Karen Hilyard

Blog Functions as Risk and Crisis Communication During Hurricane Katrina

Blogs were examined during the 2 weeks after Hurricane Katrina hit the U.S. city of New Orleans to better understand what risk and crisis communication functions they served. The 4 major functions—communication, political, information, and helping—included both filtering and linking about rescue needs and efforts, missing persons, ways to offer and find assistance, fostering community, and providing information on damage and government response. A thinker function was fulfilled where bloggers expressed opinions, especially on government response. An additional function not previously delineated was identified, which might be termed emotive or therapeutic. In addition, several of the blog functions indicate the role the Internet plays in maintaining a sense of community in times of crisis.

The Social Ecological Model as a Framework for Determinants of 2009 H1N1 Influenza Vaccine Uptake in the United States

Research on influenza vaccine uptake has focused largely on intrapersonal determinants (perceived risk, past vaccine acceptance, perceived vaccine safety) and on physician recommendation. The authors used a social ecological framework to examine influenza vaccine uptake during the 2009 H1N1 pandemic. Surveying an adult population (n = 2,079) in January 2010 with significant oversamples of Blacks and Hispanics, this study found that 18.4% (95% confidence interval = 15.6-21.5) had gotten the 2009 H1N1 vaccine. Variables at each level of the social ecological model were significant predictors of uptake as well as of intent to get the vaccine. The intrapersonal level explained 53%, the interpersonal explained 47%, the institutional level explained 34%, and the policy and community levels each explained 8% of the variance associated with vaccine uptake. The levels together explained 65% of the variance, suggesting that interventions targeting multiple levels of the framework would be more effective than interventions aimed at a single level.

Public Support for Government Actions During a Flu Pandemic: Lessons Learned From a Statewide Survey

To better inform public health officials during a flu pandemic, this study analyzes a representative statewide telephone survey among 1,602 adults to examine knowledge and perceptions about a flu pandemic, trust in government, and support for government actions in a flu pandemic. The findings show citizens do not understand what avian/bird flu is and how it evolves into a pandemic. They also seem to have divergent perceptions regarding the susceptibility and severity of a flu pandemic. More than half of the respondents trust the government to handle a flu pandemic and show strong support for many proposed government actions in a pandemic, except for offering non—fully approved drugs. The findings suggest public health and risk communicators should reinforce support for controversial actions through trust building and personalization of risks rather than mere education or publicity. Public education and engagement should also begin pre-pandemic and continue throughout all phases of the event.

Understanding Vaccine Refusal Why We Need Social Media Now

The recent Disneyland measles outbreak brought national attention to a growing problem: vaccine refusal—herd immunity is no longer a reality in many communities. Only 70% of children aged 19–35 months are up-to-date on immunizations, and in some communities, more than a quarter of school-age children have exemptions on file (www.doh.wa.gov/Portals/1/ Documents/Pubs/348-247-SY2014-15-ImmunizationMaps. pdf). Although they vary across the ideological spectrum, vaccine refusers tend to be well educated, white, and more affluent than people who typically experience health disparities. Prior studies have found that a diversity of motivations drive vaccine refusal, including fear that vaccines cause autism, concerns over toxins, beliefs about the benefits of measles to the immune system, distrust of government, distrust of pharmaceutical companies, and preference for a “natural” lifestyle. Arguments recommended by physicians’ groups and public health agencies to counter these beliefs do not always change minds; even parents who indicate high trust in their pediatricians may not follow doctors’ recommendations. Ultimately, people “persuade themselves to change attitudes and behavior,” and communicators must tailor messages to the beliefs, attitudes, and motivations of particular audience segments. Effective health communication about vaccines requires answering three questions:

Zika vaccine misconceptions: A social media analysis

Development of the Zika virus vaccine is in its early stages, but there is already cause for concern regarding the success of the eventual vaccination campaign. Evidence suggests the public is skeptical of the development and approval process for vaccines. Extreme media attention, which Zika has already received, can make people concerned about both the disease and the vaccine. We need only look back to the 2009–2010 H1N1 pandemic to find vaccine similar skepticism [1].

