title: Vaccine Hesitancy: In Search of the Risk Communication Comfort Zone.
abstract: BACKGROUND
  This paper reports the findings of a national online survey to parents of children aged 5 and younger. The objectives of the study were to assess parental understanding of childhood immunizations, identify sources of information that they trust for vaccine-related content, assess where parents with young children stand on the key issues in the public debate about vaccination, and identify which risk communication messages are most effective for influencing the behaviours of vaccine hesitant parents.
  
  
  METHODS
  A total of 1,000 surveys (closed and open-ended questions) were administered in November 2015 using the Angus Reid Forum Panel, a key consumer panel consisting of approximately 150,000 Canadian adults aged 18 and older, spread across all geographic regions of Canada.
  
  
  RESULTS
  Approximately 92% of the Canadian parents surveyed consider vaccines safe and effective, and trust doctors and public health officials to provide timely and credible vaccine-related information. However, a concerning number of them either believe or are uncertain whether there is a link between vaccines and autism (28%), worry that vaccines might seriously harm their children (27%), or believe the pharmaceutical industry is behind the push for mandatory immunization (33%). Moreover, despite the common assumption that social media are becoming the go-to source of health news and information, most parents still rely on traditional media and official government websites for timely and credible information about vaccines and vaccine preventable diseases, particularly during community-based disease outbreaks. Finally, parents reported high levels of support for pro-vaccine messaging that has been demonstrated in previous research to have little to no positive impact on behaviour change, and may even be counterproductive.
  
  
  CONCLUSIONS
  The study's results are highly relevant in a context where public health officials are expending significant resources to increase rates of childhood immunization and combat vaccine hesitancy. The data offer insight into where parents stand on the political and public debate about mandatory vaccination, what aspects of vaccine science remain uncertain to them, which media and institutional sources they use and trust to navigate the health information environment, how they look for information and whom they trust during periods of health emergency or crisis, and which communication strategies are considered most effective in persuading vaccine hesitant parents to immunize their children.
authors.affiliation: School of Journalism and Communication, Carleton University, Ottawa, Ontario, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Greenberg
authors.affiliation: Institut National de Santé Publique du Québec, Québec, Canada; Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Dubé
authors.affiliation: Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Driedger
keywords: MMR vaccine; anti-vaccination; health communication; immunization; public health; risk communication; vaccine hesitancy