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?
Adolescent vaccine coverage, U.S. Adolescents ages 13-17 % Vaccinated 100 90 80 70 60 50 40 30 20 10 0 Healthy People 2020 Goal 07 08 09 10 11 12 13 14 Year Tdap Meningococcal HPV (3 doses, females) HPV (3 doses, males) Data from National Immunization Survey-Teen
Industry 83% of parents of adolescent girls heard of HPV vaccine from a drug company ad n=889, Hughes, Brewer, et al., 2009, CEBP
Source Merck Gardasil CDC ACS [none] Industry
Industry 62% thought non-profits ads were from a drug company n=544, Pepper et al., 2012. STI
Industry 62% thought non-profits ads were from a drug company Source (drug co.) -.21* -.16* Trust.31* Liking.46* Motivation to vaccinate n=544, Pepper et al., 2012. STI
HPV Vaccination-Mandate Bills and Orders in the States, 2006 2008. Legislation Colgrove et al., 2010, NEJM
Brewer & Gilkey, 2012. JAMA 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
Impact of school requirements Embargoed data redacted: Analyses examined the impact of school entry requirements on HPV vaccination Moss, et al., under review
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 30,621 users made 83,551 tweets that reached 51,397,377 followers Dunn, et al., 2015
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
Introducing vaccines Accepted vaccine Announcement It s time for shots. 90% Optional What do you want to do about shots? 17% n=111, Opel, et al., 2015
Introducing vaccines Embargoed data redacted: Analyses examined the impact of participatory and efficient physician-patient communication styles on HPV vaccination coverage n=9,021, NIS-Teen, Moss, et al., in press
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.