title: Understanding vaccination resistance: vaccine search term selection bias and the valence of retrieved information.
abstract: BACKGROUND
  Dubious vaccination-related information on the Internet leads some parents to opt out of vaccinating their children.
  
  
  OBJECTIVE
  To determine if negative, neutral and positive search terms retrieve vaccination information that differs in valence and confirms searchers' assumptions about vaccination.
  
  
  METHODS
  A content analysis of first-page Google search results was conducted using three negative, three neutral, and three positive search terms for the concepts "vaccine," "vaccination," and "MMR"; 84 of the 90 websites retrieved met inclusion requirements. Two coders independently and reliably coded for the presence or absence of each of 15 myths about vaccination (e.g., "vaccines cause autism"), statements that countered these myths, and recommendations for or against vaccination. Data were analyzed using descriptive statistics.
  
  
  RESULTS
  Across all websites, at least one myth was perpetuated on 16.7% of websites and at least one myth was countered on 64.3% of websites. The mean number of myths perpetuated on websites retrieved with negative, neutral, and positive search terms, respectively, was 1.93, 0.53, and 0.40. The mean number of myths countered on websites retrieved with negative, neutral, and positive search terms, respectively, was 3.0, 3.27, and 2.87. Explicit recommendations regarding vaccination were offered on 22.6% of websites. A recommendation against vaccination was more often made on websites retrieved with negative search terms (37.5% of recommendations) than on websites retrieved with neutral (12.5%) or positive (0%) search terms.
  
  
  CONCLUSIONS
  The concerned parent who seeks information about the risks of childhood immunizations will find more websites that perpetuate vaccine myths and recommend against vaccination than the parent who seeks information about the benefits of vaccination. This suggests that search term valence can lead to online information that supports concerned parents' misconceptions about vaccines.
authors.affiliation: Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA. Electronic address: jbruiz@ucdavis.edu.
authors.forename: Jeanette B
authors.initials: JB
authors.lastname: Ruiz
authors.affiliation: Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA; Department of Public Health Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA. Electronic address: rabell@ucdavis.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bell
mesh_terms: D054626:Consumer Health Information; D006801:Humans; D020407:Internet; D007600:Judgment; D010290:Parents / Q000523:psychology*; D045808:Refusal to Participate / Q000523:psychology*; D057386:Search Engine; D015983:Selection Bias; D014611:Vaccination / Q000523:psychology*
keywords: Content analysis; Internet search terms; Vaccine resistance; Vaccine websites