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News Tips from the American Public Health Association Meeting in Chicago


Anti-vaccine positions are frequently embedded with information about positive behaviors

A content analysis of nearly 500 anti-vaccination websites found that over two-thirds used what they represented as scientific evidence to support the idea that vaccines are dangerous and nearly one-third contained anecdotes that reinforced the perception.

The sites contained a considerable amount of misinformation and pseudoscience, with more than two-thirds suggesting that vaccines were dangerous, just under two-thirds suggesting they cause autism and just over 4 in 10 claiming vaccines cause “brain injury.” More than two-thirds used what they represented as scientific evidence that in fact was not, while about 3 in 10 used anecdotes to support these claims.

The sites also promoted positive behaviors, including eating healthy (18.5 percent of them), eating organic (5.2 percent) and breastfeeding (5.5 percent).

“The biggest global takeaway is that we need to communicate to the vaccine-hesitant parent in a way that resonates with them and is sensitive to their concerns,” says Meghan Moran, PhD, associate professor in the Bloomberg School’s Department of Health, Behavior and Society and lead author of the study. “In our review, we saw communication for things we consider healthy, such as breastfeeding, eating organic, the types of behavior public health officials want to encourage.  I think we can leverage these good things and reframe our communication in a way that makes sense to those parents resisting vaccines for their children.”

Moran presented the research at the American Public Health Association’s Annual Meeting in Chicago on Nov. 3.

For their study, researchers looked at sites with content about childhood vaccines but did not break out their analysis by individual vaccine. They searched four search engines – Google, Bing, Yahoo and Ask Jeeves – using terms like “immunization dangers” and “vaccine danger” and others identified using Google Trends. After eliminating duplicates, they had a mix of personal websites and blogs, Facebook pages and health websites. A team of four coders coded the content for the vaccine misinformation presented, the source of the vaccine misinformation and the types of persuasive tactics used.  The coders also coded for behaviors and values co-promoted by the websites that could help vaccine promotion efforts develop better-targeted materials.

 “Why are anti-vaccine messages so persuasive? A content analysis of anti-vaccine websites to inform the development of vaccine promotion strategies” was written by Meghan Moran, PhD, Kristen Everhart, MA, University of Nebraska-Lincoln, and Melissa Lucas, MA, University of Maryland, College Park.

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Amounts don’t always reflect recipient country’s health needs and highlight global inequities

An analysis of country-to-country aid for health over a 20-year period suggests wide variations among donor countries’ giving that do not always reflect recipient countries’ health needs.

The study, believed to be the first to examine these types of differences among bilateral, or country-to-country, donors, was presented at the American Public Health Association’s meeting in Chicago on Nov. 3.

As of 2014, more than $35 billion in development assistance for health (DAH) is estimated to be donated each year, with about 40 percent, or $14 billion, coming in the form of country-to country bilateral assistance. (The balance is donated by and through institutions such as the World Health Organization, Save the Children, the Global Fund, the Bill & Melinda Gates Foundation and GAVI, among others.)

For the study, Krycia Cowling, MPH, a doctoral student in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, analyzed annual data for 23 donor countries to 141 recipient countries between 1990 and 2010 as well as recipient country disease burdens as measured by disability-adjusted life-years or DALYs. A DALY depicts years lost to illness or death, and is a standard metric used to describe a country’s disease burden.

For all 23 donor countries, there was little relationship between the relative amount of country-to-country aid given for health and recipient countries' disease burdens. In some years, some donors allocated bilateral aid for health in more direct relation to the disease burden of recipient countries - but no donor appears to be doing this consistently over time.

“I thought this was interesting to explore because bilateral aid may be most susceptible to being dictated by relationships between countries,” says Cowling, MPH. “The general perception seems to be that funds are given in relation to a country’s health needs but that doesn’t seem to be happening. We should recognize that, and have a discussion about how funds are being allocated.”

Cowling used data from the Institute for Health Metrics and Evaluation at the University of Washington, where she was a research fellow from 2008 to 2011.

 “Assessing equity in the distribution of bilateral development assistance for health, 1990-2010” was written by Krycia Cowling, MPH.

