1. The HPV Vaccine Post- Licensure: Have Online News Stories Changed Over Time? A Follow-up Study. March 30, 2009 Presented by: Jillian R. Doss, MPH, Public Health Prevention Service (PHPS) Fellow Centers for Disease Control and Prevention Assigned to Florida Department of Health. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

2. Collaborators Nicole Liddon, PhD a Nicole Liddon, PhD a Melissa Habel, MPH a Melissa Habel, MPH a a Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of STD Prevention.

3. Background: Human Papillomavirus (HPV) Most common STI in the U.S. Most common STI in the U.S. ~ 20 million people currently infected ~ 20 million people currently infected 100+ strains, 40+ sexually transmitted 100+ strains, 40+ sexually transmitted High risk vs. Low risk types High risk vs. Low risk types High risk types can develop into cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancers (Includes types 16 and 18) High risk types can develop into cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancers (Includes types 16 and 18) Low risk types can cause genital warts (includes types 6 and 11) Low risk types can cause genital warts (includes types 6 and 11)

4. HPV Vaccine Gardasil, Merck Pharmaceuticals Gardasil, Merck Pharmaceuticals Quadrivalent vaccine Quadrivalent vaccine  HPV types 6, 11,16,& 18 Approved for girls and women 9-26 years old Approved for girls and women 9-26 years old Not approved for adult women or males Not approved for adult women or males Cervarix, GlaxoSmithKline (GSK) Cervarix, GlaxoSmithKline (GSK) Undergoing FDA approval Undergoing FDA approval HPV types 16 and 18 HPV types 16 and 18

5. Literature HPV vaccine information in the media may influence personal attitudes and vaccine uptake HPV vaccine information in the media may influence personal attitudes and vaccine uptake News coverage on HPV vaccine in TV and print newspapers often found to have incomplete or misleading information News coverage on HPV vaccine in TV and print newspapers often found to have incomplete or misleading information Public more likely to seek medical/health information on the Internet Public more likely to seek medical/health information on the Internet 50 million Americans use internet 50 million Americans use internet 70% of U.S. Adults lookup health information 70% of U.S. Adults lookup health information Youtube study Youtube study Source: Calloway et al., 2006.;Danovaro-Holliday et al., 2002.,; Habel et al., 2009;. Ache& Wallace, 2008; Horrigan and Rainie, 2002; Horrigan, 2006.

6. Purpose Explore media portrayal of the vaccine post- licensure to determine if the content has changed over time Explore media portrayal of the vaccine post- licensure to determine if the content has changed over time Trends in social issues & concerns Trends in social issues & concerns Changes in media framing of headlines Changes in media framing of headlines

7. Research Methods Random sample of internet news stories Random sample of internet news stories Time 1: June 2006 – September 2006 (n=250) Time 1: June 2006 – September 2006 (n=250) Time 2: November 2007 – March 2008 (n=174) Time 2: November 2007 – March 2008 (n=174) Searched Google News, Yahoo News, CNN.com, MSNBC.com Searched Google News, Yahoo News, CNN.com, MSNBC.com Search terms Search terms HPV vaccine HPV vaccine Vaccine for cervical cancer Vaccine for cervical cancer Cervical cancer vaccine Cervical cancer vaccine STD vaccine STD vaccine STI vaccine STI vaccine Genital warts vaccine Genital warts vaccine Adolescent HPV vaccine Adolescent HPV vaccine Top 3 hits Top 3 hits

9. Research Methods Measures Measures General Headline Frame General Headline Frame Vaccine label Vaccine label Other adolescent vaccines Other adolescent vaccines HPV vaccine information HPV vaccine information Potential social issues and concerns Potential social issues and concerns Safety issues & adverse events Safety issues & adverse events Development of Coding Instrument & Codebook Development of Coding Instrument & Codebook Coder training Coder training

10. Reliability & Data Analysis Inter-rater reliability Inter-rater reliability 10% of total sample 10% of total sample Cohen’s Kappa =.60 Cohen’s Kappa =.60 Data analysis (SPSS) Data analysis (SPSS) Univariate (Time 2) Univariate (Time 2) Frequencies Frequencies Bivariate (Time 1 vs Time 2) Bivariate (Time 1 vs Time 2) Chi-square Chi-square Change over time Change over time

