A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial.

BACKGROUND: Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol. METHODS: The study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention. DISCUSSION: Recruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden. TRIAL REGISTRATION: NCT05057312.

HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives.

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

Scaling up the discovery of hesitancy profiles by identifying the framing of beliefs towards vaccine confidence in Twitter discourse.

Our study focused on the discovery of how vaccine hesitancy is framed in Twitter discourse, allowing us to recognize at-scale all tweets that evoke any of the hesitancy framings as well as the stance of the tweet authors towards the frame. By categorizing the hesitancy framings that propagate misinformation, address issues of trust in vaccines, or highlight moral issues or civil rights, we were able to empirically recognize their ontological commitments. Ontological commitments of vaccine hesitancy framings couples with the stance of tweet authors allowed us to identify hesitancy profiles for two most controversial yet effective and underutilized vaccines for which there remains substantial reluctance among the public: the Human Papillomavirus and the COVID-19 vaccines. The discovered hesitancy profiles inform public health messaging approaches to effectively reach Twitter users with promise to shift or bolster vaccine attitudes.

Addressing racial/ethnic inequities in vaccine hesitancy and uptake: lessons learned from the California alliance against COVID-19.

Lack of trust in biomedical research, government, and health care systems, especially among racial/ethnic minorities and under-resourced communities, is a longstanding issue rooted in social injustice. The COVID-19 pandemic has further highlighted existing health and socioeconomic inequities and increased the urgency for solutions to provide access to timely, culturally, and linguistically appropriate evidence-based information about COVID-19; and ultimately to promote vaccine uptake. California's statewide alliance STOP COVID-19 CA (comprising eleven sites), leverages long standing community partnerships to better understand concerns, misinformation, and address racial/ethnic inequities in vaccine hesitancy and uptake. Using data from the California CEAL Communication Working Group, we demonstrate the wide range of strategies, communication methods, languages, and trusted messengers that have been effective in reaching diverse communities across the state. We also showcase challenges and lessons learned, such as the importance of including trusted community partners to share information or provide vaccines. These approaches, rooted in community engagement, are crucial for addressing inequities and responding to future public health emergencies.

Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women.

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute's evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women's interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women's online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

Perceptions of changes in clinical, informational, and supportive relationships after end of treatment among parents of young childhood cancer survivors.

BACKGROUND: Parents of childhood cancer patients experience changes in relationships with their health-care team as the child transitions from treatment to long-term survivorship (LTS). These changes may affect parent receptivity of survivorship-health-related programs, yet little is known about the experience of changing clinical relationships for parents as treatment ends and children transition into LTS. METHODS: In-depth, semistructured interviews were conducted with 20 English-speaking parents of childhood cancer survivors less than 13 years old who were greater than 1-year posttreatment. Audiotaped, transcribed interview content was analyzed using emergent themes grouped and refined in a process of multistaged constant comparison. RESULTS: There was a consensus among parents regarding the emotional stressors of the period immediately after the end of treatment. Regardless of positive or negative recollection of treatment, parents commonly viewed their health-care team with affection and this period as one of stability and security. Transitioning off treatment was viewed as a severe disruption of the security of weekly, treatment-related contact with nurses, nurse practitioners, physician's assistants, and physicians. LTS was generally viewed as presenting lower levels, but new types of stress as new, psychosocial late effects were seen to emerge. Clinical needs shifted to prevention and late-effect management. CONCLUSION: Parents of young childhood cancer survivors experience a similar emotional trajectory from treatment to transitioning off treatment and into LTS. This period is seen by parents as uniquely distressing because it represents a disruption of the hard-won safety represented by regular clinical relationships.

A social network-informed latent class analysis of patterns of substance use, sexual behavior, and mental health: Social Network Study III, Winnipeg, Manitoba, Canada.

OBJECTIVES: We assessed whether a meaningful set of latent risk profiles could be identified in an inner-city population through individual and network characteristics of substance use, sexual behaviors, and mental health status. METHODS: Data came from 600 participants in Social Network Study III, conducted in 2009 in Winnipeg, Manitoba, Canada. We used latent class analysis (LCA) to identify risk profiles and, with covariates, to identify predictors of class. RESULTS: A 4-class model of risk profiles fit the data best: (1) solitary users reported polydrug use at the individual level, but low probabilities of substance use or concurrent sexual partners with network members; (2) social-all-substance users reported polydrug use at the individual and network levels; (3) social-noninjection drug users reported less likelihood of injection drug and solvent use; (4) low-risk users reported low probabilities across substances. Unstable housing, preadolescent substance use, age, and hepatitis C status predicted risk profiles. CONCLUSIONS: Incorporation of social network variables into LCA can distinguish important subgroups with varying patterns of risk behaviors that can lead to sexually transmitted and bloodborne infections.

