A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts.

With SARS-CoV-2 vaccines under development, research is needed to assess intention to vaccinate. We conducted a survey (N = 3,159) with U.S. adults in May 2020 assessing SARS-CoV-2 vaccine intentions, intentions with a provider recommendation, and sociodemographic and psychosocial variables. Participants had high SARS-CoV-2 vaccine intentions (M = 5.23/7-point scale), which increased significantly with a provider recommendation (M = 5.47). Hierarchical linear regression showed that less education and working in health care were associated with lower intent, and liberal political views, altruism, and COVID-19-related health beliefs were associated with higher intent. This work can inform interventions to increase vaccine uptake, ultimately reducing COVID-19-related morbidity and mortality.

Ethics and Childhood Vaccination Policy in the United States.

Childhood immunization involves a balance between parents' autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals. In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates. Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policy-making.

Use of drawings to explore U.S. women's perspectives on why people might decline HIV testing.

The purpose of this research is to explore through drawings and verbal descriptions women's perspectives about reasons why persons might decline human immunodeficiency virus (HIV) testing. We asked 30 participants to draw a person that would NOT get tested for HIV and then explain drawings. Using qualitative content analysis, we extracted seven themes. We found apprehension about knowing the result of an HIV test to be the most commonly identified theme in women's explanations of those who would not get tested. This technique was well received and its use is extended to HIV issues.

'What, me worry?': Parents' reasons for worry and nonworry about adolescent risk for sexually transmitted infections (STI).

Little is known about the bases of parental worry about adolescents' risk for acquiring a sexually transmitted infection (STI). Parents (N = 247) of adolescents 12-17 years endorsed reasons that explained their worry or nonworry. Parents' past experience of an STI, perception of the child's sexual activity, and racial self-identification were predictors of worry. Cluster analyses identified five groups of worriers and four groups of nonworriers. Worriers tended to select reasons reflecting an external parental locus of control or child-specific reasons. Nonworriers endorsed reasons consistent with internal parental locus of control. Findings suggest that preventive health communication should be tailored to parents' perceptions of risk and protective factors.

A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States.

The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.

Predictors of influenza vaccination in the U.S. among children 9-13years of age.

BACKGROUND AND OBJECTIVES: U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9-13year old children. METHODS: An online U.S. survey of mothers of children aged 9-13 assessed children's influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. RESULTS: There were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). CONCLUSIONS: This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

Parental attitudes about sexually transmitted infection vaccination for their adolescent children.

OBJECTIVES: To evaluate parental attitudes about adolescent vaccination as a function of vaccine characteristics, including whether the vaccine prevented a sexually transmitted infection (STI), and to explore possible sociodemographic predictors of acceptability of STI vaccines. DESIGN: Participants were 278 parents who accompanied their children (69.1% female, aged 12-17 years) to appointments at medical clinics. By using computer-based questionnaires, parents rated 9 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: mode of transmission (STI or non-STI), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Willingness by parents to vaccinate their adolescents under each vaccine scenario was assessed on a scale that ranged from 0 to 100. Conjoint analysis was used to determine the relative contribution of each dimension to the ratings. RESULTS: The mean vaccine scenario rating was 81.3. Sexually transmitted infection vaccines (mean, 81.3) were not rated differently than non-STI vaccines (mean, 80.0). Conjoint analysis indicated that severity of infection and vaccine efficacy had the strongest influence on ratings, followed by availability of behavioral prevention. Mode of transmission had a negligible effect on ratings. Child age (P = .08) and sex (P = .77), parent age (P = .32) and education (P = .34), insurance status (P = .08), and data collection site (P = .48) were not significantly associated with STI vaccine acceptability. CONCLUSIONS: Parents were accepting of the idea of vaccinating their adolescent children against STIs. The most salient issues were severity of infection and vaccine efficacy, not sexual transmissibility. Parents also favored vaccines for infections that had no method of behavioral prevention available.

Parental beliefs and decision making about child and adolescent immunization: from polio to sexually transmitted infections.

Over the past 150 years, innovations in immunization practices have dramatically improved the health of children, and parents are increasingly asked to consider and accept new childhood vaccines. We present a conceptual model to frame a review of research on the role of parental attitudes and beliefs in decision making about child and adolescent immunization and describe the historical context of vaccine-related decision-making research. This review focuses on theory-based Social-environmental and parent-specific personal factors as potential influences on vaccine decision making. Relevant Social-environmental issues discussed include media coverage of vaccines, perceived social norms, and the persuasive influence of peer groups. Health care provider recommendations are presented as an exemplar of factors related to the family's interface with the health care system. Personal factors addressed include parental health beliefs, attitudes, and knowledge related to vaccine preventable diseases and immunization, as well as cognitive heuristics that are employed in the decision-making process (e.g., omission bias, protected values, framing of information). Last, promising directions for research and suggestions for clinical practice are presented.

