Noel Brewer - Academia.edu (original) (raw)
Papers by Noel Brewer
Psycho-Oncology
While a previous meta-analysis found that false-positive mammography results affect women's l... more While a previous meta-analysis found that false-positive mammography results affect women's likelihood of returning for screening, effects on well being have yet to be meta-analyzed. We investigated whether the effects of false-positive mammograms on women's well-being are limited to outcomes specific to breast cancer. We searched MEDLINE for studies of the psychosocial effects of false-positive results of routine screening mammography. We pooled effect sizes using random effects meta-analysis. Across 17 studies (n=20781), receiving a false-positive mammogram the result was associated with differences in all eight breast-cancer-specific outcomes that we examined. These included greater anxiety and distress about breast cancer as well as more frequent breast self-exams and higher perceived effectiveness of screening mammography. False positives were associated with only one of six generic outcomes (i.e. generalized anxiety), and this effect size was small. False-positive mamm...
Health education & behavior : the official publication of the Society for Public Health Education, 2014
Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We ... more Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Four SHCs participated in an intervention to increase provision of recommended vaccines to 2,975 adolescents. We reviewed program materials and SHC staff reports, and interviewed parents to assess implementation fidelity and reactions to materials. Ten percent of parents returned forms with consent to at least one vaccine. Of these, 79% checked the box consenting for "all recommended" vaccines, rather than indicating individual vaccines. SHCs sent supplemental mailings to some parents that clarified (a) vaccination costs or (b) human papillomavirus vaccine recommendation for boys and required parents to reconsent. This process resulted in loss of initial consent, primarily due to nonresponse. In interviews, parents who ...
Journal of Community Health
Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening wi... more Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-te...
Journal of General Internal Medicine
Systematic reviews for the US Preventive Services Task Force have found less high-quality evidenc... more Systematic reviews for the US Preventive Services Task Force have found less high-quality evidence on psychological than physical harms of screening. To understand the extent of evidence on psychological harms, we developed an evidence map that quantifies the distribution of evidence on psychological harms for five adult screening services. We also note gaps in the literature and make recommendations for future research.
BACKGROUND: Hispanic females have the highest cervical cancer incidence rate of any racial or eth... more BACKGROUND: Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the US, yet relatively little research has examined HPV vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females. METHODS: We analyzed provider-verified vaccination data from the 2010-2011 National Immunization Survey-Teen for Hispanic females ages 13-17 (n=2,786). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of one or more doses), completion (receipt of three doses), and follow-through (receipt of three doses among those who initiated the series). RESULTS: HPV vaccine initiation was 60.9%, completion was 36.0%, and follow-through was 59.1%. Initiation and completion were more common among older daughters and those whose parents had received a provider recommendation to vaccinate (all p<0.05). Completion was less common among daughters who had moved ...
American Journal of Public Health
We applaud Monárrez-Espino et al.(1) for conducting a timely systematic review on pictorial cigar... more We applaud Monárrez-Espino et al.(1) for conducting a timely systematic review on pictorial cigarette pack warnings' impact on cigarette use. We have some concerns, however, about the dissimilarity of studies included in the review. We are also concerned that readers may be unaware of other evidence that supports the efficacy of pictorial warnings. (Am J Public Health. Published online ahead of print January 20, 2015: e1. doi:10.2105/AJPH.2014.302510).
Cancer Epidemiology Biomarkers & Prevention
Background. Hispanic females have the highest cervical cancer incidence rate of any racial or eth... more Background. Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the US, yet relatively little research has examined HPV vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females. Methods. We analyzed provider-verified vaccination data from the 2010-2011 National Immunization Survey-Teen for Hispanic females ages 13-17 (n=2,786). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of one or more doses), completion (receipt of three doses), and follow-through (receipt of three doses among those who initiated the series). Results. HPV vaccine initiation was 60.9%, completion was 36.0%, and follow-through was 59.1%. Initiation and completion were more common among older daughters and those whose parents had received a provider recommendation to vaccinate (all p<0.05). Completion was less common among daughters who had moved ...