HPV Vaccination Decision Among Catch-up Population Through a Digital Intervention: Empowering Young Adults to Their Own Health Decision-Making.

Human papillomavirus (HPV) is the most common sexually transmitted infection on U.S. college campuses. Although HPV vaccination is recommended through age 26, current efforts to improve vaccination rates have predominantly focused on adolescents. Consequently, vaccine uptake remains suboptimal among young adults. This represents a significant missed opportunity, as young adults face the highest risk for new HPV infections. To contextualize the factors impacting decision-making process for this vulnerable population, this study reports key themes that emerged from in-depth interviews with participants (N = 30) who had completed an online intervention study for HPV vaccination among college students. Twelve (40%) of the interviewees vaccinated after exposure to the intervention. Findings centered around empowerment among young adults as the facilitator to get the HPV vaccine: key themes emerged were (1) convenience is critical and empowering; (2) adulthood identity, marked by a heightened sense of autonomy, accountability, and responsibility for self/future self and others, is empowering; (3) equal access to health care and preventive resources is empowering, especially for participants with low socioeconomic status; and (4) accurate knowledge provided in the intervention destigmatized HPV vaccination to empower young adults to make informed decisions. Digital interventions with messages highlighting a newly gained autonomy, future-oriented self and social responsibility, inclusive and accurate knowledge, and providing navigation to improve access may enhance HPV vaccination among young adults.

Mutations in SLC20A2 are a major cause of familial idiopathic basal ganglia calcification.

Familial idiopathic basal ganglia calcification (IBGC) or Fahr's disease is a rare neurodegenerative disorder characterized by calcium deposits in the basal ganglia and other brain regions, which is associated with neuropsychiatric and motor symptoms. Familial IBGC is genetically heterogeneous and typically transmitted in an autosomal dominant fashion. We performed a mutational analysis of SLC20A2, the first gene found to cause IBGC, to assess its genetic contribution to familial IBGC. We recruited 218 subjects from 29 IBGC-affected families of varied ancestry and collected medical history, neurological exam, and head CT scans to characterize each patient's disease status. We screened our patient cohort for mutations in SLC20A2. Twelve novel (nonsense, deletions, missense, and splice site) potentially pathogenic variants, one synonymous variant, and one previously reported mutation were identified in 13 families. Variants predicted to be deleterious cosegregated with disease in five families. Three families showed nonsegregation with clinical disease of such variants, but retrospective review of clinical and neuroimaging data strongly suggested previous misclassification. Overall, mutations in SLC20A2 account for as many as 41% of our familial IBGC cases. Our screen in a large series expands the catalog of SLC20A2 mutations identified to date and demonstrates that mutations in SLC20A2 are a major cause of familial IBGC. Non-perfect segregation patterns of predicted deleterious variants highlight the challenges of phenotypic assessment in this condition with highly variable clinical presentation.

Understanding real-world implementation quality and "active ingredients" of PBIS.

Programs delivered in the "real world" often look substantially different from what was originally intended by program developers. Depending on which components of a program are being trimmed or altered, such modifications may seriously undermine the effectiveness of a program. In the present study, these issues are explored within a widely used school-based, non-curricular intervention, Positive Behavioral Intervention and Supports. The present study takes advantage of a uniquely large dataset to gain a better understanding of the "real-world" implementation quality of PBIS and to take a first step toward identifying the components of PBIS that "matter most" for student outcomes. Data from 27,689 students and 166 public primary and secondary schools across seven states included school and student demographics, indices of PBIS implementation quality, and reports of problem behaviors for any student who received an office discipline referral during the 2007-2008 school year. Results of the present study identify three key components of PBIS that many schools are failing to implement properly, three program components that were most related to lower rates of problem behavior (i.e., three "active ingredients" of PBIS), and several school characteristics that help to account for differences across schools in the quality of PBIS implementation. Overall, findings highlight the importance of assessing implementation quality in "real-world" settings, and the need to continue improving understanding of how and why programs work. Findings are discussed in terms of their implications for policy.

Preadolescent drug use resistance skill profiles, substance use, and substance use prevention.