WIC Peer Counselors’ Perceptions of Breastfeeding in African American Women with Lower Incomes

Background: African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors’ perceptions of breastfeeding in African American women. Objective: As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs). Methods: Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner’s socioecological model was used to group categories into themes. Results: Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs’ low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a “sense of security,” (2) cultural pressures to be a “strong black woman” can impede breastfeeding support, and (3) breastfeeding “generational gaps” have resulted from American “slavery” and when formula was “a sign of wealth.” Conclusion: As PCs described, low-income African American women’s breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.

Trust During the Early Stages of the 2009 H1N1 Pandemic

Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this article is to describe the publics trust in government recommendations during the early stages of the H1N1 pandemic and to identify factors that might account for these trust levels. The authors surveyed 1,543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009, and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks online panel. This panel is representative of the U.S. population and uses a combination of random digit dialing and address-based probability sampling frames covering 99% of the U.S. household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, Knowledge Networks provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. The authors found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic characteristics. Closely following the news about the flu virus, having some self-reported knowledge about H1N1, self-reporting of local cases, and previously experiencing discrimination were the significant attitudinal and experience predictors of trust. Using a second longitudinal survey, trust in the early stages of the pandemic predicted vaccine acceptance later but only for White, non-Hispanic individuals.

Action, Not Talk: A Simulation of Risk Communication During the First Hours of a Pandemic

This article describes the design, implementation, and evaluation of a simulation of risk communication in the first hours of a pandemic. The simulation design was based on Crisis and Emergency Risk Communication principles espoused by the Centers for Disease Control and Prevention, as well as the collective experience of the authors. Over 4 hours, 17 local health district risk communicators in Georgia responded to a scenario in which every community in the state had teenagers infected with avian flu after returning from an international conference. The evaluation revealed that local risk communicators had much greater difficulty following risk communication principles under the time pressures of a realistic and stressful event than they did in a tabletop exercise. Strengths and weaknesses of the performance of the local risk communicators are identified in addition to lessons learned about the design and implementation of a risk communication simulation.

Exploring the Continuum of Vaccine Hesitancy Between African American and White Adults: Results of a Qualitative Study

Vaccine delay and refusal present very real threats to public health. Since even a slight reduction in vaccination rates could produce major consequences as herd immunity is eroded, it is imperative to understand the factors that contribute to decision-making about vaccines. Recent scholarship on the concept of “vaccine hesitancy” emphasizes that vaccine behaviors and beliefs tend to fall along a continuum from refusal to acceptance. Most research on hesitancy has focused on parental decision-making about childhood vaccines, but could be extended to explore decision-making related to adult immunization against seasonal influenza. In particular, vaccine hesitancy could be a useful approach to understand the persistence of racial/ethnic disparities between African American and White adults. This study relied on a thematic content analysis of qualitative data, including 12 semi-structured interviews, 9 focus groups (N=90), and 16 in-depth interviews, for a total sample of 118 (N=118) African American and White adults. All data were transcribed and analyzed with Atlas.ti. A coding scheme combining both inductive and deductive codes was utilized to identify themes related to vaccine hesitancy. The study found a continuum of vaccine behavior from never-takers, sometimes-takers, and always-takers, with significant differences between African Americans and Whites. We compared our findings to the Three Cs: Complacency, Convenience, and Confidence framework. Complacency contributed to low vaccine acceptance with both races. Among sometimes-takers and always-takers, convenience was often cited as a reason for their behavior, while never-takers of both races were more likely to describe other reasons for non-vaccination, with convenience only a secondary explanation. However, for African Americans, cost was a barrier. There were racial differences in trust and confidence that impacted the decision-making process. The framework, though not a natural fit for the data, does provide some insight into the differential sources of hesitancy between these two populations. Complacency and confidence clearly impact vaccine behavior, often more profoundly than convenience, which can contribute either negatively or positively to vaccine acceptance. The Three Cs framework is a useful, but limited tool to understanding racial disparities. Understanding the distinctions in those cultural factors that drive lower vaccine confidence and greater hesitancy among African Americans could lead to more effective communication strategies as well as changes in the delivery of vaccines to increase convenience and passive acceptance.

The Vagaries Of Public Support For Government Actions In Case Of A Pandemic

Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs.