Download The Communications Revolution and Health Inequalities in the 21st

Communications of HPV and the HPV
vaccine: Challenges in the 21st Century
K. Viswanath
Harvard School of Public Health
Dana-Farber Cancer Institute
Dana-Farber/Harvard Cancer Center
• I, K. “Vish” Viswanath, have been asked to disclose any
significant relationships with commercial entities that
are either providing financial support for this program
or whose products or services are mentioned during my
presentations.
– I have no relationships to disclose.
What do we mean by communications revolution?
Two dimensions:
• An enormous capacity to generate, integrate,
manipulate and distribute information across
temporal, geographical and disciplinary boundaries.
• Integration of different digital domains – from
university libraries to private data archives to research
from scientific groups and labs, as well as information
on people
Viswanath, 2011
Communication devices and their use
The Pew Research Center’s Project for Excellence in Journalism (2012). The State of the News
Media 2012. Accessed on March 31 at: http://stateofthemedia.org/2012/overview-4/keyfindings/
New U.S. Research
Will Aim at Flood of
Digital Data
Big data refers to the rising flood of digital data
from many sources, including the Web,
biological and industrial sensors, video, e-mail
and social network communications.
For example, if you buy a used car, your best
bet is an orange one. Data scientists at Kaggle,
a pattern recognition start-up …., have
matched previously separate data sets on
buyers, colors and after-purchase problems.
They figured out that if a car’s original owner
chose an odd color, the car was most likely a
means of self-expression. That selfidentification raises the odds that the owner
cared more than usual for the vehicle.
What Does It Take
to Turn Big Data
into Big Dollars?
volume of data now being produced
continues to skyrocket, with something
on the order of 2.7 Zettabytes (2.7 x
1021) of information to be produced in
2012
Cancer Communications in 21 Century: Some facts
Have you ever looked for information about cancer from any source?*
National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014,
http://hints.cancer.gov/brief_16.aspx
Cancer Communications in 21 Century: Some facts
The most recent time you looked for cancer information, where did you go first?*
National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014,
http://hints.cancer.gov/brief_16.aspx
Cancer Communications in 21 Century: Some facts
Trust in source for cancer information
National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014,
http://hints.cancer.gov/brief_16.aspx
Health Disparities and
Communication Inequalities
Social determinants
• Race/ethnicity
• Living conditions
• Socioeconomic status
– Income
– Education
– Occupation
•
•
•
•
Gender
Sexuality
Immigration status
Stressful life events over the lifecourse
Communication Inequality…
…is differences among social classes in the generation,
manipulation, and distribution of information at the group
level and differences in access to and ability to take
advantage of information at the individual level.
Dimensions of communication inequality
Five broad dimensions
•Use/Access/Exposure
•Attention
•Information seeking
•Processing
•Communication Effects
Broadband use: Exemplar of Intersectionality
NTIA, 2010
Cancer Communications in 21 Century: Some facts
National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014,
http://hints.cancer.gov/brief_16.aspx
Cancer Communications in 21 Century: Some facts
Percent survey who say that their physician always explains things so they can
understand
Ackerson LK,Viswanath K.The social context of interpersonal communication and health. J Health Comm 2009; 14:1,5–17.
Ackerson LK, Viswanath K. Communication inequalities, social determinants, and intermittent smoking in the 2003 Health Information
National Trends Survey. Prev Chronic Dis 2009 Apr;6(2):A40.
Cancer Communications in 21 Century: Some facts
National Cancer Institute, Health Information National Trends Survey, Accessed on November 6, 2014,
http://hints.cancer.gov/brief_16.aspx
Age-adjusted prevalence of respondents to the 2003 HINTS survey who say that their physician always respects what they have to say.
Cancer Communications in 21 Century: Some facts
Percent survey who say that their physician always respects what they have to say
Ackerson LK,Viswanath K.The social context of interpersonal communication and health. J Health Comm 2009; 14:1,5–17.
Ackerson LK, Viswanath K. Communication inequalities, social determinants, and intermittent smoking in the 2003 Health Information
National Trends Survey. Prev Chronic Dis 2009 Apr;6(2):A40.