Background: Low uptake of HPV and other adolescent vaccines calls for novel approaches for increa... more Background: Low uptake of HPV and other adolescent vaccines calls for novel approaches for increasing use. We tested the efficacy of a school health center (SHC) global consent intervention to promote uptake of 4 recommended vaccines. Methods: Participating North Carolina sites had existing SHCs enrolling 3,614 students. Study intervention included a cover letter and enhanced consent form allowing parents to give global consent for all vaccines or to elect individually. Parent confusion regarding vaccine costs and appropriateness of HPV vaccination for boys resulted in additional consent procedures for some students. Researchers collected data through school health records on total numbers of pre- and post-intervention doses administered for the 4 vaccines in September through January 2011 and again in 2012. Results: Among parents who initially provided consent to vaccinate (10%), most provided global consent (79%). Supplemental consent procedures dramatically reduced initial consen...
Journal of Adolescent Health
We examined parents' and adolescents' preferences regarding potential strategies to incre... more We examined parents' and adolescents' preferences regarding potential strategies to increase human papillomavirus (HPV) vaccination rates, including offering the vaccine in alternative settings, concomitant administration of vaccines, and optimizing the structure of vaccination medical visits. A national sample of U.S. parents of adolescent boys aged 11-17 years (n = 506) and their sons (n = 391) completed online surveys in August and September 2010. We used analysis of variance for mixed designs to examine preferences for vaccination settings. Parents and sons were most comfortable with sons receiving HPV vaccine in a doctor's office. Parents of sons who had not visited their regular health care providers in the past year were more comfortable with sons receiving HPV vaccine at a public clinic (p < .001) or school (p < .05) compared with parents whose sons had recent visits. Results from the son survey showed a similar pattern. Parents and sons reported moderate l...
Preventive Medicine, 2015
Background. Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our s... more Background. Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type.
Background: Gay and bisexual men have a high prevalence of human papillomavirus (HPV) infection a... more Background: Gay and bisexual men have a high prevalence of human papillomavirus (HPV) infection and are at high risk of HPV-related cancers, notably anal cancer. Objective/Purpose: Characterize acceptability of HPV vaccine among gay and bisexual men and identify correlates of acceptability. Methods: We surveyed men aged 18 to 59 who self-identified as either gay (n=201) or bisexual (n=63) and participated in a national, Internet-based survey panel. Data were analyzed using t-tests and linear regression. Results: Overall, 55% of participants indicated they would probably or definitely be willing to get HPV vaccine. This percentage dropped to 34% when participants learned the vaccine may be less effective following sexual initiation. Acceptability was higher among gay men compared to bisexual men and increased when participants learned HPV vaccine may prevent certain cancers (oral, anal, or penile) and genital warts, as opposed to only genital warts (p<0.05). Higher perceived HPV v...
Purpose: Most parents report that they heard of HPV vaccine through paid drug company advertiseme... more Purpose: Most parents report that they heard of HPV vaccine through paid drug company advertisements, but no research has established whether these self reports are accurate. We conducted an experiment to examine whether parents could accurately identify the source of ads promoting HPV vaccine for boys and whether the impact of ads varied by source. Method: A national sample of 547 parents of adolescent males ages 11-17 years completed the online between-subjects experiment. The experiment presented parents with an advertisement encouraging HPV vaccination for boys with a logo from a randomly assigned message source (Merck, Gardasil, Centers for Disease Control and Prevention (CDC), American Cancer Society (ACS), or no logo). Parents offered three evaluations (trust, liking, and motivation for vaccination) while viewing the ad. After the ad was removed from the screen, parents indicated who they believed sponsored it. Result: Nearly half of parents who viewed an advertisement contai...
BACKGROUND: Although defaults may encourage some health behaviors, how defaults influence controv... more BACKGROUND: Although defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of default policies on parents' consent to their sons hypothetically receiving HPV vaccine at school. METHODS: A national sample of 404 parents of adolescent sons ages 11-17 participated in an online 3x2 between-subjects factorial experiment during Fall 2010. One factor varied the default consent policy for sons receiving HPV vaccine at school (opt-in, opt-out, or neutral). The second factor varied the default number of vaccines sons would receive (HPV vaccine alone or HPV vaccine with two other recommended adolescent vaccines). The outcome was parents' consent to sons hypothetically receiving HPV vaccine at school. Analyses used factorial logistic regression. RESULTS: Consent for sons to receive HPV vaccine was higher in the opt-in condition than the opt-out condition (OR=2.72, 95% CI: 1.067.00), among parents wanti...
