Reactions to messages about smoking, vaping and COVID-19: two national experiments.

INTRODUCTION: The pace and scale of the COVID-19 pandemic, coupled with ongoing efforts by health agencies to communicate harms, have created a pressing need for data to inform messaging about smoking, vaping, and COVID-19. We examined reactions to COVID-19 and traditional health harms messages discouraging smoking and vaping. METHODS: Participants were a national convenience sample of 810 US adults recruited online in May 2020. All participated in a smoking message experiment and a vaping message experiment, presented in a random order. In each experiment, participants viewed one message formatted as a Twitter post. The experiments adopted a 3 (traditional health harms of smoking or vaping: three harms, one harm, absent) × 2 (COVID-19 harms: one harm, absent) between-subjects design. Outcomes included perceived message effectiveness (primary) and constructs from the Tobacco Warnings Model (secondary: attention, negative affect, cognitive elaboration, social interactions). RESULTS: Smoking messages with traditional or COVID-19 harms elicited higher perceived effectiveness for discouraging smoking than control messages without these harms (all p <0.001). However, including both traditional and COVID-19 harms in smoking messages had no benefit beyond including either alone. Smoking messages affected Tobacco Warnings Model constructs and did not elicit more reactance than control messages. Smoking messages also elicited higher perceived effectiveness for discouraging vaping. Including traditional harms in messages about vaping elicited higher perceived effectiveness for discouraging vaping (p <0.05), but including COVID-19 harms did not. CONCLUSIONS: Messages linking smoking with COVID-19 may hold promise for discouraging smoking and may have the added benefit of also discouraging vaping.

HPV vaccine communication training in healthcare systems: Evaluating a train-the-trainer model.

BACKGROUND: Large healthcare systems provide an opportunity to disseminate evidence-based interventions to primary care. We evaluated the impact of a train-the-trainer model in two large systems to disseminate the Announcement Approach Training, which teaches providers to communicate about HPV vaccination more effectively. METHODS: In collaboration with the American Cancer Society, we partnered with two midwestern healthcare systems that served over 77,000 patients ages 11 through 17. Both systems hosted a 2-hour train-the-trainer workshop. Providers from one system then conducted in-person 1-hour CME-eligible trainings, using our standard slide set and script (available at hpvIQ.org). The other system did not implement trainings, providing a natural experiment. RESULTS: The train-the-trainer workshop included physicians, nurses and other clinical staff (n = 11/13 for intervention/comparison systems). The intervention system delivered 18 trainings to 234 physicians, nurses, and other clinic staff. From baseline to 6-month follow-up, the intervention system had an increase in HPV vaccine uptake that was larger than that of the comparison system for adolescents ages 11 through 12 (1.9%, p = .002) and ages 13 through 17 (1.5%, p = .015). Attending the training was associated with increased intentions to routinely recommend HPV vaccine when patients turn 11 or 12 (mean 4.19 (SD = 0.95) vs. 4.43 (SD = 0.83) as well as increased positive vaccine attitudes, self-efficacy, and norms (all p < .001). Participant satisfaction with the trainings was high (90%-94%). CONCLUSION: The train-the-trainer model was effective in increasing provider motivation to recommend HPV vaccination and led to a small increase in vaccine uptake. Dissemination through large healthcare systems is promising but faces some challenges.