Human Papillomavirus Vaccine Initiation among 9-13-Year-Olds in the United States.

OBJECTIVE: The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9-26-year-old males and females, with routine vaccination recommended for 11-12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13-17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9-13-year-olds in the United States. METHODS: A national sample of mothers of 9-13-year-olds in the United States (N=2,446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). RESULTS: Approximately 35% of the full sample and 27.5% of the 9-10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. CONCLUSIONS: Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage.

Parental perspectives on vaccinating children against sexually transmitted infections.

Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents' risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies. This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decision-maker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents.

Vaccine message framing and parents' intent to immunize their infants for MMR.

BACKGROUND AND OBJECTIVE: Emphasizing societal benefits of vaccines has been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children. The objective was to determine whether emphasizing the benefits of measles-mumps-rubella (MMR) vaccination directly to the vaccine recipient or to society differentially impacts parents' vaccine intentions for their infants. METHODS: In a national online survey, parents (N = 802) of infants <12 months old were randomly assigned to receive 1 of 4 MMR vaccine messages: (1) the Centers for Disease Control and Prevention Vaccine Information Statement (VIS), (2) VIS and information emphasizing the MMR vaccine's benefits to the child, (3) VIS and information emphasizing societal benefits, or (4) VIS and information emphasizing benefits both to the child and society. Parents reported their likelihood of vaccinating their infants for MMR on a response scale of 0 (extremely unlikely) to 100 (extremely likely). RESULTS: Compared with the VIS-only group (mean intention = 86.3), parents reported increased vaccine intentions for their infants when receiving additional information emphasizing the MMR vaccine's benefits either directly to the child (mean intention = 91.6, P = .01) or to both the child and society (mean intention = 90.8, P = .03). Emphasizing the MMR vaccine's benefits only to society did not increase intentions (mean intention = 86.4, P = .97). CONCLUSIONS: We did not see increases in parents' MMR vaccine intentions for their infants when societal benefits were emphasized without mention of benefits directly to the child. This finding suggests that providers should emphasize benefits directly to the child. Mentioning societal benefits seems to neither add value to, nor interfere with, information highlighting benefits directly to the child.

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

The role of herd immunity in parents' decision to vaccinate children: a systematic review.

BACKGROUND AND OBJECTIVE: Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents' decisions to immunize their children. Our objective was to determine if the concept of "benefit to others" has been found in the literature to influence parents' motivation for childhood immunization. METHODS: We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others. RESULTS: The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making. CONCLUSIONS: There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.

Community partners as co-teachers in resident continuity clinics.

Standard approaches to teaching the management of psychosocial issues in pediatrics--visits to community-based organizations and stand-alone block rotations in developmental-behavioral pediatrics and community pediatrics--neither expose residents to models of interdisciplinary collaboration between faculty preceptors and community providers nor take advantage of the efficacy of learning in continuity clinics. The authors describe their project, developed from an existing Community Pediatrics Training Initiative with long-standing relationships with a domestic violence shelter, a community center for Latino families, and a special needs resource organization for parents. They lay out in detail the project's innovative use of partners from community-based organizations, colocated within pediatric continuity clinics, who teach both residents and faculty about community resources and linkages with multidisciplinary providers. The authors present lessons learned by faculty preceptors, residents, the community partners, and project staff that can guide future applications of this model in other residency training programs. Faculty and residents indicated an increased awareness of available community resources and how linkages can be incorporated into pediatric outpatient visits. Community partners identified keys to successful co-teaching, including readiness to adopt an assertive communication style and frequent presence in the clinics. Project staff recognized the challenges of staff turnover at community-based organizations and the need to choose community partners with expertise that fits the sociodemographic issues of the clinic's patients.

The effects of vaccine characteristics on adult women's attitudes about vaccination: a conjoint analysis study.

The number of current and future vaccines for adults has been steadily increasing. Yet, vaccine coverage rates for adult vaccinations have historically been low, and less is known about how adults in the mid-adult age range make vaccine decisions for themselves. The purpose of this study was to assess which vaccine characteristics affect vaccine decision-making among mid-adult women. Adult women, aged 27-55 (n=258) rated 9 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: mode of transmission (STI or non-STI), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Ratings ranged from 0 to 100. Conjoint analysis was used to assess the effect of relative preferences for the vaccine scenario characteristics on participant ratings of scenarios. The mean vaccine scenario rating was 78.2. Nearly half (40%, n=104) of participants rated all nine scenarios the same, with the majority of those (84%) holding strongly positive views. Conjoint analysis of the other 154 participants who discriminated between scenarios indicated that the main drivers for vaccine acceptability were severity of the disease and the efficacy of the vaccine to prevent the disease. Mode of transmission and availability of a preventative behavioral measure did not play a significant role. Future studies should further assess how women's understanding of severity of the disease and efficacy of the vaccine to prevent disease may be useful for increasing vaccine acceptability.

