Topics associated with conflict in print news coverage of the HPV vaccine during 2005 to 2009

Figures & data

Table 1. Newspaper articles discussing HPV vaccination in 2005–2009, by paper, type of article and article location (N = 447)

			Year of Publication
	Total N = 447	%	2005 n = 28	2006 n = 98	2007 n = 249	2008 n = 63	2009 n = 9
Paper (by circulation)^+			# of articles per year
USA Today	18	4	2	5	7	4	0
The Wall Street Journal	35	8	3	11	14	6	1
The New York Times	52	12	3	10	28	10	1
Los Angeles Times	16	4	0	4	7	3	2
Daily News (NY)	10	2	2	3	5	0	0
The New York Post	9	2	1	3	4	1	0
The Washington Post	67	15	4	16	41	5	1
Chicago Tribune	50	11	6	12	24	8	0
The Houston Chronicle	62	14	2	7	44	9	0
The Arizona Republic	41	9	0	9	26	5	1
Regional Papers
The Virginia Pilot	29	6	1	2	18	8	0
The Richmond Times Dispatch	11	2	0	3	7	1	0
The Baltimore Sun	47	11	4	13	24	3	3
Type of article
News article	335	75	23	77	174	53	8
Opinion/editorial	112	25	5	21	75	10	1
Article location
Front page (of section/paper)	116	26	6	31	69	7	3
Other location	331	74	22	67	180	56	6

Table 2. Characteristics of newspaper articles discussing HPV vaccination in 2005–2009, by article topic, tone, and event, and conflict (N = 447)

			Year of Publication
	Total N = 447	%	2005 n = 28	2006 n = 98	2007 n = 249	2008 n = 63	2009 n = 9	X^2*
Article topic (up to 2/article)			% of articles by year
HPV/Vaccine Characteristics	287	64	71	79	50	90	89	<0.001
Government/State Activities	246	55	25	59	61	43	11	0.002
Social Influences/Reactions/Attitudes	117	26	46	18	30	14	33	0.08
Stakeholders	112	25	32	19	28	19	22	0.23
Behaviors	49	11	18	14	8	11	22	0.14
Ethical Issues	36	8	0	2	11	10	0	0.005
Tone (1/article)								<0.001
Positive (e.g., vaccine benefits)	206	46	61	75	35	38	55
Mixed	162	36	32	22	41	41	33
Negative (e.g., risks; barriers)	44	10	0	0	15	11	0
Neutral; none of the above	35	8	7	3	9	10	11
Event prompting story (1/article)								<0.01
Research/scientific advancement	121	27	64	21	17	57	45
Legislative activities	120	27	0	5	45	6	0
Government action/ Regulatory body	89	20	7	53	10	16	11
Other stakeholder action	55	12	14	8	14	11	0
Other event	25	6	7	5	6	3	11
No event evident	21	5	4	4	4	53	33
Response to op/ed	16	3	1	4	10	1	0
Conflict present	296	66	57	56	73	59	56	0.001

⁺Top 10 newspapers listed in order of circulation (BurrellesLuce, 2009)

*p-values reported for Pearson X² test for the variable by time where 2007 was the reference year compared to 2005–2006 and 2008–2009.

Table 3. Sources quoted in newspaper articles discussing HPV vaccination in 2005–2009, (N = 447)

Source quoted	N	%
Professional stakeholders
Provider/medical association	152	34
Researcher/professor	139	31
Advocacy/non-profit group	119	27
Health/cancer focus	53	12
Social conservative/parents’ rights focus	46	10
Other (e.g., political)	20	4
Pharmaceutical industry	109	24
State/local government	108	24
Federal government (e.g., CDC)	81	18
Lawyer	9	2
Financial/stock analyst	9	2
Insurance company	8	2
Lay stakeholders
Parent	59	13
Author of previous article/op ed	32	7
Vaccine consumer (potential or actual)	19	4
Cancer patient/survivor	16	4
Other source (e.g., advertisement, teacher, radio show)	11	2
Multiple roles (for one source) are coded	84	19
No source cited	60	13

Table 4. Odds of the presence of conflict and positive tone in news articles discussing HPV vaccination by topic, year, and article characteristics

	N	Conflict		Positive Tone
Topic		OR	95% CI	OR	95% CI
HPV/cervical cancer/vaccine characteristics	287	0.25**	0.16–0.41	4.39**	2.83–6.78
Government/state activities	246	2.91**	1.94–4.37	0.49**	0.33–0.72
Social influences/reactions/attitudes	117	4.37**	2.47–7.74	0.44**	0.28–0.69
Stakeholders	112	0.76	0.49–1.19	0.62*	0.40–0.98
Behaviors	49	0.71	0.39–1.31	3.90**	1.86–8.07
Ethical Issues	36	2.23	0.96–5.23	0.45*	0.21–0.95
Year
2007	249	1.00	(reference)	1.00	(reference)
2005–2006	126	0.47**	0.30–0.73	4.64**	2.85–7.56
2008–2009	72	0.50*	0.29–0.87	1.29	0.74–2.25
Type of article
News article	335	0.42**	0.25–0.70	1.22	0.79–1.90
Opinion/editorial	112	1.00	(reference)	1.00	(reference)
Article location
Front page (of section/paper)	116	1.59*	1.09–2.31	0.76	0.54–1.06
Other location	331	1.00	(reference)	1.00	(reference)

**p < 0.01.

*p < 0.05.