BACKGROUND: One potentially effective strategy to increase low uptake of HPV vaccine among adoles... more BACKGROUND: One potentially effective strategy to increase low uptake of HPV vaccine among adolescents is to offer vaccination in settings other than the traditional medical home, such as schools and pharmacies. METHODS: A national (U.S.) sample of parents of adolescent males ages 11-17 years (n=506) and their sons (n=391) completed our online surveys in Fall 2010. Most parents were less than 45 years old (61%), female (54%), and non-Hispanic white (67%). We identified correlates of parents' and sons' comfort with HPV vaccination in alternative settings (pharmacies and schools) using multivariate regression. RESULTS: About one-third of parents (37%) and a quarter of sons (23%) were comfortable with sons receiving HPV vaccine in alternative settings. Parents' and sons' ratings of comfort with vaccination in alternative settings were correlated (r=.50, p<.001), though parents were more comfortable than sons (p<.001). Both groups were more comfortable with HPV vac...
BACKGROUND: HPV vaccination has elicited controversy confined to a small but vocal minority of Am... more BACKGROUND: HPV vaccination has elicited controversy confined to a small but vocal minority of Americans. This study examined how comments about HPV vaccination made during the 2012 presidential Republican debates, which received nationwide coverage, affected parents' decisions. METHODS: In Fall 2010 and 2011, a national sample of parents of males ages 11-17 (n=327) completed online surveys. Baseline data collection occurred before, and follow-up came one to two months after, the presidential candidates' comments. RESULTS: Only 17% of parents had heard that the candidates made comments about HPV vaccine during the debates. Of these parents, most (66%) recalled the comments as being largely against the vaccine, and some (25%) recalled largely favorable comments. Most parents said that the comments did not change their opinions (68%). Belief that HPV vaccine might cause short-term side effects increased between baseline and follow-up more among parents who heard the comments t...
BACKGROUND: HPV vaccine became available for males in the U.S. in 2009. We conducted a longitudin... more BACKGROUND: HPV vaccine became available for males in the U.S. in 2009. We conducted a longitudinal study to examine HPV vaccine uptake among adolescent males and identify predictors of vaccination. METHODS: In Fall of 2010 and 2011, a national sample of parents of adolescent males ages 11-17 (n=327) and their sons (n=228) completed online surveys. We used multivariate logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up. RESULTS: Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 7% at follow-up. Parents were more likely to report HPV vaccination among their sons if they had talked more with their sons about the vaccine (OR=1.93, 95%CI: 1.00-3.74). Non-Hispanic white parents were less likely to report HPV vaccination (OR=0.31, 95%CI: 0.12-0.79). Willingness to get sons HPV vaccine decreased from baseline to follow-up among parents (42% vs. 28%, p<0.001) and sons (29% vs. 18%, p=0.001). At b...
Tobacco control, 2014
We sought to systematically review the literature on electronic nicotine delivery systems (ENDS, ... more We sought to systematically review the literature on electronic nicotine delivery systems (ENDS, also called electronic cigarettes) awareness, use, reactions and beliefs. We searched five databases for articles published between 2006 and 1 July 2013 that contained variations of the phrases 'electronic cigarette', 'e-cigarette' and 'electronic nicotine delivery'. Of the 244 abstracts identified, we excluded articles not published in English, articles unrelated to ENDS, dissertation abstracts and articles without original data on prespecified outcomes. Two reviewers coded each article for ENDS awareness, use, reactions and beliefs. 49 studies met inclusion criteria. ENDS awareness increased from 16% to 58% from 2009 to 2011, and use increased from 1% to 6%. The majority of users were current or former smokers. Many users found ENDS satisfying, and some engaged in dual use of ENDS and other tobacco. No longitudinal studies examined whether ENDS serve as 'gat...
Tobacco control, 2014
Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery devices that have beco... more Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery devices that have become popular among smokers. We conducted an experiment to understand adult smokers' responses to e-cigarette advertisements and investigate the impact of ads' arguments and imagery. A U.S. national sample of smokers who had never tried e-cigarettes (n=3253) participated in a between-subjects experiment. Smokers viewed an online advertisement promoting e-cigarettes using one of three comparison types (emphasising similarity to regular cigarettes, differences or neither) with one of three images, for nine conditions total. Smokers then indicated their interest in trying e-cigarettes. Ads that emphasised differences between e-cigarettes and regular cigarettes elicited more interest than ads without comparisons (p<0.01), primarily due to claims about e-cigarettes' lower cost, greater healthfulness and utility for smoking cessation. However, ads that emphasised the similarities o...
