many pregnant people remain hesitant. Approximately half of US adults regularly consume news from social media platforms, which are a fertile ground for the spread of vaccine disinformation. The lack of information regarding COVID-19 vaccine safety early in the pandemic fueled vaccine myths targeting the fears of pregnant people about vaccination risks. Saddened by the spike in maternal deaths of unvaccinated individuals during the COVID-19 Delta variant surge in the fall of 2021, we created a social media campaign to promote scientific communication regarding the risks of COVID-19 disease in pregnancy and the benefits of vaccination. We called the campaign "One Vax Two Lives," which refers to the ability of 1 maternal vaccine to benefit the health and lives of both the pregnant individual and their fetus. We present a blueprint of how we leveraged a large, interdisciplinary student workforce to create a social media campaign and research program studying vaccine hesitancy, which can be replicated by other groups. Community engagement and partnerships with key stakeholders, such as the Washington State Department of Health, were essential for amplifying the campaign and providing our team with feedback on content and approach. We present the analytics of our social media advertisements, web articles, and video content that helped inform the iterative design process of the multimedia content. Moving forward, we are launching collaborative research programs to study vaccine hesitancy and inform the development of new social media content designed for pregnant individuals who are: (1) Spanish-speaking Hispanic/Latina/x, (2) Black or Afro-Latinx, and (3) residents of rural communities in the State of Washington. Data from these mixed methods studies will inform new communication campaigns to reach vaccine-hesitant individuals. Finally, we discuss lessons learned and how the most impactful elements of the campaign can be translated to related areas of maternal public health.

COVID-19 vaccine hesitancy among young adults in Canada

OBJECTIVES

Vaccine hesitancy is a multifaceted decision process that encompasses various factors for which an individual may choose to get vaccinated or not. We aimed to identify the relationship between COVID-19 conspiracy theories, general attitudes towards vaccines, current COVID-19 vaccine factors, and COVID-19 vaccine hesitancy.

METHODS

The present research is a multi-province cross-sectional study design. Survey data were collected in May and June 2021 (n=4905) in the Canadian provinces of Alberta, Ontario, and Quebec. Multivariate ordinal regression models were used to assess the association between vaccine hesitant profiles and COVID-19 conspiracy theories, general attitudes towards vaccines, and specific factors pertaining to COVID-19 vaccines.

RESULTS

Participants were aged 18 to 40 years and 59% were women. Individuals with low income, with low educational attainment, and/or who are unemployed were more likely to be vaccine hesitant. COVID-19 conspiracy theory beliefs and general attitudes towards vaccines are significantly associated with greater hesitancy for the COVID-19 vaccine. Vaccine factors including pro-vaccine actions and opinions of friends and family and trust in scientists and government as well as the country in which a vaccine is manufactured are associated with less vaccine hesitancy.

CONCLUSION

Conspiracy theories are distinct from criticism and concerns regarding the vaccine. Nevertheless, poverty, low level of education, and distrust towards the government are associated with higher odds of being vaccine hesitant. Results suggest it is imperative to deliver transparent and nuanced health communications to address legitimate distrust towards political and scientific actors and address the societal gap regarding general attitudes towards vaccines as opposed to focusing solely on COVID-19.

A comparative analysis of anti-vax discourse on twitter before and after COVID-19 onset

This study aimed to identify and assess the prevalence of vaccine-hesitancy-related topics on Twitter in the periods before and after the Coronavirus Disease 2019 (COVID-19) outbreak. Using a search query, 272,780 tweets associated with anti-vaccine topics and posted between 1 January 2011, and 15 January 2021, were collected. The tweets were classified into a list of 11 topics and analyzed for trends during the periods before and after the onset of COVID-19. Since the beginning of COVID-19, the percentage of anti-vaccine tweets has increased for two topics, “government and politics” and “conspiracy theories,” and decreased for “developmental disabilities.” Compared to tweets regarding flu and measles, mumps, and rubella vaccines, those concerning COVID-19 vaccines showed larger percentages for the topics of conspiracy theories and alternative treatments, and a lower percentage for developmental disabilities. The results support existing anti-vaccine literature and the assertion that anti-vaccine sentiments are an important public-health issue.

Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey

BACKGROUND

Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media.

OBJECTIVE

This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child.

METHODS

Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group.

RESULTS

Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be "undecided/not wanting the vaccine" if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001).

CONCLUSIONS

Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions.

