The influence of social norms on flu vaccination among African American and White adults.

Adult influenza vaccination rates remain suboptimal, particularly among African Americans. Social norms may influence vaccination behavior, but little research has focused on influenza vaccine and almost no research has focused on racially-specific norms. This mixed methods investigation utilizes qualitative interviews and focus groups (n = 118) and national survey results (n = 1643) to assess both descriptive and subjective norms surrounding influenza vaccination. Qualitative results suggest a perceived descriptive norm that 'about half' of the population gets vaccinated. Participants describe differing norms by race and vaccine behavior. Quantitative results confirm a perceived descriptive norm that 40-60% of the population gets vaccinated. Both African Americans and Whites accurately identified race-specific vaccination rates relative to the general population. Individuals who report that a majority of people around them want them to be vaccinated were significantly more likely to be vaccinated, suggesting subjective norms are influential for both White and African American adults. While perceived descriptive norms are somewhat accurate (mirroring the actual influenza vaccination rate), emphasizing a suboptimal vaccination rate may not be beneficial. Health promotion efforts, particularly those targeting African Americans, may benefit from focusing on subjective norms and encouraging friends and family members to talk about the benefits of influenza vaccination.

Effective vaccine communication during the disneyland measles outbreak.

Vaccine refusal rates have increased in recent years, highlighting the need for effective risk communication, especially over social media. Fuzzy-trace theory predicts that individuals encode bottom-line meaning ("gist") and statistical information ("verbatim") in parallel and those articles expressing a clear gist will be most compelling. We coded news articles (n=4581) collected during the 2014-2015 Disneyland measles for content including statistics, stories, or bottom-line gists regarding vaccines and vaccine-preventable illnesses. We measured the extent to which articles were compelling by how frequently they were shared on Facebook. The most widely shared articles expressed bottom-line gists, although articles containing statistics were also more likely to be shared than articles lacking statistics. Stories had limited impact on Facebook shares. Results support Fuzzy Trace Theory's predictions regarding the distinct yet parallel impact of categorical gist and statistical verbatim information on public health communication.

Determinants of Parental Acceptance of the H1N1 Vaccine.

Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.S. children received the vaccine, a relatively low percentage compared with high-risk groups in seasonal influenza, such as the elderly, whose vaccine rates typically top 70%. To better understand parental decision making and predictors of acceptance of the H1N1 vaccine, we examined data from a representative national sample of parents (n = 684), using the health belief model as a framework. The most important predictors of vaccine acceptance were "cues to action" at multiple levels, from intrapersonal to mass communication, including the influence of friends, family, the media, and modeling by the Obama family; costs and benefits and self-efficacy were also significant predictors of vaccine acceptance. Higher perceived levels of H1N1 risk were not associated with vaccine uptake. Results suggest that traditional measures of perceived risk may not account for the cost-benefit analysis inherent in vaccine decision making, and that messages designed to emphasize disease risk may be ineffective. The authors recommend emphasizing cues to action that support norming and modeling of vaccine acceptance.

Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey.

With the growing recognition of the critical role that risk communication plays in a public health emergency, a number of articles have provided prescriptive best practices to enhance such communication. However, little empirical research has examined perceptions of the quality of communication, the impact of uncertainty on changing communication, use of information sources, and trust in specific government spokespersons. Similarly, although there is significant conceptual focus on trust and communication as important in vaccination intent and acceptance, little research has explored these relationships empirically. We conducted an online survey in late January 2010 with a nationally representative sample (N=2,079) that included Hispanic and African American oversamples. The completion rate was 56%. We found that public health officials were the most trusted spokespersons, with President Obama being the most highly trusted elected official. Demographic variables, including race, accounted for 21% of the variance in trust of the president. Perceptions of the quality of communication were high, including significant understanding of uncertainty and appreciation for officials' openness about evolving information. Other factors that contributed to vaccination acceptance were quality of communication, closely following the news, and confidence in the vaccine because of a role model effect of the Obama daughters' immunizations; these factors significantly increased trust in government actions. Because the challenges of communication often vary over the course of a pandemic, there is a consistent need to pay close attention to both communication content and delivery and prepare public health officials at all levels to be effective communicators.

US public support for vaccine donation to poorer countries in the 2009 H1N1 pandemic.

BACKGROUND: During the 2009 H1N1 pandemic, the global health community sought to make vaccine available "in developing nations in the same timeframe as developed nations." However, richer nations placed advance orders with manufacturers, leaving poorer nations dependent on the quantity and timing of vaccine donations by manufacturers and rich nations. Knowledge of public support for timely donations could be important to policy makers during the next pandemic. We explored what the United States (US) public believes about vaccine donation by its country to poorer countries. METHODS AND FINDINGS: We surveyed 2079 US adults between January 22(nd) and February 1(st) 2010 about their beliefs regarding vaccine donation to poorer countries. Income (p = 0.014), objective priority status (p = 0.005), nativity, party affiliation, and political ideology (p<0.001) were significantly related to views on the amount of vaccine to be donated. Though party affiliation and political ideology were related to willingness to donate vaccine (p<0.001), there was bipartisan support for timely donations of 10% of the US vaccine supply so that those "at risk in poorer countries can get the vaccine at the same time" as those at risk in the US. CONCLUSIONS: We suggest that the US and other developed nations would do well to bolster support with education and public discussion on this issue prior to an emerging pandemic when emotional reactions could potentially influence support for donation. We conclude that given our evidence for bipartisan support for timely donations, it may be necessary to design multiple arguments, from utilitarian to moral, to strengthen public and policy makers' support for donations.

The social ecological model as a framework for determinants of 2009 H1N1 influenza vaccine uptake in the United States.

Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived risk, past vaccine acceptance, perceived vaccine safety) and on physician recommendation. The authors used a social ecological framework to examine influenza vaccine uptake during the 2009 H1N1 pandemic. Surveying an adult population (n = 2,079) in January 2010 with significant oversamples of Blacks and Hispanics, this study found that 18.4% (95% confidence interval = 15.6-21.5) had gotten the 2009 H1N1 vaccine. Variables at each level of the social ecological model were significant predictors of uptake as well as of intent to get the vaccine. The intrapersonal level explained 53%, the interpersonal explained 47%, the institutional level explained 34%, and the policy and community levels each explained 8% of the variance associated with vaccine uptake. The levels together explained 65% of the variance, suggesting that interventions targeting multiple levels of the framework would be more effective than interventions aimed at a single level.

The vagaries of public support for government actions in case of a pandemic.

Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs.

Action, not talk: a simulation of risk communication during the first hours of a pandemic.

This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.