Tobacco Control, 2015
Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired ... more Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own packs. We tested a cigarette pack labelling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cigarette packs. Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Our findings suggest a feasible pack labelling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomised controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labelling policy. NCT02247908.
A growing number of people use the Internet to obtain health information, including information a... more A growing number of people use the Internet to obtain health information, including information about vaccines. Websites that allow and promote interaction among users are an increasingly popular source of health information. Users of such so-called Web 2.0 applications (e.g. social media), while still in the minority, represent a growing proportion of online communicators, including vocal and active antivaccination groups as well as public health communicators. In this paper, the authors: define Web 2.0 and examine how it may influence vaccination decisions; discuss how anti-vaccination movements use Web 2.0 as well as the challenges Web 2.0 holds for public health communicators; describe the types of information used in these different settings; introduce the theoretical background that can be used to design effective vaccination communication in a Web 2.0 environment; make recommendations for practice and pose open questions for future research. The authors conclude that, as a result of the Internet and Web 2.0, private and public concerns surrounding vaccinations have the potential to virally spread across the globe in a quick, efficient and vivid manner. Web 2.0 may influence vaccination decisions by delivering information that alters the perceived personal risk of vaccine-preventable diseases or vaccination side-effects. It appears useful for public health officials to put effort into increasing the effectiveness of existing communication by implementing interactive, customized communication. A key step to providing successful public health communication is to identify those who are particularly vulnerable to finding and using unreliable and misleading information. Thus, it appears worthwhile that public health websites strive to be easy to find, easy to use, attractive in its presentation and readily provide the information, support and advice that the searcher is looking for. This holds especially when less knowledgeable individuals are in need of reliable information about vaccination risks and benefits.
Psycho-Oncology
While a previous meta-analysis found that false-positive mammography results affect women's l... more While a previous meta-analysis found that false-positive mammography results affect women's likelihood of returning for screening, effects on well being have yet to be meta-analyzed. We investigated whether the effects of false-positive mammograms on women's well-being are limited to outcomes specific to breast cancer. We searched MEDLINE for studies of the psychosocial effects of false-positive results of routine screening mammography. We pooled effect sizes using random effects meta-analysis. Across 17 studies (n=20781), receiving a false-positive mammogram the result was associated with differences in all eight breast-cancer-specific outcomes that we examined. These included greater anxiety and distress about breast cancer as well as more frequent breast self-exams and higher perceived effectiveness of screening mammography. False positives were associated with only one of six generic outcomes (i.e. generalized anxiety), and this effect size was small. False-positive mamm...
Health education & behavior : the official publication of the Society for Public Health Education, 2014
Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We ... more Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Four SHCs participated in an intervention to increase provision of recommended vaccines to 2,975 adolescents. We reviewed program materials and SHC staff reports, and interviewed parents to assess implementation fidelity and reactions to materials. Ten percent of parents returned forms with consent to at least one vaccine. Of these, 79% checked the box consenting for "all recommended" vaccines, rather than indicating individual vaccines. SHCs sent supplemental mailings to some parents that clarified (a) vaccination costs or (b) human papillomavirus vaccine recommendation for boys and required parents to reconsent. This process resulted in loss of initial consent, primarily due to nonresponse. In interviews, parents who ...
Journal of Community Health
Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening wi... more Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-te...
Journal of General Internal Medicine
Systematic reviews for the US Preventive Services Task Force have found less high-quality evidenc... more Systematic reviews for the US Preventive Services Task Force have found less high-quality evidence on psychological than physical harms of screening. To understand the extent of evidence on psychological harms, we developed an evidence map that quantifies the distribution of evidence on psychological harms for five adult screening services. We also note gaps in the literature and make recommendations for future research.