The Complex Media Effects on Civic Participation Intention Amid COVID-19 Pandemic: Empirical Evidence from Wuhan College Students

In the context of the COVID-19 pandemic, media exposure is crucial to motivate public action for the combat with COVID-19 pandemic. However, media effects on civic participation intention are understudied. This study applied the Differential Susceptibility to Media effects Model (DSMM) to explore the relations among Wuhan college students' media use, their pandemic-relevant beliefs, and civic participation intention, with a focus on the possible mediation of pandemic-relevant beliefs. Data of 4355 students from a large-scale cross-sectional survey were analyzed. Results show that traditional media use and online media interaction both directly and indirectly affect civic participation intention via pandemic-relevant beliefs. Pandemic-relevant beliefs distort the relations that direct and indirect effects of new media use on civic participation intention are significant but in opposite directions. The influence of pandemic news on civic participation intention is entirely mediated by pandemic-relevant beliefs. To conclude, during pandemic, the role of traditional media use is unreplaceable in its direct and indirect impact on civic participation intention. Pandemic-relevant beliefs play as a distorter variable. The balance between overexposure and insufficiency of pandemic-relevant news is vital. Online media interaction, as a main trait of new media use, plays a crucial role in civic participation intention, directly and indirectly.

Google Trends on Human Papillomavirus Vaccine Searches in the United States From 2010 to 2021: Infodemiology Study

Background

The human papillomavirus (HPV) vaccine is recommended for adolescents and young adults to prevent HPV-related cancers and genital warts. However, HPV vaccine uptake among the target age groups is suboptimal.

Objective

The aim of this infodemiology study was to examine public online searches in the United States related to the HPV vaccine from January 2010 to December 2021.

Methods

Google Trends (GT) was used to explore online searches related to the HPV vaccine from January 1, 2010, to December 31, 2021. Online searches and queries on the HPV vaccine were investigated using relative search volumes (RSVs). Analysis of variance was performed to investigate quarterly differences in HPV vaccine searches in each year from 2010 to 2021. A joinpoint regression was used to identify statistically significant changes over time; the α level was set to .05.

Results

The year-wise online search volume related to the HPV vaccine increased from 2010 to 2021, often following federal changes related to vaccine administration. Joinpoint regression analysis showed that HPV vaccine searches significantly increased on average by 8.6% (95% CI 5.9%-11.4%) across each year from 2010 to 2021. Moreover, HPV vaccine searches demonstrated a similar pattern across years, with search interest increasing through August nearly every year. At the state level, the highest 12-year mean RSV was observed in California (59.9, SD 14.3) and the lowest was observed in Wyoming (17.4, SD 8.5) during the period of 2010-2021.

Conclusions

Online searches related to the HPV vaccine increased by an average of 8.6% across each year from 2010 to 2021, with noticeable spikes corresponding to key changes in vaccine recommendations. We identified patterns across years and differences at the state level in the online search interest related to the HPV vaccine. Public health organizations can use GT as a tool to characterize the public interest in and promote the HPV vaccine in the United States.

Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages

Background

Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance.

Objective

In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media.

Methods

A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother–daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages.

Results

Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=–0.10, 95% CI –0.12 to –0.08, P<.001) and daughters (b=–0.10, 95% CI –0.18 to –0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=–0.04, 95% CI –0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers’ intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=–0.50, 95% CI –0.99 to –0.01, P=.05).

Conclusions

Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general.

Trial Registration

ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807

Vaccine hesitancy and COVID-19 immunization among rural young adults

Rural young adults may be more averse to receiving a COVID-19 immunization than urban young adults. We aimed to assess differences in COVID-19 vaccine hesitancy for rural, compared with urban, young adults and characterize modifiable factors. This cross-sectional online survey collected demographic data, vaccination attitudes, and COVID-19 impacts from 2937 young adults, ages 18-26 years, across the western U.S. from October 2020 to April 2021. Rurality was determined by participants' zip code and classified using the rural and urban continuum codes (RUCC). Multivariable logistic regression described adjusted (age, gender, race and ethnicity, being a current student, and month of survey) odds of self-reported intent to receive the COVID-19 vaccination by rurality. Mediation analysis was used to decompose total effects into average direct effects and average causal mediation (indirect) effects. Rural participants had 40% lower odds than urban participants of intending to receive the COVID-19 vaccine after adjustments (adjusted odds ratio, 0.62 [95% CI, 0.50-0.76]). The direct effect remained (P < 0.001), but was mediated by both education (8.3%, P < 0.001) and month in which the survey was taken (23.5%, P < 0.001). We observed a divergence after December 2020 in vaccination intent between rural and urban young adults that widened over time. Hesitancy to receive the COVID-19 vaccine was greater among rural, compared with urban young adults, and grew disproportionally after December 2020. Mediation by whether one was a current student or not suggests differences in sources of information for vaccination decision-making, and highlights areas for addressing vaccine hesitancy.