The aims of the current study were threefold: (1) specify the skills component of social influence prevention interventions for preadolescents, (2) examine the relationship between resistance skill profiles and substance use among preadolescents, and (3) evaluate whether subgroups of preadolescents based on their resistance skills and refusal confidence may be differentially impacted by the kiR prevention program. Latent class analysis showed a four-class model of 5th grader resistance skill profiles. Approximately half of preadolescents (53%) were familiar with four prototypical resistance skills and showed confidence to apply these skills in real-world settings (highly competent profile); 15% were familiar with resistance skills but had little confidence (skillful profile); 18% were confident yet had little knowledge (confident profile); while 15% had low knowledge and confidence (low competence profile). These skill profiles significantly predicted 8th grade recent substance use (2LL = -2,262.21, df = 3, p = .0005). As predicted by theory, the highly competent skill profile reported lower mean recent substance use than the population sample mean use. Latent transition analysis showed that although patterns of transiting into the highly competent skill profile over time were observed in the expected direction, this pattern was not significant when comparing treatment and control. Identifying skill profiles that predict recent substance use is theoretically consistent and has important implications for healthy and substance-free development.

Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study.

BACKGROUND: Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. OBJECTIVE: In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members' motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. METHODS: Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. RESULTS: In total, 13 (65%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members' receptivity to the messages. Themes that could potentially impact family members' willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of hoi tham, respect for a physician's recommendation, prevention versus symptom orientation, the family health advocate's bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. CONCLUSIONS: The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families.

Understanding underlying moral values and language use of COVID-19 vaccine attitudes on twitter.

Public sentiment toward the COVID-19 vaccine as expressed on social media can interfere with communication by public health agencies on the importance of getting vaccinated. We investigated Twitter data to understand differences in sentiment, moral values, and language use between political ideologies on the COVID-19 vaccine. We estimated political ideology, conducted a sentiment analysis, and guided by the tenets of moral foundations theory (MFT), we analyzed 262,267 English language tweets from the United States containing COVID-19 vaccine-related keywords between May 2020 and October 2021. We applied the Moral Foundations Dictionary and used topic modeling and Word2Vec to understand moral values and the context of words central to the discussion of the vaccine debate. A quadratic trend showed that extreme ideologies of both Liberals and Conservatives expressed a higher negative sentiment than Moderates, with Conservatives expressing more negative sentiment than Liberals. Compared to Conservative tweets, we found the expression of Liberal tweets to be rooted in a wider set of moral values, associated with moral foundations of care (getting the vaccine for protection), fairness (having access to the vaccine), liberty (related to the vaccine mandate), and authority (trusting the vaccine mandate imposed by the government). Conservative tweets were found to be associated with harm (around safety of the vaccine) and oppression (around the government mandate). Furthermore, political ideology was associated with the expression of different meanings for the same words, e.g. "science" and "death." Our results inform public health outreach communication strategies to best tailor vaccine information to different groups.

Digital HPV education to increase vaccine uptake among low income women.

Objective: The objective of this formative study was to gather women's perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine. Methods: Twenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro. Results: Most women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities. Conclusions: Among low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations. Innovation: Designing a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

Effects of a narrative HPV vaccination intervention aimed at reaching college women: a randomized controlled trial.

This longitudinal study reports on the development and evaluation of a narrative intervention aimed at increasing human papillomavirus (HPV) vaccination among college women. The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer, the second leading cause of cancer deaths among women worldwide. Pilot work utilizing culture-centric narrative theory guided development of the intervention content. Exemplification theory led to hypotheses comparing communication sources of the narrative messages (peer only, medical expert only, or a combination of the two source types) in a four-arm randomized controlled trial (N = 404; 18-26 year olds). The combined peer-expert narrative intervention nearly doubled vaccination compared to controls (22% vs. 12%). The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported. As predicted, the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women. Furthermore, the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent. Theoretical and practical implications for designing effective HPV vaccine messages are discussed.

Associations between Coronavirus Crisis Perception, Perceived Economic Risk of Coronavirus, General Self-Efficacy, and Coronavirus Anxiety at the Start of the Pandemic: Differences by Gender and Race.

The coronavirus pandemic has escalated rates of anxiety in the general U.S. population. Understanding how factors associated with coronavirus anxiety at the start of the pandemic differed among populations hardest impacted by coronavirus anxiety is key to effectively remediating negatively associated health outcomes and to better understand how to address concerns of the public at the start of a global pandemic. This study was a secondary analysis of data from a cross-sectional online survey of 1165 Prolific users between 13 and 15 March 2020. Data were collected from a stratified sample of U.S. adults aged 20 or older and currently living in the United States. The sample was stratified for age, gender, and race. Coronavirus anxiety was assessed as the dependent variable, alongside three independent variables: coronavirus crisis perception, perceived economic risk of coronavirus, and general self-efficacy. Multiple linear regression assessed the associations between the independent variables and coronavirus anxiety. Interactions between independent variables and two sociodemographic variables (i.e., gender, race) were also explored. The models were adjusted for age, gender, race, education, employment, and income. The average age of participants was 45.6 ± 15.7. The majority (76%) identified as White, approximately half identified as female and reported obtaining a bachelor's degree or higher. Coronavirus crisis perception and perceived economic risk of coronavirus were positively associated with coronavirus anxiety (ß = 0.46, 95% CI = 0.41, 1.00; ß = 0.14, 95% CI = 0.09, 1.00, respectively). General self-efficacy was negatively associated with coronavirus anxiety (ß = -0.15, 95% CI = -1.00, -0.11). Gender and race both moderated the association between coronavirus crisis perception and anxiety. Race moderated the association between perceived economic risk and coronavirus crisis perception. These results provide a foundation to further explore cognitive factors in subgroups disproportionately affected by anxiety during the pandemic.