BACKGROUND: Hispanic females have the highest cervical cancer incidence rate of any racial or eth... more BACKGROUND: Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the US, yet relatively little research has examined HPV vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females. METHODS: We analyzed provider-verified vaccination data from the 2010-2011 National Immunization Survey-Teen for Hispanic females ages 13-17 (n=2,786). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of one or more doses), completion (receipt of three doses), and follow-through (receipt of three doses among those who initiated the series). RESULTS: HPV vaccine initiation was 60.9%, completion was 36.0%, and follow-through was 59.1%. Initiation and completion were more common among older daughters and those whose parents had received a provider recommendation to vaccinate (all p<0.05). Completion was less common among daughters who had moved ...
American Journal of Public Health
We applaud Monárrez-Espino et al.(1) for conducting a timely systematic review on pictorial cigar... more We applaud Monárrez-Espino et al.(1) for conducting a timely systematic review on pictorial cigarette pack warnings' impact on cigarette use. We have some concerns, however, about the dissimilarity of studies included in the review. We are also concerned that readers may be unaware of other evidence that supports the efficacy of pictorial warnings. (Am J Public Health. Published online ahead of print January 20, 2015: e1. doi:10.2105/AJPH.2014.302510).
Cancer Epidemiology Biomarkers & Prevention
Background. Hispanic females have the highest cervical cancer incidence rate of any racial or eth... more Background. Hispanic females have the highest cervical cancer incidence rate of any racial or ethnic group in the US, yet relatively little research has examined HPV vaccination among this fast-growing population. We examined HPV vaccination among a national sample of Hispanic adolescent females. Methods. We analyzed provider-verified vaccination data from the 2010-2011 National Immunization Survey-Teen for Hispanic females ages 13-17 (n=2,786). We used weighted logistic regression to identify correlates of HPV vaccine initiation (receipt of one or more doses), completion (receipt of three doses), and follow-through (receipt of three doses among those who initiated the series). Results. HPV vaccine initiation was 60.9%, completion was 36.0%, and follow-through was 59.1%. Initiation and completion were more common among older daughters and those whose parents had received a provider recommendation to vaccinate (all p<0.05). Completion was less common among daughters who had moved ...
Background: Low uptake of HPV and other adolescent vaccines calls for novel approaches for increa... more Background: Low uptake of HPV and other adolescent vaccines calls for novel approaches for increasing use. We tested the efficacy of a school health center (SHC) global consent intervention to promote uptake of 4 recommended vaccines. Methods: Participating North Carolina sites had existing SHCs enrolling 3,614 students. Study intervention included a cover letter and enhanced consent form allowing parents to give global consent for all vaccines or to elect individually. Parent confusion regarding vaccine costs and appropriateness of HPV vaccination for boys resulted in additional consent procedures for some students. Researchers collected data through school health records on total numbers of pre- and post-intervention doses administered for the 4 vaccines in September through January 2011 and again in 2012. Results: Among parents who initially provided consent to vaccinate (10%), most provided global consent (79%). Supplemental consent procedures dramatically reduced initial consen...
Journal of Adolescent Health
We examined parents' and adolescents' preferences regarding potential strategies to incre... more We examined parents' and adolescents' preferences regarding potential strategies to increase human papillomavirus (HPV) vaccination rates, including offering the vaccine in alternative settings, concomitant administration of vaccines, and optimizing the structure of vaccination medical visits. A national sample of U.S. parents of adolescent boys aged 11-17 years (n = 506) and their sons (n = 391) completed online surveys in August and September 2010. We used analysis of variance for mixed designs to examine preferences for vaccination settings. Parents and sons were most comfortable with sons receiving HPV vaccine in a doctor's office. Parents of sons who had not visited their regular health care providers in the past year were more comfortable with sons receiving HPV vaccine at a public clinic (p < .001) or school (p < .05) compared with parents whose sons had recent visits. Results from the son survey showed a similar pattern. Parents and sons reported moderate l...
Preventive Medicine, 2015
Background. Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our s... more Background. Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type.