Exploring content of misinformation about HPV vaccine on twitter

Although social media can be a source of guidance about HPV vaccination for parents, the information may not always be complete or accurate. We conducted a retrospective content analysis to identify content and frequencies of occurrence of disinformation and misinformation about HPV vaccine posted on Twitter between December 15, 2019, through March 31, 2020, among 3876 unique, English language #HPV Tweets, excluding retweets. We found that 24% of Tweets contained disinformation or misinformation, and the remaining 76% contained support/education. The most prevalent categories of disinformation/misinformation were (1) adverse health effects (59%), (2) mandatory vaccination (19%), and (3) inefficacy of the vaccine (14%). Among the adverse health effects Tweets, non-specific harm/injury (51%) and death (23%) were most frequent. Disinformation/misinformation Tweets vs. supportive Tweets had 5.44 (95% CI 5.33–5.56) times the incidence rate of retweet. In conclusion, almost one-quarter of #HPV Tweets contained disinformation or misinformation about the HPV vaccine and these tweets received higher audience engagement including likes and retweets. Implications for vaccine hesitancy are discussed.

Media Data and Vaccine Hesitancy: Scoping Review

Background

Media studies are important for vaccine hesitancy research, as they analyze how the media shapes risk perceptions and vaccine uptake. Despite the growth in studies in this field owing to advances in computing and language processing and an expanding social media landscape, no study has consolidated the methodological approaches used to study vaccine hesitancy. Synthesizing this information can better structure and set a precedent for this growing subfield of digital epidemiology.

Objective

This review aimed to identify and illustrate the media platforms and methods used to study vaccine hesitancy and how they build or contribute to the study of the media's influence on vaccine hesitancy and public health.

Methods

This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search was conducted on PubMed and Scopus for any studies that used media data (social media or traditional media), had an outcome related to vaccine sentiment (opinion, uptake, hesitancy, acceptance, or stance), were written in English, and were published after 2010. Studies were screened by only 1 reviewer and extracted for media platform, analysis method, the theoretical models used, and outcomes.

Results

In total, 125 studies were included, of which 71 (56.8%) used traditional research methods and 54 (43.2%) used computational methods. Of the traditional methods, most used content analysis (43/71, 61%) and sentiment analysis (21/71, 30%) to analyze the texts. The most common platforms were newspapers, print media, and web-based news. The computational methods mostly used sentiment analysis (31/54, 57%), topic modeling (18/54, 33%), and network analysis (17/54, 31%). Fewer studies used projections (2/54, 4%) and feature extraction (1/54, 2%). The most common platforms were Twitter and Facebook. Theoretically, most studies were weak. The following five major categories of studies arose: antivaccination themes centered on the distrust of institutions, civil liberties, misinformation, conspiracy theories, and vaccine-specific concerns; provaccination themes centered on ensuring vaccine safety using scientific literature; framing being important and health professionals and personal stories having the largest impact on shaping vaccine opinion; the coverage of vaccination-related data mostly identifying negative vaccine content and revealing deeply fractured vaccine communities and echo chambers; and the public reacting to and focusing on certain signals-in particular cases, deaths, and scandals-which suggests a more volatile period for the spread of information.

Conclusions

The heterogeneity in the use of media to study vaccines can be better consolidated through theoretical grounding. Areas of suggested research include understanding how trust in institutions is associated with vaccine uptake, how misinformation and information signaling influence vaccine uptake, and the evaluation of government communications on vaccine rollouts and vaccine-related events. The review ends with a statement that media data analyses, though groundbreaking in approach, should supplement-not supplant-current practices in public health research.

