The science of trust: future directions, research gaps, and implications for health and risk communication.

'Trust is among the most important factors in human life, as it pervades' all domains of society [1] and related decision-making processes. This includes people's trust in science, and in clinical and public health solutions. Unequivocally, community and patient trust are foundational to the adoption and maintenance of health-related behaviors, social norms, and policies. Yet, trust has to be earned and developed over time and through multiple interactions. Trust is about dialogue and human connection. It's about listening and knowing that one interaction will not be enough to build trust. It is also influenced by a variety of social, economic, cultural, and political factors, past experiences, and the history of specific communities and patient groups. It should be at the core of the health and social systems with which people interact. More recently, trust in evidence-based information has also been affected by misinformation, not only on social media but also in a variety of community, institutional, and patient settings. Ultimately, we are in the midst of a global trust crisis that precedes the COVID-19 pandemic and is often rooted in the health, racial, and social inequities many groups experience [2].

Facebook Pages, the "Disneyland" Measles Outbreak, and Promotion of Vaccine Refusal as a Civil Right, 2009-2019.

Objectives. To understand changes in how Facebook pages frame vaccine opposition.Methods. We categorized 204 Facebook pages expressing vaccine opposition, extracting public posts through November 20, 2019. We analyzed posts from October 2009 through October 2019 to examine if pages' content was coalescing.Results. Activity in pages promoting vaccine choice as a civil liberty increased in January 2015, April 2016, and January 2019 (t[76] = 11.33 [P < .001]; t[46] = 7.88 [P < .001]; and t[41] = 17.27 [P < .001], respectively). The 2019 increase was strongest in pages mentioning US states (t[41] = 19.06; P < .001). Discussion about vaccine safety decreased (rs[119] = -0.61; P < .001) while discussion about civil liberties increased (rs[119] = 0.33; Py < .001]). Page categories increasingly resembled one another (civil liberties: rs[119] = -0.50 [P < .001]; alternative medicine: rs[84] = -0.77 [P < .001]; conspiracy theories: rs[119] = -0.46 [P < .001]; morality: rs[106] = -0.65 [P < .001]; safety and efficacy: rs[119] = -0.46 [P < .001]).Conclusions. The "Disneyland" measles outbreak drew vaccine opposition into the political mainstream, followed by promotional campaigns conducted in pages framing vaccine refusal as a civil right. Political mobilization in state-focused pages followed in 2019.Public Health Implications. Policymakers should expect increasing attempts to alter state legislation associated with vaccine exemptions, potentially accompanied by fiercer lobbying from specific celebrities.

Adapting and Extending a Typology to Identify Vaccine Misinformation on Twitter.

Objectives. To adapt and extend an existing typology of vaccine misinformation to classify the major topics of discussion across the total vaccine discourse on Twitter.Methods. Using 1.8 million vaccine-relevant tweets compiled from 2014 to 2017, we adapted an existing typology to Twitter data, first in a manual content analysis and then using latent Dirichlet allocation (LDA) topic modeling to extract 100 topics from the data set.Results. Manual annotation identified 22% of the data set as antivaccine, of which safety concerns and conspiracies were the most common themes. Seventeen percent of content was identified as provaccine, with roughly equal proportions of vaccine promotion, criticizing antivaccine beliefs, and vaccine safety and effectiveness. Of the 100 LDA topics, 48 contained provaccine sentiment and 28 contained antivaccine sentiment, with 9 containing both.Conclusions. Our updated typology successfully combines manual annotation with machine-learning methods to estimate the distribution of vaccine arguments, with greater detail on the most distinctive topics of discussion. With this information, communication efforts can be developed to better promote vaccines and avoid amplifying antivaccine rhetoric on Twitter.

Culturally aware mentorship: Lasting impacts of a novel intervention on academic administrators and faculty.

National efforts to address the diversity dilemma in Science, Technology, Engineering, and Math (STEM) often emphasize increasing numbers of historically underrepresented (HU) students and faculty, but fall short in instituting concrete changes for inclusion and belonging. Therefore, increasing the pool of senior faculty who wish to become guides and advocates for emerging scientists from HU populations is an essential step toward creating new pathways for their career advancement. As a step toward achieving this goal, we created a novel eight-hour intervention on Culturally Aware Mentoring (CAM), a program of the National Research Mentoring Network (NRMN) targeted to faculty and administrators. A previous report of surveys at the end of the CAM sessions revealed substantial awareness and knowledge gains, with participants expressing intentions to use and implement new skills they had learned. In this paper, we provide the results of our thematic analysis of qualitative interviews with academic administrators and faculty, 18-24 months after participation in CAM. Interviews were designed to determine: 1) What changes in self-perceptions and interactions occurred as a result of participation in CAM? 2) What specific components of CAM are associated with changes in individual beliefs and practices? 3) How did participants actively make changes after the CAM workshop? 4) What barriers or challenges do participants encounter after the CAM intervention? The results demonstrate the lasting influences of CAM on participants' awareness of cultural differences, their assumptions about and approaches toward interactions with colleagues and students, and their efforts to change their behaviors to promote inclusive practices in their mentoring and teaching of HU students in STEM. Our findings provide evidence that CAM can be incorporated into existing mentor training programs designed to improve the confidence and capacity of senior research faculty mentors to make culturally-informed, scholar-centered decisions to more deliberately recognize and respond to cultural differences within their mentoring and collegial relationships.

Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter.

In February 2020, the World Health Organization announced an 'infodemic' -- a deluge of both accurate and inaccurate health information -- that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the 'infodemic' during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the 'infodemic,' researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information -- from both reliable and unreliable sources -- that the public is likely to encounter online.

Examining prevalence and correlates of cigarette and marijuana co-use among young adults using ten years of NHANES data.

BACKGROUND: Prior research has documented a strong association between cigarette and marijuana use among young adults; it is critical to study patterns and risk factors for co-use. METHODS: Appended, cross-sectional National Health and Nutrition Examination Survey (NHANES) data were used to assess prevalence and correlates of cigarette and marijuana co-use among young adults (ages 21-30) over a 10-year period (2005-2014). Respondents (unweighted sample = 4,948) were classified into four categories regarding past-month behavior: neither use, cigarette-only use, marijuana-only use, and co-use of both. Regression models were computed to predict these categories using three waves of NHANES (unweighted sample = 3,073). RESULTS: Prevalence of past-month cigarette use decreased from 30.9% in 2005-2006 to 23.7% in 2013-2014 (p = 0.024) while past-month marijuana use (average 18.0%) and past-month co-use (average 9.8%) remained stable during this time. Co-use differed significantly by gender (p < 0.001; average 12.9% men, 6.8% women). Co-users were less likely to be married, more likely to endorse non-Hispanic black racial identity, more likely to have engaged in non-marijuana drug use in their lifetime and more likely to drink alcohol monthly than cigarette-only users. Co-users were more likely to have depressive symptoms, ever use non-marijuana drugs, live with a smoker, and initiate marijuana at a younger age than marijuana-only users. CONCLUSIONS: Co-use of cigarettes and marijuana remained stable but high over a ten-year period; understanding the unique characteristics, living situations, experiences, and substance use behaviors of co-users can contribute to more effective, tailored prevention and education strategies to reduce the burden of comorbid cigarette and marijuana use.

Social media use and influenza vaccine uptake among White and African American adults.

Influenza vaccination rates in the U.S. remain low at 41% among adults over 18 years according to the Centers for Disease Control and Prevention's 2016 data. Reasons for the low rate vary and include factors such as risk perception, vaccine hesitancy, and access to health care. This cross-sectional study sought to examine the relationship between social media use and influenza vaccine uptake among a sample of White and African Americans over 18 years of age. Using bivariate, and unadjusted and adjusted logistic regression tests, this study examined the relationship among social media use, social media as a source of health information, and influenza vaccination status in 2015. Our results indicate that users of Twitter (OR4.41, 95%CI: 1.43-13.60) and Facebook (OR 1.66, 95%CI: 1.01-2.72) as sources of health information were more likely to be vaccinated in comparison to users who do not use Twitter or Facebook as a source of health information. These findings have implications for the potential of using social media platforms to disseminate influenza vaccine information and encourage users to get vaccinated annually.

Pilot Study of an Intervention to Increase Cultural Awareness in Research Mentoring: Implications for Diversifying the Scientific Workforce.

INTRODUCTION: Innovative evidence-based-interventions are needed to equip research mentors with skills to address cultural diversity within research mentoring relationships. A pilot study assessed initial outcomes of a culturally tailored effort to create and disseminate a novel intervention titled Culturally Aware Mentoring (CAM) for research mentors. INTERVENTION: Intervention development resulted in four products: a 6hr CAM training curriculum, a facilitator guide, an online pre-training module, and metrics to evaluate the effectiveness of CAM training. METHOD: Participants were 64 research mentors from three US research-intensive universities. Quantitative pre and post-training evaluation survey data were collected. RESULTS: Participants found high value and satisfaction with the CAM training, reported gains in personal cultural awareness and cultural skills, and increased intentions and confidence to address cultural diversity in their mentoring. CONCLUSIONS: Study findings indicate that the CAM training holds promise to build research mentors' capacity and confidence to engage directly with racial/ethnic topics in research mentoring relationships.