Information Seeking
Recently there has been an increased emphasis on
•Patients gathering information
•Carefully weighing evidence
•Taking into account their personal preferences and
values in order to fully participate in clinical decisions
Types of information sought,
by education
70
60
50
High School or Less
40
High School to Associate
College
30
Postgraduate
20
10
0
Treatment Information
Self Care Management
Pre-Treatment Information
Galarce, Ramanadhan, Weeks, Schneider, Gray, Viswanath, 2011
Participants seeking work/finance
information by level of wealth
70
60
50
40
30
20
10
0
Low
Mid-Low
Mid-High
High
Galarce, Ramanadhan, Weeks, Schneider, Gray, Viswanath, 2011
Determinants of Vaccine Acceptance
Factors that influence vaccine acceptance
•Knowledge
•Attitudes towards the vaccines and
vaccination
•Availability of vaccine services
•Affordability
•Accessibility
HPV knowledge
Viswanath, 2011
HPV knowledge
Viswanath, 2011
HPV knowledge
Viswanath, 2011
HPV knowledge
HPV knowledge
Communication Inequalities in HPV Knowledge: Race and
Ethnicity
90
80
70
60
50
Aware of HPV vaccine
40
Knowledgeable HPV is a cause of cervical
cancer
Knowledgeable HPV is transmitted through
sexual contact
30
20
10
0
Race/ethnicity
Non-Hispanic
white
Non-Hispanic
black
Hispanic
Other
Kontos EZ, Emmons KM, Puleo E, Viswanath K. Contribution of communication inequalities to disparities in
HPV vaccine awareness and knowledge. American Journal of Public Health. 2012 Oct;102(10):1911-20.
Communication Inequalities in HPV Knowledge: Education
90
80
70
60
Aware of HPV vaccine
50
Knowledgeable HPV is a cause of cervical
cancer
40
Knowledgeable HPV is transmitted through
sexual contact
30
20
10
0
Education
<HS
HS
Some college
≥College
Kontos EZ, Emmons KM, Puleo E, Viswanath K. Contribution of communication inequalities to disparities in
HPV vaccine awareness and knowledge. American Journal of Public Health. 2012 Oct;102(10):1911-20.
Communication Inequalities in HPV Knowledge: Income
90
80
70
60
Aware of HPV vaccine
50
40
Knowledgeable HPV is a cause of cervical
cancer
30
Knowledgeable HPV is transmitted through
sexual contact
20
10
0
HH income
<20k
20-34k
35-49k
50-74k
>75k
Didn’t
report
Kontos EZ, Emmons KM, Puleo E, Viswanath K. Contribution of communication inequalities to disparities in
HPV vaccine awareness and knowledge. American Journal of Public Health. 2012 Oct;102(10):1911-20.
Communication Inequalities in HPV Knowledge: Gender
90
80
70
60
50
Sex
Male
40
Female
30
20
10
0
Aware of HPV vaccine
Knowledgeable HPV is a cause of
cervical cancer
Knowledgeable HPV is transmitted
through sexual contact
Kontos EZ, Emmons KM, Puleo E, Viswanath K. Contribution of communication inequalities to disparities in
HPV vaccine awareness and knowledge. American Journal of Public Health. 2012 Oct;102(10):1911-20.
Communication & HPV: Way forward
• A study of provider-parent communication and
conversation showed that “routine” recommendation is
more powerful and robust than “detailed” conversation.
• Provider recommendation is the key
– There are many “missed opportunities” in provider-patient
interactions
– Some providers may be hesitant
• Pharmacists and “immunization neighborhood”
– Additional venues/access points
– Coordinated communications
Communication & HPV: Way forward
• Vaccination as a social norm
– Social network as a gatekeeper and re-inforcer
• Address parental refusal/attitudes which is a major barrier
–
–
–
–
–
“mistrust” towards vaccine in general
Providers need communication training on how to talk to parents
Need for a toolkits to talk to parents
Address myths
Risk perceptions
Communication & HPV: Way forward
• Media framing
– Shift conversation from STDs to cancer prevention
– Address misinformation and stories that are covered in the media
– Work with reporters
• Importance of addressing communication inequalities
– Customizing communications development and delivery
Members of the Lab
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Jaclyn Alexander-Molloy
Carmenza Bruff
Hope Cummings
Josephine Crisostomo
Hana Hayashi
Alyssa Jordan
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Nancy Klockson
Leesa Lin
Rachel McCloud
Sara Minsky
Yudy Muneton
Shoba Ramanadhan
www.viswanathlab.org