Background Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. Objective This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. Methods We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical (“Narrative”) presentation of information, intervention video 2 focusing on delivering a fact-based information (“Fact”), and intervention video 3 using a hybrid design (“Hybrid”). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics (“Recognize”), willingness to share misinformation (“Share”), and willingness to take the COVID-19 vaccine (“Willingness”). Results There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). Conclusions Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation.

Vaccine hesitancy is a key contributor to reduced COVID-19 vaccine uptake and remains a threat to COVID-19 mitigation strategies as many countries are rolling out the campaign for booster shots. The goal of our study is to identify and compare the top vaccine concerns in four countries: Canada, Italy, Sweden, and the USA and how these concerns relate to vaccine hesitancy. While most individuals in these countries are now vaccinated, we expect our results to be helpful in guiding vaccination efforts for additional doses, and more in general for other vaccines in the future. We sought to empirically test whether vaccine related concerns followed similar thematic issues in the four countries included in this study, and then to see how these themes related to vaccine hesitancy using data from a cross-sectional survey conducted in May 2021. We applied CFA and created vaccine concern scales for analysis. We then utilized these results in regression-based modeling to determine how concerns related to vaccine hesitancy and whether there were similar or different concerns by country. The results quantitatively highlight that the same vaccine related concerns permeated multiple countries at the same point in time. This implies that COVID-19 vaccination communications could benefit from global collaboration.

In the last decade, readily available electronic devices have created unprecedented opportunities for teens to access a wide variety of information and media–both positive and negative–on the internet. Despite the increasing number of initiatives taking place worldwide intended to assess and mitigate the online risks encountered by children and adolescents, there is still a need for a better understanding of how adolescents use the internet and their susceptibility to exposure to risks in the online space. We conducted a cross-sectional online survey of a convenience sample of 733 8th and 9th grade students in Utah. The survey contained eight questions regarding students’ exposure to three types of online risk scenarios: content risk, contact risk, and criminal risk. Independent variables included students’ online behaviors, use of social media and private messaging apps, and adult supervision of online activities. Logistic and negative binomial regression models indicated that gender, social media use, and chatting with strangers were associated with exposure to multiple risky online scenarios. Our results provide critical information to educators involved in the development of initiatives focusing on the reduction of youth online risk by identifying correlates of risky online events, allowing them to tailor their initiatives to meet the needs of potentially vulnerable populations.

Despite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: (1) describe and compare vaccine hesitancy proportions by country; (2) categorize vaccine-related concerns; (3) rank vaccine-related concerns; and (4) compare vaccine-related concerns by country and hesitancy status in four countries—the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between 21–28 May 2021. Results showed vaccine-related concerns varied across three topical areas—vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Concerns related to freedom were the most universal. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives are global.

This presentation outlines the results of the primary programmatic evaluation efforts the Emergency Preparedness Research Evaluation and Practice (EPREP) Program has conducted since 2016. The presentation begins with an overview of the methodology of selecting outcome measures to evaluate program efficacy, as well as a description of the evaluation framework. Results of the longitudinal and quasi-experimental 2017 evaluation of the Online4Good Academy—on of the training events at the focus of the Boston CVE Pilot Program—are presented and discussed. In 2018, the EPREP Program utilized a longitudinal and quasi-experimental design to evaluate the efficacy of the Peer2Peer antihatred campaign Kombat with Kindness. Results and implications from this study are discussed. The final portion of the presentation describes the more recent activities of the EPREP Program—an evaluation of the online safety program Operation 250 (OP250). This portion of the lecture describes the psychological framework and theory of change under which OP250 implements their initiative. During the final segment we also present the preliminary results of a randomized controlled trial conducted at two different study sites in Massachusetts designed to evaluate the programs’ efficacy.

Today's youth have extensive access to the internet and frequently engage in social networking activities using various social media platforms and devices. This is a phenomenon that hate groups are exploiting when disseminating their propaganda. This study seeks to better understand youth exposure to hateful material in the online space by exploring predictors of such exposure including demographic characteristics (age, gender, and race), academic performance, online behaviors, online disinhibition, risk perception, and parents/guardians' supervision of online activities. We implemented a cross-sectional study design, using a paper questionnaire, in two high schools in Massachusetts (USA), focusing on students 14 to 19 years old. Logistic regression models were used to study the association between independent variables (demographics, online behaviors, risk perception, parental supervision) and exposure to hate online. Results revealed an association between exposure to hate messages in the online space and time spent online, academic performance, communicating with a stranger on social media, and benign online disinhibition. In our sample, benign online disinhibition was also associated with students' risk of encountering someone online that tried to convince them of racist views. This study represents an important contribution to understanding youth's risk factors of exposure to hateful material online.

Combating violent extremism can involve organizing Peer-to-Peer (P2P) preventing violent extremism (PVE) programs and campaigns. In recent years, hundreds of school campaigns have been launched around the world but very few have been evaluated. In this manuscript, we present the results of the evaluation of one of these initiatives. Study objectives consisted of: 1) Assessing the impact of the campaign in increasing students’ exposure to messages of acceptance and decreasing exposure to hate messages in the school environment, 2) Assess the impact of the campaign in improving students’ attitudes towards ethnocultural diversity. We conducted a longitudinal cohort study with control groups. The study was implemented in Utah in schools of 8th and 9th-grade levels. Two schools were identified as campaign implementation sites, and two schools of similar socio-economic and ethnocultural characteristics were identified as the control sites. We utilized univariate and multivariate regression analysis to assess changes in students’ exposure to hate messages and attitudes towards ethnocultural diversity. Our study findings can be useful for the development of future campaigns and educational programs as they highlight the importance of ethnocultural empathic awareness in improving students’ attitudes regarding ethnocultural diversity.