Adaptation and Dissemination of a National Cancer Institute HPV Vaccine Evidence-Based Cancer Control Program to the Social Media Messaging Environment.

Social media offers a unique opportunity to widely disseminate HPV vaccine messaging to reach youth and parents, given the information channel has become mainstream with 330 million monthly users in the United States and 4.2 billion users worldwide. Yet, a gap remains on how to adapt evidence-based vaccine interventions for the in vivo competitive social media messaging environment and what strategies to employ to make vaccine messages go viral. Push-pull and RE-AIM dissemination frameworks guided our adaptation of a National Cancer Institute video-based HPV vaccine cancer control program, the HPV Vaccine Decision Narratives, for the social media environment. We also aimed to understand how dissemination might differ across three platforms, namely Instagram, TikTok, and Twitter, to increase reach and engagement. Centering theory and a question-answer framework guided the adaptation process of segmenting vaccine decision story videos into shorter coherent segments for social media. Twelve strategies were implemented over 4 months to build a following and disseminate the intervention. The evaluation showed that all platforms increased following, but Instagram and TikTok outperformed Twitter on impressions, followers, engagement, and reach metrics. Although TikTok increased reach the most (unique accounts that viewed content), Instagram increased followers, engagement, and impressions the most. For Instagram, the top performer, six of 12 strategies contributed to increasing reach, including the use of videos, more than 11 hashtags, COVID-19 hashtags, mentions, and follow-for-follow strategies. This observational social media study identified dissemination strategies that significantly increased the reach of vaccine messages in a real-world competitive social media messaging environment. Engagement presented greater challenges. Results inform the planning and adaptation considerations necessary for transforming public health HPV vaccine interventions for social media environments, with unique considerations depending on the platform.

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one's health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Adolescent COVID-19 Vaccine Decision-Making among Parents in Southern California.

Adolescent COVID-19 vaccination has stalled at 53% in the United States. Vaccinating adolescents remains critical to preventing the continued transmission of COVID-19, the emergence of variants, and rare but serious disease in children, and it is the best preventive measure available to return to in-person schooling. We investigated parent-adolescent COVID-19 vaccine decision-making. Between 24 February and 15 March 2021, we conducted surveys and 12 focus groups with 46 parent-adolescent dyads in Southern California. Parents and adolescents completed a survey prior to participation in a focus group discussion, which focused on exploring COVID-19 vaccine acceptance or uncertainty and was guided by the 5C vaccine hesitancy model. Parents uncertain about vaccinating adolescents expressed low vaccine confidence and high COVID-19 disease risk complacency. Parents who accepted COVID-19 vaccination for adolescents expressed high confidence in health authority vaccine recommendations, high perceived COVID-19 risk, and collective responsibility to vaccinate children. Additionally, unique pandemic-related factors of vaccine acceptance included vaccinating for emotional health, resuming social activities, and vaccine mandates. Among parents, 46% were willing to vaccinate their adolescent, 11% were not, and 43% were unsure. Among adolescents, 63% were willing to vaccinate. Despite vaccine availability, 47% of adolescents remain unvaccinated against COVID-19. Factors associated with vaccine uncertainty and acceptability inform health care practitioner, school, community, and public health messaging to reach parents and adolescents.

College women's HPV vaccine decision narratives.

Drawing on 38 in-depth qualitative interviews with college women and college health clinicians, we collected human papillomavirus (HPV) vaccine decision narratives to identify the implicit and explicit values underlying HPV vaccine decision making. Narratives of vaccine acceptance and resistance were identified. Vaccine acceptance narratives consisted of four themes: supportive family messages, explicit health care provider endorsement, peer descriptive norms reducing stigma of vaccination, and disease framing (e.g., cancer, HPV) shaping vaccine benefit perceptions. Vaccine resistance narratives consisted of five themes: skepticism of vaccine safety, invoking alternative prevention strategies, articulating stigmatizing HPV messages, overcoming self-efficacy barriers (e.g., cost, availability, time, and fear of parental disclosure), and delay strategies. Common to all decision narratives was that relationship status framed college women's perceptions of HPV susceptibility. Theoretical and practical implications for designing HPV vaccine messages aimed at college-aged women are discussed.