11. Univariate Results: Time 2 Time 2 Data Range: November 2007-March 2008

12. Results: Time 2 (n=174) Most (70.1%) articles framed as neutral toward the HPV vaccine Most (70.1%) articles framed as neutral toward the HPV vaccine Articles were more likely to be recorded as “positive” toward the vaccine (20.1%) than “negative” toward the vaccine (9.8%) Articles were more likely to be recorded as “positive” toward the vaccine (20.1%) than “negative” toward the vaccine (9.8%) Vaccine referenced as: Vaccine referenced as: HPV vaccine –(66.7%) HPV vaccine –(66.7%) Brand name “GARDASIL” –(65.5%) Brand name “GARDASIL” –(65.5%) Brand name “Cervarix” –(22.4%) Brand name “Cervarix” –(22.4%) STD/STI vaccine –(14.9%) STD/STI vaccine –(14.9%) Genital warts vaccine – (4.0%) Genital warts vaccine – (4.0%)

13. Examples of Headlines Positive: Positive: “Vaccine can reduce cancer risk” “Vaccine can reduce cancer risk” “Worth Getting Vaccinated ” “Worth Getting Vaccinated ” Neutral: Neutral: “HPV Vaccine” “HPV Vaccine” “Cervical Cancer bill goes to Senate” “Cervical Cancer bill goes to Senate” Negative: Negative: “Vaccine too risky” “Vaccine too risky” “Girls guinea pigs for HPV vaccine” “Girls guinea pigs for HPV vaccine”

14. Most Common Social Issues & Concerns

15. Safety & Adverse Events

16. Vaccine Information Least commonly mentioned: Least commonly mentioned: Other adolescent vaccines (13.8%) Other adolescent vaccines (13.8%) Tdap Tdap MCV4 MCV4 Both (Tdap and MCV4) Both (Tdap and MCV4) Others Others Vaccine not protecting against all HPV types, cervical cancers or genital warts (3.4%) Vaccine not protecting against all HPV types, cervical cancers or genital warts (3.4%) Vaccine not approved for boys (9.8%) Vaccine not approved for boys (9.8%)

17. Bivariate Results: Combined Time 1 and Time 2 (over time) Time 1 Data Range: June 2006- September 2008 Time 2 Data Range: November 2007-March 2008

18. Results: Over Time (n=424) Over time, headline framing most likely to be neutral (p=.0001) Over time, headline framing most likely to be neutral (p=.0001) Netural Frame-(53.4 % to 70.1%, p=.001) Netural Frame-(53.4 % to 70.1%, p=.001) Significant decrease in positive and negative headlines Significant decrease in positive and negative headlines The vaccine was most commonly referred to by its brand name “GARDASIL” and an “HPV vaccine” as compared to “Cervical cancer vaccine” in Time I (June 2006-September 2006). The vaccine was most commonly referred to by its brand name “GARDASIL” and an “HPV vaccine” as compared to “Cervical cancer vaccine” in Time I (June 2006-September 2006).

19. Social Issues and Concerns, Over Time Time 1 Data Range: June 2006- September 2008 Time 2 Data Range: November 2007-March 2008

20. Vaccine Information, Over Time

21. Discussion Over time, vaccine information has remained balanced with a change in some public issues and concerns Over time, vaccine information has remained balanced with a change in some public issues and concerns Article headlines were mainly coded as neutral Article headlines were mainly coded as neutral Media is framing vaccine as an HPV vaccine or by its Brand Name Media is framing vaccine as an HPV vaccine or by its Brand Name

22. Discussion Social Issues & Concerns have changed over time Social Issues & Concerns have changed over time Safety/Adverse events Safety/Adverse events Affordability Affordability Increased sexual risk behavior Increased sexual risk behavior Continued Pap Smears Continued Pap Smears Missed opportunities Missed opportunities Implications Implications

23. Strengths & Limitations Strengths Strengths Few studies to examine HPV vaccine news coverage on the internet post-licensure Few studies to examine HPV vaccine news coverage on the internet post-licensure Explored specific social issues & concerns Explored specific social issues & concerns Monitored trends over time Monitored trends over time Limitations Limitations May have been duplicate articles May have been duplicate articles Longer time period for searching Longer time period for searching Other news media sources Other news media sources Further improvements to coding instrument Further improvements to coding instrument

24. Thank You! Questions??? Questions???