HPV and COVID-19 vaccines: Social media use, confidence, and intentions among parents living in different community types in the United States

Our study measured parental confidence and intention/uptake of two adolescent vaccines (HPV and COVID-19), focusing on differences among community types including urban, suburban, and rural. Although social media provides a way for misinformation to spread, it remains a viable forum for countering misinformation and engaging parents with positive vaccine information across community types. Yet, little is understood about differences in social media use and vaccine attitudes and behaviors for parents living in rural, suburban and urban areas. We sought to determine how to better reach parents living in different community types with targeted social media channels and messaging. In August 2021, we used a cross-sectional survey programmed in Qualtrics to collect data from 452 parents of children ages 9 to 14 living in different community types across the United States. Participants came from a survey panel maintained by CloudResearch. Survey questions asked about demographics, political affiliation, community type, social media use, health and vaccine information sources, and attitudes and behaviors regarding the HPV and COVID-19 vaccines. Our sample of parents (n = 452) most frequently used Facebook (76%), followed by YouTube (55%), and Instagram (43%). When comparing social media use by community type, parents used the top platforms at similar rates. Social media use was associated with vaccine confidence and intention/uptake in unadjusted models but not in adjusted models. Further, there were no significant differences in HPV vaccine confidence or intention/uptake by community type (i.e., rural, suburban, urban). For the COVID-19 vaccine, parents in rural communities were less likely to have vaccine confidence and intention/uptake in the unadjusted model. For both HPV and COVID-19 vaccines, political affiliation was the only common factor associated with both vaccine confidence and intention/uptake. Parents who identified as Democrat compared to Republican had greater confidence in the vaccines and had higher odds of vaccine intention/uptake for their children. Although rurality has been associated with vaccine confidence in the past we did not find that in our study. Instead, political affiliation appeared to explain most of the variation in vaccine confidence and intention/uptake, suggesting that more research is needed to identify best practices for using social media to reach parents with different political beliefs.

Assessing the Level of Knowledge, Beliefs and Acceptance of HPV Vaccine: A Cross-Sectional Study in Romania

(1) Background: The infection with Human papilloma virus (HPV) is the most common sexually transmitted infection and it has been associated with cervical cancer (CC) in 99.7% of the cases. In Romania, CC is the second most common, with incidence (22.6%₀₀₀) and mortality rates (9.6%₀₀₀) three times higher than any other European country. Our aim was to assess the level of knowledge regarding HPV infection among parents, highschool students, medical students and doctors, with an emphasis on their main source of information—the Internet. (2) Methods: We applied five questionnaires to six categories of respondents: parents of pupils in the 6th–8th grades, medical students, doctors, boys in the 11th–12th grades, girls in the 11th–12th grades and their mothers. (3) Results: We included a total of 3108 respondents. 83.83% of all respondents had known about HPV infection. The level of information about HPV infection and vaccination was either satisfactory, poor or very poor. Their main source of information varied depending on the respondent profile and professional activity. Medical students were informed by doctors and healthcare professionals (53.0%), doctors gathered their information from books, journals and specialized brochures (61.6%). For the other categories of respondents, the Internet was the main source of information. Most respondents answered that doctors and healthcare professionals should provide information on HPV infection and vaccination, but very few of them actually seeked information from their general practitioner. (4) Conclusions: Population adherence to the appropriate preventative programs, as well as relevant information disseminated by the medical staff are key elements towards reducing the risk of HPV-associated cancers. An important role could also be played by schools, where teachers and school doctors could provide relevant information on the general aspects of HPV infection. Additionally, sex education classes and parent-teacher meetings should cover the main characteristics of HPV infection and what preventative measures can be employed against it.

HPV Vaccination: An Underused Strategy for the Prevention of Cancer

Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world's cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.

Mother’s Media Use and Children’s Vaccination Status in Indonesia: A Community-Based Cross-Sectional Study

Exposing appropriate information to mothers is a key factor for children’s immunization status. This study aims to assess the influence of mothers’ media use on their children’s vaccination status in Indonesia, using the 2017 Indonesia Demographic Health Survey data. A multilevel multinomial logistic regression model was employed. Mothers who used media irregularly and regularly had higher odds of having partially vaccinated children (vs unvaccinated) than mothers who never used media with adjusted odds ratio (aOR): 1.74; 95% Confidence interval (95% CI): 1.06-2.85 and aOR: 1.48; 95% CI: 1.02-2.16, respectively. Furthermore, they had higher odds of having a fully vaccinated child (vs unvaccinated) (aOR: 1.86; 95% CI: 1.12-3.08 for irregular media use and aOR: 2.41; 95% CI: 1.64-3.53 for regular media use vs. no media use). Our findings suggest that mothers’ media use could positively affect their children’s vaccination status by increasing mothers’ knowledge about children’s vaccination.