Background: Gay and bisexual men have a high prevalence of human papillomavirus (HPV) infection a... more Background: Gay and bisexual men have a high prevalence of human papillomavirus (HPV) infection and are at high risk of HPV-related cancers, notably anal cancer. Objective/Purpose: Characterize acceptability of HPV vaccine among gay and bisexual men and identify correlates of acceptability. Methods: We surveyed men aged 18 to 59 who self-identified as either gay (n=201) or bisexual (n=63) and participated in a national, Internet-based survey panel. Data were analyzed using t-tests and linear regression. Results: Overall, 55% of participants indicated they would probably or definitely be willing to get HPV vaccine. This percentage dropped to 34% when participants learned the vaccine may be less effective following sexual initiation. Acceptability was higher among gay men compared to bisexual men and increased when participants learned HPV vaccine may prevent certain cancers (oral, anal, or penile) and genital warts, as opposed to only genital warts (p<0.05). Higher perceived HPV v...
Purpose: Most parents report that they heard of HPV vaccine through paid drug company advertiseme... more Purpose: Most parents report that they heard of HPV vaccine through paid drug company advertisements, but no research has established whether these self reports are accurate. We conducted an experiment to examine whether parents could accurately identify the source of ads promoting HPV vaccine for boys and whether the impact of ads varied by source. Method: A national sample of 547 parents of adolescent males ages 11-17 years completed the online between-subjects experiment. The experiment presented parents with an advertisement encouraging HPV vaccination for boys with a logo from a randomly assigned message source (Merck, Gardasil, Centers for Disease Control and Prevention (CDC), American Cancer Society (ACS), or no logo). Parents offered three evaluations (trust, liking, and motivation for vaccination) while viewing the ad. After the ad was removed from the screen, parents indicated who they believed sponsored it. Result: Nearly half of parents who viewed an advertisement contai...
BACKGROUND: Although defaults may encourage some health behaviors, how defaults influence controv... more BACKGROUND: Although defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of default policies on parents' consent to their sons hypothetically receiving HPV vaccine at school. METHODS: A national sample of 404 parents of adolescent sons ages 11-17 participated in an online 3x2 between-subjects factorial experiment during Fall 2010. One factor varied the default consent policy for sons receiving HPV vaccine at school (opt-in, opt-out, or neutral). The second factor varied the default number of vaccines sons would receive (HPV vaccine alone or HPV vaccine with two other recommended adolescent vaccines). The outcome was parents' consent to sons hypothetically receiving HPV vaccine at school. Analyses used factorial logistic regression. RESULTS: Consent for sons to receive HPV vaccine was higher in the opt-in condition than the opt-out condition (OR=2.72, 95% CI: 1.067.00), among parents wanti...
BACKGROUND: One potentially effective strategy to increase low uptake of HPV vaccine among adoles... more BACKGROUND: One potentially effective strategy to increase low uptake of HPV vaccine among adolescents is to offer vaccination in settings other than the traditional medical home, such as schools and pharmacies. METHODS: A national (U.S.) sample of parents of adolescent males ages 11-17 years (n=506) and their sons (n=391) completed our online surveys in Fall 2010. Most parents were less than 45 years old (61%), female (54%), and non-Hispanic white (67%). We identified correlates of parents' and sons' comfort with HPV vaccination in alternative settings (pharmacies and schools) using multivariate regression. RESULTS: About one-third of parents (37%) and a quarter of sons (23%) were comfortable with sons receiving HPV vaccine in alternative settings. Parents' and sons' ratings of comfort with vaccination in alternative settings were correlated (r=.50, p<.001), though parents were more comfortable than sons (p<.001). Both groups were more comfortable with HPV vac...
BACKGROUND: HPV vaccination has elicited controversy confined to a small but vocal minority of Am... more BACKGROUND: HPV vaccination has elicited controversy confined to a small but vocal minority of Americans. This study examined how comments about HPV vaccination made during the 2012 presidential Republican debates, which received nationwide coverage, affected parents' decisions. METHODS: In Fall 2010 and 2011, a national sample of parents of males ages 11-17 (n=327) completed online surveys. Baseline data collection occurred before, and follow-up came one to two months after, the presidential candidates' comments. RESULTS: Only 17% of parents had heard that the candidates made comments about HPV vaccine during the debates. Of these parents, most (66%) recalled the comments as being largely against the vaccine, and some (25%) recalled largely favorable comments. Most parents said that the comments did not change their opinions (68%). Belief that HPV vaccine might cause short-term side effects increased between baseline and follow-up more among parents who heard the comments t...