Commentary: Critical Race Theory Training to Eliminate Racial and Ethnic Health Disparities: The Public Health Critical Race Praxis Institute.

Racism is a fundamental cause of racial and ethnic disparities in health outcomes. Researchers have a critical role to play in confronting racism by understanding it and intervening on its impact on the health and well-being of minority populations. This requires new paradigms and theoretical frameworks that are responsive to structural racism's present-day influence on health, health disparities, and research. To address the complexity with which racism influences both health and the production of knowledge about minority populations, the field must accelerate the professional development of researchers who are committed to eliminating racial and ethnic health disparities and achieving health equity. In this commentary, we describe a unique and vital training experience, the Public Health Critical Race Praxis Institute at the University of Maryland's Center for Health Equity. Through this training institute, we have focused on the experiential knowledge of diverse researchers committed to examining racism and trained them on putting racism at the forefront of their research agendas. The Institute brought together investigators from across the United States, including junior and senior faculty as well as postdoctoral fellows. The public health critical race methodology was purposefully used to structure the Institute's curriculum, which instructed the scholars on Critical Race Theory as a framework in research. During a 2.5-day training in February 2014, scholars participated in activities, attended presentations, joined in reflections, and interacted with Institute faculty. The scholars indicated a strong desire to focus on race and racism and adopt a Public Health Critical Race Praxis framework by utilizing Critical Race Theory in their research.

Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.

OBJECTIVES: To understand how Twitter bots and trolls ("bots") promote online health content. METHODS: We compared bots' to average users' rates of vaccine-relevant messages, which we collected online from July 2014 through September 2017. We estimated the likelihood that users were bots, comparing proportions of polarized and antivaccine tweets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity. RESULTS: Compared with average users, Russian trolls (χ2(1) = 102.0; P < .001), sophisticated bots (χ2(1) = 28.6; P < .001), and "content polluters" (χ2(1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ2(1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ2(1) = 12.1; P < .001) and antivaccine (χ2(1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive. CONCLUSIONS: Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination. Public Health Implications. Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.

Mission of Mercy emergency dental clinics: an opportunity to promote general and oral health.

BACKGROUND: Mission of Mercy (MOM) emergency dental clinics are a resource for populations lacking access to dental care. We designed a MOM event incorporating health equity components with established community partners who shared a common vision of addressing the oral health, physical health, and social service needs of Maryland and Washington, DC area residents. Although studies have explored associations between oral and chronic health conditions, few studies to our knowledge have examined the relationship between these conditions and receipt of dental services. Therefore, this study explored these associations and the opportunity for better care coordination. METHODS: Oral health data from the 2014 Mid-Maryland Mission of Mercy and Health Equity Festival event was analyzed. A descriptive analysis assessed frequencies and percentages of participant sociodemographics characteristics, oral health and chronic disease risk(s), and dental services delivered. Chi-square tests and multivariate logistic regression were conducted to determine the associations between 1) oral health and chronic disease risk(s) and dental services; and 2) oral health and chronic disease risk(s) and participant characteristics. RESULTS: Approximately 66.2% (n = 666) of the 1007 participants had one or more chronic conditions and/or risk factors (diabetes, high blood pressure, and tobacco use). These individuals had a significantly higher likelihood of receiving an oral surgery procedure (specifically, tooth extraction) (only one condition/risk: OR = 2.40, 95%, CI = 1.48-3.90, p < .001; two conditions/risks: OR = 3.12, 95% CI = 1.78-5.46, p < .001). CONCLUSION: The 2014 Mid-Maryland Mission of Mercy emergency dental clinic attracted people with risk factors for oral and chronic diseases. Those with one or more risk factors were more likely to receive oral surgery (specifically, tooth extraction). These findings strongly suggest that organizers of MOM emergency dental clinics include wrap-around primary care, health promotion and disease prevention services along with provision of dental services. While such events will not solve the general and oral health challenges of participants, we believe they provide an opportunity to provide basic preventive services. These findings also present an opportunity to inform planning for future MOMs and emphasize the importance of using these public health events to create linkages with other services to support follow-up and care coordination.

The Health Equity Leadership Institute (HELI): Developing workforce capacity for health disparities research.

INTRODUCTION: Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research. METHODS: Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute-the Health Equity Leadership Institute (HELI)-with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research. RESULTS: In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding. CONCLUSIONS: HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.

Public Understanding of Medical Countermeasures.

