Vaccine Communication

Noel T. Brewer, PhD Associate Professor of Health Behavior, UNC Chair, National HPV Vaccination Roundtable

Disclosures

Grants, advisory boards or paid speaker American Cancer Society Centers for Disease Control and Prevention Federal Drug Administration GlaxoSmithKline Merck National Cancer Institute Pfizer Robert Wood Johnson Foundation

What went wrong HPV vaccine

communication?

0

10

20

30

40

50

60

70

80

90

100

07 08 09 10 11 12 13 14

% V

acci

nate

d

Year

Data from National Immunization Survey-Teen

Healthy People 2020 Goal Tdap

Meningococcal

HPV (3 doses, females)

HPV (3 doses, males)

Adolescent vaccine coverage, U.S. Adolescents ages 13-17

83% of parents of adolescent girls heard of HPV vaccine

from a drug company ad

n=889, Hughes, Brewer, et al., 2009, CEBP

Industry

Source Merck Gardasil CDC ACS [none]

Industry

62% thought non-profits’ ads were from a drug company

Industry

n=544, Pepper et al., 2012. STI

62% thought non-profits’ ads were from a drug company

n=544, Pepper et al., 2012. STI

Trust .31*

-.16*

-.21*

.46* Liking

Motivation to vaccinate

Source (drug co.)

Industry

Colgrove et al., 2010, NEJM

HPV Vaccination-Mandate Bills and Orders in the States, 2006–2008. Legislation

School entry requirements

Modest support 44% (25%-62%)

8 studies (n=4,811)

High support w/opt-out 84% (64%-92%)

3 studies (n=1,423)

CA, MA, NC

Brewer & Gilkey, 2012. JAMA

Impact of school requirements

Moss, et al., under review

Embargoed data redacted: Analyses examined the impact of school entry requirements on HPV vaccination

Sexual disinhibition

No studies show SD.

Few parents believe in it: 10% (3-26%). 8 studies, n=4,597

This belief is a result of vaccination, not a predictor of it Brewer et al. 2011; Schuler et al. 2011

Retardation

“Well, I will tell you that I had a mother last night come up to me here in Tampa, Florida, after the debate. She told me her little daughter took that -- took that vaccine, that injection, and she suffered from mental retardation thereafter. It can have very dangerous side effects. The mother was crying when she came up to me last night. I didn't know who she was before the debate. This is the very real concern. And people have to draw their own conclusions.” Michelle Bachman, 9/13/11, NBC's "Today" show

Retardation

Heard p=.005 Time p<.001 HxT p<.001 n=326

n=327, Zucker et al., 2015

Anti-vaccination sentiment

Nittinger, 1856.

Twitter, 2016.

YouTube

https://youtu.be/jenfrOyeiGw?t=57 https://youtu.be/t5GquxhjDRY?t=181

Tweets on HPV Vaccine

Dunn, et al., 2015

30,621 users made 83,551 tweets that reached 51,397,377 followers

Clustering

Vaccine hesitant parents cluster Geographically In social media

Dunn, et al., 2015

Confidence continuum

Cooper-Robbins et al., 2010

How do we increase confidence?

HCPs

Parents with a healthcare provider’s recommendation much more likely to vaccinate

Only 10% of parents had

received a provider’s recommendation

7 studies; n=18,955 OR=18 (range 2.2-172)

n=327, Reiter et al., 2013, AJPH

Announcement “It’s time for shots.” 90%

Optional “What do you want to do about shots?”

17%

Introducing vaccines

Accepted vaccine

n=111, Opel, et al., 2015

Introducing vaccines

n=9,021, NIS-Teen, Moss, et al., in press

Embargoed data redacted: Analyses examined the impact of participatory and efficient physician-patient communication styles on HPV vaccination coverage

Addressing parent concerns

Ask, Advise, Acknowledge Henricksen et al., 2015, Peds

CASE (Corroborate, About me, Science, Explain/advise) Singer

EASE Elicit main concern Acknowledge Share your commitment Explain the research Brewer et al., unpublished

Motivational statements

Embargoed data redacted: Analyses examined how well motivational statements motivated parents to want to get HPV Vaccination for their adolescent children

Summary

Clinician communication Early, always, high-quality Brief

Respected organizations taking charge of

communication Social media

Contact information

Noel Brewer ntb@unc.edu

UNC Gillings School of Global Public Health HPV research: www.unc.edu/~ntbrewer/hpv.htm

References Brewer, N. T., Gottlieb, S. L., Reiter, P. L., McRee, A. L., Liddon, N., Markowitz, L. E., & Smith, J. S. (2011). Longitudinal predictors of HPV vaccine initiation among adolescent girls in a high-risk geographic area. Sexually Transmitted Diseases, 38, 197-204. Fischhoff, B. (2012). Communicating risks and benefits: An evidence based user's guide. Government Printing Office. Gilkey, M. B., & Brewer, N. T. (2012). Mandatory HPV vaccination. [peer-reviewed letter] JAMA, 307, 252-253. PMID: 22253386 Hughes, J. H., Cates, J. R., Liddon, N., Smith, J. S., Gottlieb, S. L., & Brewer, N. T. (2009). Disparities in how parents are learning about the human papillomavirus vaccine. Cancer Epidemiology, Biomarkers & Prevention, 18, 363-372. PMID: 1919016 Pepper J. K., Reiter, P. L., McRee, A. L., & Brewer, N. T. (2012). Advertisements promoting HPV vaccine for adolescent males: Does source matter? Sexually Transmitted Infections, 88, 264-265. PMID: 22223814 Reiter, P. L., McRee, A. L., Pepper, J. K., Gilkey, M. B., Galbraith, K. V., & Brewer, N. T. (2013). Longitudinal predictors of HPV vaccination among a national sample of adolescent males. American Journal of Public Health, 103, 1419-1427. PMID: 23763402. Schuler, C. L., Reiter, P. L., Smith, J. S., & Brewer, N. T. (2011). Human papillomavirus vaccine and behavioral disinhibition. Sexually Transmitted Infections, 87, 349-353. Zucker, R. A., Reiter, P. L., Mayer, M. K., & Brewer, N. T. (2015). Effects of a presidential candidate’s comments on HPV vaccine. Journal of Health Communication, 20, 789-789. PMID: 25950109

References Colgrove, J., Abiola, S., & Mello, M. M. (2010). HPV vaccination mandates—lawmaking amid political and scientific controversy. New England Journal of Medicine, 363(8), 785-791. Dunn, A. G., Leask, J., Zhou, X., Mandl, K. D., & Coiera, E. (2015). Associations Between Exposure to and Expression of Negative Opinions About Human Papillomavirus Vaccines on Social Media: An Observational Study. Journal of Medical Internet Research, 17(6). Henrikson, N. B., Opel, D. J., Grothaus, L., Nelson, J., Scrol, A., Dunn, J., ... & Grossman, D. C. (2015). Physician communication training and parental vaccine hesitancy: A randomized trial. Pediatrics, 136(1), 70-79. National Immunization Survey –Teen, http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/index.html Opel, D. J., Mangione-Smith, R., Robinson, J. D., Heritage, J., DeVere, V., Salas, H. S., ... & Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998-2004. Cooper Robbins, S. C., Bernard, D., McCaffery, K., Brotherton, J. M., & Skinner, S. R. (2010). “I just signed”: Factors influencing decision-making for school-based HPV vaccination of adolescent girls. Health Psychology, 29(6), 618.