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African Americans who did not engage in physical activity were nearly twice as likely to abuse alcohol

A large-scale survey of African-American men and women found that those who rarely or never exercised had about twice the odds of abusing alcohol than those who exercised frequently, a finding that could have implications across all groups.

The survey of 5,002 African-American men and women found that those who did not engage in physical activity at all or only occasionally had nearly double the chance -- between a 84 percent and 88 percent higher odds -- of abusing alcohol than those who regularly engaged in some form of physical activity. This was after adjusting for demographic factors such as income and neighborhood characteristics.

Survey participants were drawn from the National Survey of American Life (NSAL), a study that took place between 2001 and 2003 and aimed to identify racial and ethnic differences in mental disorders and other psychological distress, including those used by the Diagnostic and Statistical Manual of Mental Disorders. The study used the DSM-IV definition of alcohol abuse, which is defined as drinking that has negative social, professional and/or legal consequences.

The survey finding was presented at the American Public Health Association meeting in Chicago on Nov. 2.

“There have been studies of the association between substance use and related comorbid health conditions, such as depression and anxiety,” notes April Joy Damian, a doctoral student in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and the study’s author. “There has been little research that has examined the connection between exercise and decreased odds of alcohol use disorder.

“Because the NSAL study was essentially a snapshot that was taken at one point in time, we can’t say that engaging in physical activity will prevent people from developing alcohol use disorder or that alcohol use disorder can be treated with physical activity,” Damian says. “Given that alcohol use disorder has a high rate of co-occurrence for depression and anxiety, it merits further study all around, for African Americans as well as others. We should consider how physical activity contributes to alcohol-related behavior and design interventions for people who are at risk.”

“Association between physical activity and alcohol abuse and dependence: Findings from the National Survey of American Life (NSAL)” was written by April Joy Damian.

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In case study, ‘peer-crowd’ campaign resulted in less adolescent smoking

Health campaigns that target teens based their social groups and subcultures, such as hip hop, preppy or alternative, can be an effective tool in dissuading adolescents from engaging in risky behaviors such as smoking and drinking, suggests a survey of the literature and a case study.

The findings were presented at the APHA meeting in Chicago on Tuesday, Nov. 3.

“In public health, we typically segment more in terms of sociodemographics like race, gender and income,” says Meghan Moran, an associate professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Health, Behavior and Society and lead author of the study. “But, we know that young people identify strongly with groups along subcultures and these groups vary on their health behavior, too. For instance, the teens we categorize as alternative, be they goth or skateboarders, are at a higher risk for alcohol use. If we develop campaigns that incorporate the style of the group, it can increase their effectiveness.”

For their study, researchers surveyed journal articles highlighting evidence related to the use of peer crowds to develop targeted health campaigns aimed at adolescents. Such campaigns can work on several levels. One, the teens identify with the individuals and the culture represented in a targeted campaign. Secondly, teen groups have different risk profiles. For instance, skaters are at an increased risk for smoking and preppy teens exhibit an increased likelihood of alcohol use. Campaigns can tap these vulnerable points. Finally, the campaigns can factor in cues the group likely receives in its cultural consumption – music, TV, movies – some of which may promote the very risky behavior the campaigns seek to curtail.

The researchers also describe a case study of an ongoing anti-smoking campaign developed by the Virginia Foundation for Healthy Youth. The campaign targets alternative youth who identify with crowds such as rockers or hardcore (punk) and strives to prevent smoking from being seen as socially acceptable in these music scenes.

The review was conducted with colleagues from the Rescue Social Change Group, a marketing firm based in San Diego, California.

The U.S. Food and Drug Administration recently launched “Fresh Empire,” a peer crowd anti-smoking campaign aimed at hip-hop youth. The $128 million campaign will run in 36 markets over the next 24 months and aired nationally for the first time during the 2015 BET Hip-Hop Awards earlier this month.

The FDA’s campaign is too new to gauge its effectiveness, notes Moran.

 “Why adolescent peer crowds matter: Incorporating youth subcultures and values in health behavior campaigns” was written by Meghan Moran, PhD; Jeffrey W. Jordan, MA and Mayo Djakaria, MPH.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or and Stephanie Desmon at 410-955-7619 or