Table 5. Odds of the presence of conflict in news articles discussing HPV vaccination by sexual behavior-related content and government/state activities

	N	OR	95% CI
Sexual behavior variables
Sexual activity	196	2.35**	1.55–3.55
Abstinence	61	4.60**	2.03–10.36
Early initiation of sexual activity	43	5.58**	1.95–15.91
Condom use	31	0.69	0.33–1.44
Promiscuity	69	2.48**	1.31–4.69
Implied approval of sexual activity	115	17.27**	6.87–43.42
Government/state activity variables
Legislation	160	5.48**	3.28–9.17
Executive Order	83	28.07**	6.80–115.91
Opt-out	89	5.13**	2.57–10.25
Politics	31	16.92**	2.28–125.30
Lawsuits	20	2.10	0.69–6.40
Federal approval/recommendations	260	0.88	0.59–1.31
VFC program	31	3.69*	1.27–10.74
Low-income/government funding in general	81	3.17**	1.69–5.94
Vaccine requirement/mandate	238	12.13**	7.42–19.85
Abstinence only programs	14	3.15	0.70–14.25
Education/sex education	39	2.49*	1.07–5.79
Vaccine adverse events reporting	15	always associated with conflict (OR cannot be estimated)
Role of school/effect on schools	160	7.37**	4.23–12.82
cost to government/state (incl. budget)	54	2.16*	1.08–4.33

**p < 0.01.

*p < 0.05.

Table 6. Illustrative examples of text containing conflict

Title	Source, Article Type, Date	Coded Variables	Text
Making health a priority; Benefits of HPV vaccine for young girls outweigh cost and moral concerns.	The Houston Chronicle, opinion, 1/23/2007	Early initiation of sexual activity	“Unfortunately, we live in a world where kids grow up way too fast. Those against this vaccination believe that it will somehow encourage young girls to become sexually active at an earlier age. What they ignore is that everything these days encourages early sexual behavior.”^39
Vaccine for Girls Raises Thorny Issues; Parents Weigh Anti-Cancer Benefits Against Concerns About Cost and Lost Innocence.	The Washington Post, news, 11/7/2006	Mandates, safety, promiscuity, parents’ rights	“Proponents of the vaccine have been advocating mandatory vaccination of girls, sparking an intense nationwide debate. Opponents say that the vaccine may encourage sexual activity and that its safety and long-term effectiveness are not clear because it is so new. They argue that the decision should be made by parents individually.”^40
Vaccine for Girls Raises Thorny Issues; Parents Weigh Anti-Cancer Benefits Against Concerns About Cost and Lost Innocence	The Washington Post, news, 11/7/2006	Doctor recommendation, abstinence, sexual activity, role of men/boys	“So some pediatricians are advising parents who are confident their daughters will be abstinent until they are older, perhaps even until marriage, to wait… . Supporters argue that parents have no way of really knowing when their daughters will become sexually active or whether they may be sexually assaulted. And even if they remain abstinent until marriage, their husbands may be infected.” ^40
Perry muscle flexing falls flat; Controversial executive orders spur lawmakers to exercise their own authority	The Houston Chronicle, news, 2/25/2007	Executive Order, mandate, politics	“The next day, a House committee approved a bill to overturn Perry's executive mandate that all sixth-grade girls be vaccinated against a sexually transmitted virus that causes most cervical cancers. ‘On the vaccine, the Legislature was relatively insulted about that,’ said House Appropriations Chairman Warren Chisum, a Republican who has been allied with Perry in the past. ‘They just felt it was important to exercise their authority as a Legislature.’"^41
Early Shots at STD - Vaccine To Schools	The New York Post, news, 3/30/2007	VFC program, low-income funding, Role of/effect on schools, lobbying, promiscuity	"The federal Vaccines for Children program provides free vaccines to girls age 9 through 18 who are on Medicaid or have inadequate insurance. State law requires that other girls get coverage through their private insurers. Health officials were quick to note that parental consent is required to give the vaccine. Merck, the manufacturer of Gardasil, has backed state laws to make it easier to distribute the HPV vaccine in schools. But it recently backed off its lobbying campaign following criticism that such laws would encourage promiscuity among youths.” ^42
Drugmaker Helps Push Mandatory HPV Shots	The Washington Post, news, 2/11/2007	Mandate, politics, stakeholders, parents’ rights, promiscuity	“In the case of mandating the HPV vaccine, there are good political reasons for nonprofit health groups to stay out of the debate, which has engaged critics who believe requiring a vaccine against a sexually transmitted disease would undermine parental authority and also encourage promiscuity (Gardner, 2007).” ^43
Moves to Vaccinate Girls For Cervical Cancer Draw Fire; As Merck Lobbies States To Require Shots, Some Fret Over Side Effects, Morals	The Wall Street Journal, news, 2/7/2007	Legislation, opt-out, mandate, role of/effect on schools	“Bills being drafted in some 20 US states that would make a cervical-cancer vaccine mandatory for preteen girls are sparking a backlash among parents and consumer advocates… . Many of the state bills contain opt-out clauses, but a few don't. The bill pending in Florida would bar students ages 11 or 12 from being admitted to public or private school in the state unless they can provide proof that they have been vaccinated or that their parents opted them out after receiving information about cervical cancer and the vaccine.” ^44
Utah Vaccine Campaign to Be Funded Privately	Los Angeles Times, news, 4/4/2007	Legislation, cost to government/state, education, low-income/government funding, promiscuity	“The bill's backers had high hopes. They proposed that Utah spend $1 million for a public education campaign about the risks of cervical cancer and a new vaccine that can prevent it, as well as fund vaccinations for poor, uninsured patients. But conservatives in the state legislature objected, partly because cervical cancer is spread sexually and they feared that making vaccines available would encourage children to be promiscuous. The program was withdrawn from consideration in early February.” ^45

Brotherton C. Making health a priority; benefits of HPV vaccine for young girls outweigh cost and moral concerns. The Houston Chronicle (2 Star Ed.). 2007 Jan 23: Sect. Star: pg 3.

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