Surveillance of HPV vaccination discourse on Twitter in the United States A case study of Kansas and Rhode Island Christopher Wheldon, 1 Jiang Bian, 2 Richard Moser 1 1 National Cancer Institute National Institutes of Health U.S. Department of Health and Human Services 2 Health Outcomes & Policy College of Medicine University of Florida Introduction Human papillomavirus (HPV) vaccination is a safe and effective strategy in the primary prevention of HPV-related cancers (e.g., cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers). Coverage for HPV vaccination remain low and varies considerably by state Low coverage and state variations maybe related to public perceptions and attitudes towards HPV vaccination Scientific problem: There are no automated national surveillance systems with the capacity to monitor population attitudes toward HPV vaccination in a timely manner, leaving public health professionals and policy makers with limited information to respond to public concerns, misinformation, and low vaccine uptake. Research objectives: Characterize discourse regarding HPV vaccination with regard to (1) popularity of the topic, (2) sentiment of discourse, (3) content, and (4) information sources. Introduction Human papillomavirus (HPV) vaccination is a safe and effective strategy in the primary prevention of HPV-related cancers (e.g., cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers). Coverage for HPV vaccination remain low and varies considerably by state Low coverage and state variations maybe related to public perceptions and attitudes towards HPV vaccination Scientific problem: There are no automated national surveillance systems with the capacity to monitor population attitudes toward HPV vaccination in a timely manner, leaving public health professionals and policy makers with limited information to respond to public concerns, misinformation, and low vaccine uptake. Research objectives: Characterize discourse regarding HPV vaccination with regard to (1) popularity of the topic, (2) sentiment of discourse, (3) content, and (4) information sources. Methods Data source: twython library for accessing the Twitter APIs. Example keywords: hpv; Human Papillomavirus Vaccine. Sample: Tweets in English with identifiable geolocation within the United States posted between 2/18/2016-6/16/2016. Measures/Analysis: Popularity. Volume of tweets normalized by each state’s population according to the 2010 statistics published by the U.S. Census Bureau. Sentiment. Linguistic Inquiry and Word Count (LIWC) tool. Coverage National Immunization Survey-Teen (NIS-Teen). Received > 1 doses of HPV vaccination, adolescents Tweet Content. Qualitative content analysis (MAXQDA) was used to code tweets to identify themes pertaining to specific topics and information sources. Methods Data source: twython library for accessing the Twitter APIs. Example keywords: hpv; Human Papillomavirus Vaccine. Sample: Tweets in English with identifiable geolocation within the United States posted between 2/18/2016-6/16/2016. Measures/Analysis: Popularity. Volume of tweets normalized by each state’s population according to the 2010 statistics published by the U.S. Census Bureau. Sentiment. Linguistic Inquiry and Word Count (LIWC) tool. Coverage National Immunization Survey-Teen (NIS-Teen). Received > 1 doses of HPV vaccination, adolescents Tweet Content. Qualitative content analysis (MAXQDA) was used to code tweets to identify themes pertaining to specific topics and information sources. Results Conclusions & Future Work Kansas Negative sentiment directed toward low-vaccine uptake and not the vaccine itself Expressed “alarm” over the state’s low number of HPV vaccinations Anti-vaccination content was minimal Rhode Island Tweets in support of legislation to remove the 2014 mandate that children in RI receive HPV vaccination before entering the 7th grade Grassroots political action Conflict between mandate and awareness of the link between HPV infection and cancer Relevant Tweets N = 436,617 English Tweets with state geographic information (N = 21,158) Kansas (N = 356) Rhode Island (N = 269) High tweet volume (volume normalized by State population) Kansas Hawaii Maryland Vermont Rhode Island State# Tweets % of total U.S. States # Distinct Users Avg. # posts per users 1. Rhode Island % Hawaii % Vermont 860.4% Maryland % Kansas % % >21K tweets Kansas rates for #HPV vaccination are the lowest in the nation. "The vaccine prevents cancer. What's the problem?" At #RhodeIsland State House working to remove the HPV vaccine mandate. We appreciate all of you! #VaccineChoiceRI retweets 76% Shared URL Rhode Island Kansas Characteristics of tweets in high volume states RI:31% KS:27% RI:22% KS:31% FemalesMales National Average60.0(±1.9)41.7(±1.8) Rhode Island (Highest)76.0(±7.7)69.0(±7.5) Kansas (Lowest for Females) 38.3(±9.5)32.8(±8.6) Test alternative sentiment classification methods to identify people’s attitudes toward HPV vaccination Explore correlations between sentiment, volume, and HPV vaccine coverage. The target of classification (sentiment toward HPV vaccination) was missed using general HPV-related keywords Qualitative analysis of Twitter data provided context for public health intervention 28% of tweets from Kansas University Cancer Center in support of HPV vaccination and promoting a Twitter chat Thematic codes 32% of tweets from group lobbying to overturn state HPV-vaccine mandate