BACKGROUND: HPV vaccine became available for males in the U.S. in 2009. We conducted a longitudin... more BACKGROUND: HPV vaccine became available for males in the U.S. in 2009. We conducted a longitudinal study to examine HPV vaccine uptake among adolescent males and identify predictors of vaccination. METHODS: In Fall of 2010 and 2011, a national sample of parents of adolescent males ages 11-17 (n=327) and their sons (n=228) completed online surveys. We used multivariate logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up. RESULTS: Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 7% at follow-up. Parents were more likely to report HPV vaccination among their sons if they had talked more with their sons about the vaccine (OR=1.93, 95%CI: 1.00-3.74). Non-Hispanic white parents were less likely to report HPV vaccination (OR=0.31, 95%CI: 0.12-0.79). Willingness to get sons HPV vaccine decreased from baseline to follow-up among parents (42% vs. 28%, p<0.001) and sons (29% vs. 18%, p=0.001). At b...
Tobacco control, 2014
We sought to systematically review the literature on electronic nicotine delivery systems (ENDS, ... more We sought to systematically review the literature on electronic nicotine delivery systems (ENDS, also called electronic cigarettes) awareness, use, reactions and beliefs. We searched five databases for articles published between 2006 and 1 July 2013 that contained variations of the phrases 'electronic cigarette', 'e-cigarette' and 'electronic nicotine delivery'. Of the 244 abstracts identified, we excluded articles not published in English, articles unrelated to ENDS, dissertation abstracts and articles without original data on prespecified outcomes. Two reviewers coded each article for ENDS awareness, use, reactions and beliefs. 49 studies met inclusion criteria. ENDS awareness increased from 16% to 58% from 2009 to 2011, and use increased from 1% to 6%. The majority of users were current or former smokers. Many users found ENDS satisfying, and some engaged in dual use of ENDS and other tobacco. No longitudinal studies examined whether ENDS serve as 'gat...
Tobacco control, 2014
Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery devices that have beco... more Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery devices that have become popular among smokers. We conducted an experiment to understand adult smokers' responses to e-cigarette advertisements and investigate the impact of ads' arguments and imagery. A U.S. national sample of smokers who had never tried e-cigarettes (n=3253) participated in a between-subjects experiment. Smokers viewed an online advertisement promoting e-cigarettes using one of three comparison types (emphasising similarity to regular cigarettes, differences or neither) with one of three images, for nine conditions total. Smokers then indicated their interest in trying e-cigarettes. Ads that emphasised differences between e-cigarettes and regular cigarettes elicited more interest than ads without comparisons (p<0.01), primarily due to claims about e-cigarettes' lower cost, greater healthfulness and utility for smoking cessation. However, ads that emphasised the similarities o...
Tobacco Control, 2015
Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired ... more Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own packs. We tested a cigarette pack labelling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cigarette packs. Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Our findings suggest a feasible pack labelling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomised controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labelling policy. NCT02247908.
A growing number of people use the Internet to obtain health information, including information a... more A growing number of people use the Internet to obtain health information, including information about vaccines. Websites that allow and promote interaction among users are an increasingly popular source of health information. Users of such so-called Web 2.0 applications (e.g. social media), while still in the minority, represent a growing proportion of online communicators, including vocal and active antivaccination groups as well as public health communicators. In this paper, the authors: define Web 2.0 and examine how it may influence vaccination decisions; discuss how anti-vaccination movements use Web 2.0 as well as the challenges Web 2.0 holds for public health communicators; describe the types of information used in these different settings; introduce the theoretical background that can be used to design effective vaccination communication in a Web 2.0 environment; make recommendations for practice and pose open questions for future research. The authors conclude that, as a result of the Internet and Web 2.0, private and public concerns surrounding vaccinations have the potential to virally spread across the globe in a quick, efficient and vivid manner. Web 2.0 may influence vaccination decisions by delivering information that alters the perceived personal risk of vaccine-preventable diseases or vaccination side-effects. It appears useful for public health officials to put effort into increasing the effectiveness of existing communication by implementing interactive, customized communication. A key step to providing successful public health communication is to identify those who are particularly vulnerable to finding and using unreliable and misleading information. Thus, it appears worthwhile that public health websites strive to be easy to find, easy to use, attractive in its presentation and readily provide the information, support and advice that the searcher is looking for. This holds especially when less knowledgeable individuals are in need of reliable information about vaccination risks and benefits.