Background: Effective and easy to implement interventions to improve adherence to antiretroviral therapy are needed. Objective: To compare site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy to the study site's standard of care. Methods: A randomized controlled trial of site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy. Subjects were randomized to receive site nurse-initiated telephone calls (intervention) or no additional calls to the site's standard of care (control). Subjects received calls 1 to 3 days after initiating antiretrovirals, on weeks 1, 2, 3, 6, 10, 14, 18, 22, and 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits. Results: A total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with >95% mean total adherence (87.9% and 91.2%; P = .34) and mean self-reported total adherence (97.9% and 98.4%) in the intervention and control groups, respectively, or in symptom distress and clinical endpoints. Conclusions: In the context of a clinical trial where self-reported adherence was exceptionally high, the site nurse-initiated telephone calls did not further improve self-reported adherence, symptom distress, or clinical outcomes.

CONTEXT:In patients with diabetes, intraday glucose variability might predict health outcomes independently from glycosylated hemoglobin (HbA1c).OBJECTIVE:Our objective was to evaluate patient satisfaction (PS), quality of life (QoL), glycemic control, and variability during insulin intensification to HbA1c below 7.0%.PATIENTS, DESIGN, AND SETTING:Eighty-two type 1 and 306 insulin-treated type 2 diabetes patients (47% male; age 54±11 yr; HbA1c=7.8±0.7%) participated in this multicenter, randomized, crossover trial at 52 U.S. centers.INTERVENTIONS:Interventions included insulin glargine plus premeal glulisine (n=192) vs. twice-daily premix 75/25 or 70/30 analog insulin (n=196) for 12 wk and crossed to the alternate arm for 12 wk.MAIN OUTCOME MEASURES:Main outcome measures included PS and QoL questionnaires, 3-d continuous glucose monitoring (CGM), and HbA1c every 4-8 wk.RESULTS:Mean±se HbA1c change was -0.39±0.09% for glargine-glulisine and -0.05±0.09% for premix (P<0.0001). The PS net benefit scale (0-100) improved from 51.1 to 60.5±1.2 for glargine-glulisine and worsened to 45.4±1.2 for premix (P<0.0001). The PS regimen acceptance scale was comparable (P=0.33). Overall QoL favored glargine-glulisine (P<0.001), as did perceived health (P<0.0001), symptom distress (P<0.0001), general health perceptions (P<0.01), and psychosocial (P<0.02). CGM daily glucose mean, daily glucose sd (glycemic variability), and percent time over 140 mg/dl were lower for glargine-glulisine by 13.1±2.7 mg/dl, 5.9±1.4 mg/dl, and 7.3±1.6%, respectively (all P<0.0001), with no difference in CGM percent time below 70 mg/dl (P=0.09). Symptomatic hypoglycemia rates were comparable. HbA1c, mean CGM daily glucose, and glycemic variability were independent predictors of PS net benefit.CONCLUSIONS:Patient satisfaction was impacted more positively by improved QoL, reduced glucose variability, and better glycemic control with a basal-bolus regimen than negatively by the burden of additional injections, thereby facilitating insulin intensification and the ability to achieve HbA1c below 7.0%.

Context: In patients with diabetes, intraday glucose variability might predict health outcomes independently from glycosylated hemoglobin (HbA1c). Objective: Our objective was to evaluate patient satisfaction (PS), quality of life (QoL), glycemic control, and variability during insulin intensification to HbA1c below 7.0%. Patients, Design, and Setting: Eighty-two type 1 and 306 insulin-treated type 2 diabetes patients (47% male; age 54±11 yr; HbA1c= 7.8±0.7%) participated in this multicenter, randomized, crossover trial at 52 US centers. Interventions: Interventions included insulin glargine plus premeal glulisine (n= 192) vs. twice-daily premix 75/25 or 70/30 analog insulin (n= 196) for 12 wk and crossed to the alternate arm for 12 wk. Main Outcome Measures: Main outcome measures included PS and QoL questionnaires, 3-d continuous glucose monitoring (CGM), and HbA1c every 4–8 wk. Results: Mean±se HbA1c …

OBJECTIVE:To determine whether proactive telephone support improves adherence to antiretroviral therapy (ART) and clinical outcomes when compared to standard care.METHODS:A multisite, randomized controlled trial (RCT) was conducted with 109 ART-naive subjects coenrolled in AIDS Clinical Trials Group (ACTG) 384. Subjects received standard clinic-based patient education (SC) or SC plus structured proactive telephone calls. The customized calls were conducted from a central site over 16 weeks by trained registered nurses. Outcome measures (collected over 64 weeks) included an ACTG adherence questionnaire and 384 study endpoints.RESULTS:For the primary endpoint, self-reported adherence, a significantly better overall treatment effect was observed in the telephone group (P = 0.023). In a post hoc analysis, composite adherence scores, taken as the first 2 factor scores from a principal components analysis, also found significant intervention benefit (P = 0.023 and 0.019 respectively). For the 384 primary study endpoint, time to regimen failure, the Kaplan-Meier survival curve for the telephone group remained above the SC group at weeks 20 to 64; a Cox proportional hazard model that controlled for baseline RNA stratification, CD4, gender, age, race/ethnicity, and randomized ART treatment arm suggested the telephone group tended to have a lower risk for failure (hazard ratio = 0.68; 95% confidence interval: 0.38 to 1.23).CONCLUSIONS:Findings indicate that customized, proactive telephone calls have good potential to improve long-term adherence behavior and clinical outcomes.

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