Harvard School of Public Health Dana-Farber Cancer Institute Dana-Farber/Harvard Cancer Center Communications of HPV and the HPV vaccine: Challenges in

Harvard School of Public HealthDana-Farber Cancer InstituteDana-Farber/Harvard Cancer Center

Communications of HPV and the HPV vaccine: Challenges in the 21st Century

K. Viswanath

• I, K. “Vish” Viswanath, have been asked to disclose any significant relationships with commercial entities that are either providing financial support for this program or whose products or services are mentioned during my presentations.

– I have no relationships to disclose.

What do we mean by communications revolution?

Two dimensions:• An enormous capacity to generate, integrate,

manipulate and distribute information across temporal, geographical and disciplinary boundaries.

• Integration of different digital domains – from university libraries to private data archives to research from scientific groups and labs, as well as information on people Viswanath, 2011

Communication devices and their use

The Pew Research Center’s Project for Excellence in Journalism (2012). The State of the News Media 2012. Accessed on March 31 at: http://stateofthemedia.org/2012/overview-4/key-

findings/

New U.S. Research Will Aim at Flood of Digital DataBig data refers to the rising flood of digital data from many sources, including the Web, biological and industrial sensors, video, e-mail and social network communications.

For example, if you buy a used car, your best bet is an orange one. Data scientists at Kaggle, a pattern recognition start-up …., have matched previously separate data sets on buyers, colors and after-purchase problems. They figured out that if a car’s original owner chose an odd color, the car was most likely a means of self-expression. That self-identification raises the odds that the owner cared more than usual for the vehicle.

What Does It Take to Turn Big Data into Big Dollars?

volume of data now being produced continues to skyrocket, with something on the order of 2.7 Zettabytes (2.7 x 1021) of information to be produced in 2012

Cancer Communications in 21 Century: Some facts

Have you ever looked for information about cancer from any source?*

National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014, http://hints.cancer.gov/brief_16.aspx


The most recent time you looked for cancer information, where did you go first?*



Trust in source for cancer information


Health Disparities and Communication Inequalities

Social determinants

• Race/ethnicity• Living conditions• Socioeconomic status

– Income– Education– Occupation

• Gender• Sexuality• Immigration status• Stressful life events over the lifecourse

…is differences among social classes in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level.

Communication Inequality…

Dimensions of communication inequality

Five broad dimensions•Use/Access/Exposure

•Attention

•Information seeking

•Processing

•Communication Effects

Broadband use: Exemplar of Intersectionality

NTIA, 2010



Cancer Communications in 21 Century: Some facts Percent survey who say that their physician always explains things so they can understand

Ackerson LK,Viswanath K.The social context of interpersonal communication and health. J Health Comm 2009; 14:1,5–17.Ackerson LK, Viswanath K. Communication inequalities, social determinants, and intermittent smoking in the 2003 Health Information National Trends Survey. Prev Chronic Dis 2009 Apr;6(2):A40.



Cancer Communications in 21 Century: Some facts Percent survey who say that their physician always respects what they have to say

Ackerson LK,Viswanath K.The social context of interpersonal communication and health. J Health Comm 2009; 14:1,5–17.Ackerson LK, Viswanath K. Communication inequalities, social determinants, and intermittent smoking in the 2003 Health Information National Trends Survey. Prev Chronic Dis 2009 Apr;6(2):A40.

Age-adjusted prevalence of respondents to the 2003 HINTS survey who say that their physician always respects what they have to say.

Information Seeking

Recently there has been an increased emphasis on

•Patients gathering information

•Carefully weighing evidence

•Taking into account their personal preferences and values in order to fully participate in clinical decisions

Types of information sought, by education

Treatment Information Self Care Management Pre-Treatment Information0

10

20

30

40

50

60

70

High School or Less

High School to Associate

College

Postgraduate

Galarce, Ramanadhan, Weeks, Schneider, Gray, Viswanath, 2011

Participants seeking work/finance information by level of wealth

Low Mid-Low Mid-High High0

10

20

30

40

50

60

70

Galarce, Ramanadhan, Weeks, Schneider, Gray, Viswanath, 2011

Determinants of Vaccine Acceptance

Factors that influence vaccine acceptance•Knowledge •Attitudes towards the vaccines and

vaccination •Availability of vaccine services•Affordability•Accessibility

HPV knowledge

Viswanath, 2011

HPV knowledge

Viswanath, 2011

HPV knowledge

Viswanath, 2011

HPV knowledge

HPV knowledge

Communication Inequalities in HPV Knowledge: Race and Ethnicity

Kontos EZ, Emmons KM, Puleo E, Viswanath K. Contribution of communication inequalities to disparities in HPV vaccine awareness and knowledge. American Journal of Public Health. 2012 Oct;102(10):1911-20.

Race/ethnicity Non-Hispanic white

Non-Hispanic black

Hispanic Other0

10

20

30

40

50

60

70

80

90

Aware of HPV vaccineKnowledgeable HPV is a cause of cervical cancerKnowledgeable HPV is transmitted through sexual contact

Communication Inequalities in HPV Knowledge: Education


Education <HS HS Some college ≥College0

10

20

30

40

50

60

70

80

90

Aware of HPV vaccine Knowledgeable HPV is a cause of cervical cancerKnowledgeable HPV is transmitted through sexual contact

Communication Inequalities in HPV Knowledge: Income


HH income <20k 20-34k 35-49k 50-74k >75k Didn’t report

0

10

20

30

40

50

60

70

80

90

Aware of HPV vaccineKnowledgeable HPV is a cause of cervical cancerKnowledgeable HPV is transmitted through sexual contact

Communication Inequalities in HPV Knowledge: Gender


Aware of HPV vaccine Knowledgeable HPV is a cause of cervical cancer

Knowledgeable HPV is transmitted through sexual contact

0

10

20

30

40

50

60

70

80

90

Sex Male Female

Communication & HPV: Way forward

• A study of provider-parent communication and conversation showed that “routine” recommendation is more powerful and robust than “detailed” conversation.

• Provider recommendation is the key– There are many “missed opportunities” in provider-patient

interactions– Some providers may be hesitant

• Pharmacists and “immunization neighborhood”– Additional venues/access points– Coordinated communications


• Vaccination as a social norm– Social network as a gatekeeper and re-inforcer

• Address parental refusal/attitudes which is a major barrier– “mistrust” towards vaccine in general– Providers need communication training on how to talk to parents– Need for a toolkits to talk to parents– Address myths– Risk perceptions


• Media framing– Shift conversation from STDs to cancer prevention– Address misinformation and stories that are covered in the media– Work with reporters

• Importance of addressing communication inequalities– Customizing communications development and delivery

Members of the Lab

• Jaclyn Alexander-Molloy

• Carmenza Bruff

• Hope Cummings

• Josephine Crisostomo

• Hana Hayashi

• Alyssa Jordan

• Nancy Klockson

• Leesa Lin

• Rachel McCloud

• Sara Minsky

• Yudy Muneton

• Shoba Ramanadhan

www.viswanathlab.org

Documents

Harvard School of Public Health Dana-Farber Cancer Institute Dana-Farber/Harvard Cancer Center Communications of HPV and the HPV vaccine: Challenges in