An Ounce of Prevention: Identifying Cues to (In)Action for Maternal Vaccine Refusal.

Recent increases in childhood vaccine exemption rates are a source of concern within the public health community. Drawing from the health belief model and in-depth interviews with 50 mothers ( n = 50) who refused one or more vaccine, the aim of this study was to identify the specific reasons and the broader decision context(s) that underscored participants' vaccine refusal. Results indicate that the vast majority of participants supported vaccination until a particular cue motivated them to consider otherwise, and qualitative analysis identified three main categories into which these cues fell: perceived adverse reactions, endorsements from health care professionals, and perceived contradiction among expert-endorsed messages. These categories point to the central role of health communication in motivating vaccine refusal. Better understanding these cues can inform vaccine communication scholarship and practice, and also lend theoretical insight into the intertextual nature of controversial health messages and decisions.

"You need to do your research": Vaccines, contestable science, and maternal epistemology.

Individuals who refuse vaccines are often painted as anti-science or ill-informed. However, drawing from interviews with 50 mothers who refused one or more vaccines ( n = 50), results from this study suggest that such depictions lack nuance and may detract from the ability of communication efforts to effectively address concerns. In particular, participants' explanations for vaccine refusal relied on paradoxical arguments about science and expertise. On one hand, participants defended the ideal of science but criticized existing research for failing to meet requisite standards. On the other hand, they suggested that maternal experience could supplant the ways of knowing that give rise to such claims. Collectively, these explanations reflected critical, postmodern, and feminist perspectives on science and knowledge production and can help explain the persistence of the controversy surrounding childhood vaccines in the United States.

Examining HPV threat-to-efficacy ratios in the Extended Parallel Process Model.

The Extended Parallel Process Model (EPPM) posits that an effective fear appeal includes both threat and efficacy components; however, research has not addressed whether there is an optimal threat-to-efficacy ratio. It is possible that varying levels of threat and efficacy in a persuasive message could yield different effects on attitudes, beliefs, and behaviors. In a laboratory experiment, women (n = 442) were exposed to human papilloma virus (HPV) prevention messages containing one of six threat-to-efficacy ratios and one of two message frames (messages emphasizing the connection between HPV and cervical cancer or HPV and genital warts). Multiple mediation analysis revealed that a 1-to-1 ratio of threat to efficacy was most effective at increasing prevention intentions, primarily because it caused more fear and risk susceptibility than other message ratios. Response efficacy significantly mediated the relationship between message framing and intentions, such that participants exposed to a genital warts message reported significantly higher intentions, and this association can be explained in part through response efficacy. Implications for future theoretical research as well as campaigns and intervention research are discussed.