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It's Not All About Autism: the Emerging Landscape of Anti-Vaccination

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It's Not All About Autism: the Emerging Landscape of Anti-Vaccination It’s Not All About Autism: the Emerging Landscape of Anti-Vaccination Sentiment on Facebook by Beth Louise Hoffman BSc, Brown University, 2007 Submitted to the Graduate Faculty of the Department of Behavioral and Community Health Sciences Graduate School of Public Health in partial fulfillment of the requirements for the degree of Master of Public Health University of Pittsburgh 2019 UNIVERSITY OF PITTSBURGH Graduate School Of Public Health This thesis was presented by Beth Louise Hoffman It was defended on November 19, 2018 and approved by Thesis Advisor Elizabeth Madison Felter, DrPH, MCHES Assistant Professor, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh Committee Members Kar-Hai Chu, M.S., Ph.D. Assistant Professor of Medicine and Pediatrics School of Medicine, University of Pittsburgh Jessica Griffin Burke, Ph.D. Associate Professor and Associate Chair, Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh Brian Primack, M.D., Ph.D. Dean, University of Pittsburgh Honors College Bernice L. and Morton S. Lerner Endowed Chair Professor of Medicine, Pediatrics, and Clinical and Translational Science Director, Center for Research on Media, Technology, and Health University of Pittsburgh ii Copyright © by Beth Louise Hoffman 2019 iii It’s Not All About Autism: the Emerging Landscape of Anti-Vaccination Sentiment on Facebook Beth Louise Hoffman, MPH University of Pittsburgh, 2019 Abstract Introduction: The anti-vaccination movement has been present since the early 1700s. Previous research suggests that social media may be fueling the spread of anti-vaccination messaging. Therefore, the purpose of this thesis is to (1) highlight major events in the history of the anti- vaccine movement, (2) present a stand-alone journal article from a systematic analysis of individuals known to express anti-vaccination sentiment on Facebook, and (3) integrate the conclusions presented in the article into a broader historical framework. Methods: A literature review was conducted for the historical overview. For the journal article, our data set consisted of 197 individuals with Facebook accounts who posted anti-vaccination comments on a prominent local pediatric clinic’s Facebook page. For each individual, we systematically analyzed publicly available content using quantitative coding, descriptive analysis, social network analysis, and an in-depth qualitative assessment. Results: Throughout history, the anti-vaccination movement has consistently sued fiery rhetoric and vivid imagery to spread its messages, which often center on concerns of liberty and safety. Analysis of Facebook profiles found that more individuals posted content related to mistrust in the medical community, liberty, and belief in homeopathic remedies compared to those who posted that vaccines cause autism. Among 136 individuals who divulged their location, 36 states and 8 countries outside the U.S. were represented. In a 2-mode network of individuals and topics, modularity analysis revealed 4 distinct sub-groups: (1) liberty, (2) naturalness, (3) illness, and (4) iv conspiracy. Qualitative analysis found that individuals often share posts from Facebook groups that market themselves as pro-science. Conclusion: Individuals on Facebook frequently posted anti-vaccine content that echoed historical concerns. Our findings suggest social media outlets facilitate anti-vaccination connection and organization, thus assisting in the amplification and diffusion of centuries’ old arguments and techniques. These findings are significant for public health in that they will inform the development of updated messaging around vaccination, and suggest the importance of understanding the history of the anti-vaccination movement when developing these messages. These findings also suggest a valuable opportunity for public health practitioners to leverage social networks to deliver more effective, tailored interventions to different constituencies. v Table of Contents Preface ........................................................................................................................................... X 1.0 Introduction .................................................................................................................. 1 2.0 Literature Review......................................................................................................... 5 2.1 History of the Anti-Vaccination Movement ...................................................... 5 2.1.1 Variolation ........................................................................................................ 5 2.1.2 The Smallpox Vaccine ..................................................................................... 7 2.1.3 The Polio Vaccine .......................................................................................... 11 2.1.4 The Diphtheria, Tetanus, and Pertussis (DTP) Vaccine ............................ 13 2.1.5 The MMR Vaccine......................................................................................... 16 2.1.6 The HPV Vaccine........................................................................................... 17 2.1.7 Current Vaccination Policy in The U.S. ...................................................... 19 2.2 Anti-Vaccination on Social Media .................................................................... 20 2.2.1 Anti-Vaccination Information Online ......................................................... 20 3.0 Journal Article ............................................................................................................ 25 3.1 It’s Not All About Autism: The Emerging Landscape of Anti-Vaccination Sentiment on Facebook ...................................................................................................... 25 3.2 Abstract .............................................................................................................. 26 3.3 Introduction........................................................................................................ 28 3.4 Methods .............................................................................................................. 29 3.4.1 Sample Selection ............................................................................................ 29 3.4.2 Procedures ...................................................................................................... 30 vi 3.4.3 Measures ......................................................................................................... 31 3.4.4 Analysis ........................................................................................................... 32 4.0 Results ......................................................................................................................... 35 4.1.1 Descriptive ...................................................................................................... 35 4.1.2 Social Network Analysis ................................................................................ 37 4.1.3 Qualitative Analysis ....................................................................................... 39 4.2 Discussion ........................................................................................................... 41 4.2.1 Limitations ..................................................................................................... 45 4.3 Conclusions ......................................................................................................... 45 4.4 Acknowledgments .............................................................................................. 46 4.5 References ........................................................................................................... 47 5.0 Thesis Conclusions ..................................................................................................... 53 Appendix Kids Plus Pediatrics Video ....................................................................................... 61 Bibliography ................................................................................................................................ 62 vii List of Tables Table 1 Codebook for Analyzing Facebook Posts. ....................................................................... 33 Table 2 Frequency of Anti-Vaccination Posts by Category for Profiles with Anti-Vaccination Content (n = 116). ......................................................................................................................... 36 viii List of Figures Figure 1 Visualization of the network representing Facebook profiles discussing vaccine topics. ....................................................................................................................................................... 38 Figure 2 Frequent anti-vaccination posts on Facebook profiles and in anti-vaccination groups on Facebook. ...................................................................................................................................... 40 ix Preface I would like to thank the many people who have facilitated my growth as a public health professional. First, I would like to express my deepest gratitude for the opportunities afforded to me by Dr. Brian Primack and my coworkers at the Center for Research on Media, Technology, and Health (MTH). Dr. Primack, I am forever indebted to you for your mentorship, support, and encouragement. To the entire
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