Medical countermeasures, including new drugs and vaccines, are necessary to protect the public's health from novel diseases and terrorist threats. Experience with the 2001 anthrax attack and the 2009 H1N1 pandemic suggest that there is limited willingness to accept such drugs and that minority groups may respond differently from others. We conducted 148 intercept interviews in the metropolitan Washington, DC, area, examining 2 hypothetical scenarios: a new respiratory virus and public exposure to high levels of radiation. Findings provide insights into key factors that affect whether diverse members of the public comply with recommended protective actions like taking emergency authorized vaccines. These insights can help improve how public health practitioners communicate during uncertain times.

Building a "Deep Fund of Good Will": Reframing Research Engagement.

BACKGROUND: The engagement of underrepresented populations in health research has been an ongoing challenge. Yet, the participation of these groups is recognized as key to health equity. METHODS: Semi-structured interviews with 31 experienced investigators successful in the recruitment of underrepresented minorities were analyzed with reference to the concept of social capital to determine: 1) if it is actually in use by successful researchers although yet unidentified as such; and 2) if the rubric could shed light on new directions especially for those who find it difficult to implement community-engaged recruitment methods systematically. RESULTS: Findings indicate that some elements of the concept of social capital are being used successfully, but that there are also substantial barriers to its full implementation. CONCLUSION: A lack of enforceable trust and associated institutional support for researchers is a detriment to research engagement. Efforts to remedy this would benefit large research projects, including clinical trials.

The Symbolic Value and Limitations of Racial Concordance in Minority Research Engagement.

The well-documented underrepresentation of racial and ethnic minorities in research demands action. The field of health disparities research, however, lacks scientific consensus about how best to respectfully recruit underrepresented minority populations in research. We explore the investigators' perspective regarding how their own racial and ethnic background influenced their ability to recruit minorities, including (a) the influence of racial concordance ("race-matching") in research recruitment, (b) attributes and shared values important in the development of trust with minority communities, and (c) the role self-reflection plays in the development of meaningful research relationships. In 2010, we conducted in-depth, semi-structured, telephone interviews with investigators (N= 31) experienced with minority populations. Through the analysis of this coherent narrative, we uncovered both the symbolic and surface-level assumptions regarding minority recruitment to expose a deep structural understanding of race, ethnicity, and social context that is critical for bridging the true social difference between researchers and participants.

Improving health-related quality of life in older African American and non-Latino White patients.

OBJECTIVE: To compare the effect of problem-solving therapy against a health-promotion intervention (dietary practices) on health-related quality of life (HRQOL) and examine if there is a differential effect on non-Latino white patients and African American patients between the two interventions. This paper also explores participant characteristics (problem-solving style and physical functioning) as potential predictors of HRQOL. METHODS: Secondary analysis of data from a randomized depression prevention trial involving 247 older adults (154 non-Latino white, 90 African American, 3 Asian). Participants were randomly assigned to receive either problem solving therapy for primary care (PST-PC) or coaching in healthy dietary practices (DIET). RESULTS: Both PST-PC and DIET improved HRQOL over two years and did not differ significantly from each other. African American patients in both conditions had greater improvements in mental health-related quality of life (MHRQOL) compared with non-Latino white patients. In addition, higher social problem-solving and physical functioning were predictive of improved MHRQOL. CONCLUSION: PST-PC and DIET have the potential to improve health-related quality of life in a culturally relevant manner. Both hold promise as effective and potentially scalable interventions that could be generalized to highly disadvantaged populations in which little attention to HRQOL has been paid.

Treatment of post traumatic stress disorder symptoms in emotionally distressed individuals.

Older individuals with emotional distress and a history of psychologic trauma are at risk for post traumatic stress disorder (PTSD) and major depression. This study was an exploratory, secondary analysis of data from the study "Prevention of Depression in Older African Americans". It examined whether Problem Solving Therapy-Primary Care (PST-PC) would lead to improvement in PTSD symptoms in patients with subsyndromal depression and a history of psychologic trauma. The control condition was dietary education (DIET). Participants (n=60) were age 50 or older with scores on the Center for Epidemiologic Studies-Depression scale of 11 or greater and history of psychologic trauma. Exclusions stipulated no major depression and substance dependence within a year. Participants were randomized to 6-8 sessions of either PST-PC or DIET and followed 2 years with booster sessions every 6 months; 29 participants were in the PST-PC group and 31 were in the DIET group. Mixed effects models showed that improvement of PTSD Check List scores was significantly greater in the DIET group over two years than in the PST-PC group (based on a group time interaction). We observed no intervention⁎time interactions in Beck Depression Inventory or Brief Symptom Inventory-Anxiety subscale scores.