Acceptability of the human papillomavirus vaccine among Latina mothers.

STUDY OBJECTIVE: To describe Latina mothers' acceptance of the human papillomavirus (HPV) vaccine for their daughters and explore their knowledge base regarding HPV-related issues. DESIGN: Individual interviews were conducted with a convenience sample of 40 Latina mothers of daughters 7-14 years old, from an urban, pediatric primary care clinic. Preliminary questions were asked regarding HPV knowledge and then information was verbally provided before exploring vaccine acceptance. RESULTS: Thirty-one of the Latina mothers had not heard of HPV and 34 were not aware of the connection between HPV and cervical cancer. Thirty-two mothers reported that they would allow their daughters to receive the HPV vaccine. Two overarching themes were identified as reasons for accepting the vaccine. The main theme for vaccine acceptance provided by 26 mothers was "to prevent disease." The other theme was "to protect" their child. Four mothers were undecided and 4 reported they would not vaccinate their daughter. The two themes identified from this group of mothers include not having sufficient information regarding the vaccine, and that their daughters are too young. CONCLUSION: Acceptance of the HPV vaccine was high in this sample of Latina mothers. The prevention of disease and the protection of their child were the motivating factors for vaccinating their daughters. Reasons for not accepting include lack of information and young age of daughter. The provision of information will be key to ensuring Latina mothers understand the rationale for vaccinating at a young age.

Acceptability to Latino parents of sexually transmitted infection vaccination.

OBJECTIVE: To evaluate the acceptability to Latino parents of having their adolescent children vaccinated against sexually transmitted infections, and to identify potential demographic correlates of acceptability. METHODS: We applied established methodology to a sample of 119 Latino parents who accompanied their children (51% female, aged 12-17 years) to medical appointments. The parents used computer-based questionnaires to rate 9 hypothetical vaccine scenarios. The scenarios had 4 dimensions: mode of transmission (sexually transmitted or not sexually transmitted), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Willingness by parents to vaccinate their adolescents under each vaccine scenario was assessed on a scale (range, 0-100). Conjoint analysis was used to determine the relative contribution of each dimension to the ratings. RESULTS: The study sample consisted of predominantly Mexican immigrant parents, 94% of whom chose to complete the Spanish version of the computerized interview. The mean value of the parents' willingness to accept vaccination for their adolescent children was exceptionally high. For example, the mean score of the Latino parents for the 6 sexually transmitted infection (STI) vaccine scenarios (score 86.2; SD 21.1) was far higher than the mean score in previous studies (81.3, SD 21.1). Conjoint analysis revealed that the dimensions of vaccine efficacy and severity of infection were equal in terms of their influence on vaccine ratings for the Latino parents. The next most influential dimension on vaccine ratings was the availability of behavioral prevention, followed by the sexual transmissibility of the infection. CONCLUSIONS: Our sample of predominantly Mexican parents was accepting of the concept of STI vaccination for their adolescent children. Important issues for parents include vaccine efficacy and severity of infection, followed by vaccines for infections that had no method of behavioral prevention available. Overall, there is little difference in the relative preference of a STI versus non-STI vaccine for their adolescent children.

Predictors of STI vaccine acceptability among parents and their adolescent children.

PURPOSE: To identify attitudes and behavioral factors associated with parental intent to vaccinate their adolescent children against sexually transmitted infections (STI) and adolescent intent to accept vaccination for the prevention of STI. METHODS: In this cross-sectional study, 320 parents and their adolescent children (aged 12-17 years) were recruited from urban adolescent health clinics and private practice pediatric offices to complete audio, computer-assisted self-interviews (A-CASI). Parents and their adolescents were asked about acceptability of gonorrhea, genital herpes, and human immumodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) vaccines. These three items were summed to create an STI vaccine acceptability scale, the primary outcome variable. Potential predictors measured included health beliefs, sociodemographic factors, and health and sexual behaviors. RESULTS: A substantial majority of parents and their adolescent children rated the three STI vaccines as very acceptable. Parental health beliefs and parental history of STI diagnosis were significant independent predictors of intent to vaccinate adolescent children against STI. Parental intent to vaccinate and having a friend who had engaged in sexual intercourse were significant independent predictors of adolescents' intent to accept STI vaccination. CONCLUSIONS: The majority of these parents and their adolescent children found STI vaccination very acceptable, suggesting that there will be great interest in these vaccines once they become available. Interventions designed to address parental health beliefs may prove successful at maintaining or increasing interest in STI vaccines. Adolescents are likely to look to their parents for guidance around acceptance of these vaccines, but personal experiences also may play a role.