{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:48:38Z","timestamp":1773373718600,"version":"3.50.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K01AI132741"],"award-info":[{"award-number":["K01AI132741"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000275","name":"Leverhulme Trust","doi-asserted-by":"publisher","award":["Large Center Grant"],"award-info":[{"award-number":["Large Center Grant"]}],"id":[{"id":"10.13039\/501100000275","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Adult vaccine-preventable infectious diseases contribute substantial burden each year, and vaccine uptake remains suboptimal. As digital health communication grows, digital newsletters may represent a scalable, low-cost tool to promote vaccination. We conducted a randomized prospective study to evaluate the impact of digital newsletters on subscribers\u2019 knowledge, attitudes, and behaviors regarding four adult vaccines: respiratory syncytial virus (RSV), influenza, shingles, and COVID-19. Between November 2023 and January 2024, half of subscribers to the\n                    <jats:italic>Those Nerdy Girls<\/jats:italic>\n                    (TNG) Substack newsletter received additional vaccine-focused newsletters, while the other half received only the standard twice-weekly newsletters. Pre- and post-intervention online surveys assessed vaccine knowledge, attitudes, and behaviors among adult subscribers who consented to participate. Across 1,327 pre-intervention and 1,208 post-intervention participants, knowledge gains were observed for RSV and shingles vaccines in the intervention group compared with controls, while knowledge of influenza and COVID-19 vaccines did not improve. Attitudes toward vaccination were generally positive at baseline and showed no significant intervention effects across vaccine types. Likelihood of vaccination increased for influenza, COVID-19, and RSV overall during the study period, but only influenza vaccination showed a significantly greater increase in the intervention group relative to controls. No significant effects were found for shingles vaccination. These results indicated that digital newsletters can improve knowledge and, in some contexts, support uptake, but knowledge gains did not consistently translate into changes in attitudes or behaviors. Findings highlighted the limitations of knowledge-deficit models for adult vaccination promotion. Digital newsletters should be considered as one component of broader public health strategies, particularly when paired with approaches that address logistical access, trust, and social norms.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0344258","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:40:13Z","timestamp":1773337213000},"page":"e0344258","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A randomized assessment of the impact of \u2018Those Nerdy Girls\u2019 newsletters on adult vaccination outcomes"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8198-0826","authenticated-orcid":true,"given":"Malia","family":"Jones","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6586-2547","authenticated-orcid":true,"given":"Megan","family":"Reilly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Simanek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopa","family":"Seshadri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer B.","family":"Dowd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5542-5511","authenticated-orcid":true,"given":"Ashley Z.","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"pone.0344258.ref001","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1007\/s40520-022-02110-2","article-title":"Capturing the value of vaccination: impact of vaccine-preventable disease on hospitalization","volume":"34","author":"MT Doherty","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"pone.0344258.ref002","unstructured":"CDC. Vaccine-Preventable Adult Diseases. In: Vaccine Information for Adults [Internet]. 2025 [cited 14 Jan 2026]. Available from: https:\/\/www.cdc.gov\/vaccines-adults\/diseases\/index.html"},{"key":"pone.0344258.ref003","unstructured":"The National Vaccine Program Office. National Adult Immunization Plan. US Department of Health and Human Services. 2019. Available from: https:\/\/www.hhs.gov\/sites\/default\/files\/nvpo\/national-adult-immunization-plan\/naip.pdf]"},{"key":"pone.0344258.ref004","unstructured":"CDC. About Estimated Flu Burden. In: Flu Burden [Internet]. 2024 [cited 13 Aug 2025]. Available from: https:\/\/www.cdc.gov\/flu-burden\/php\/about\/index.html"},{"key":"pone.0344258.ref005","unstructured":"CDC. Flu Vaccination Coverage, United States, 2023\u201324 Influenza Season. In: FluVaxView [Internet]. 2025 [cited 13 Aug 2025]. Available from: https:\/\/www.cdc.gov\/fluvaxview\/coverage-by-season\/2023-2024.html"},{"key":"pone.0344258.ref006","unstructured":"CDC. Preliminary Estimates of COVID-19 Burden for 2024-2025. In: COVID-19 [Internet]. [cited 19 Jan 2026]. Available from: https:\/\/www.cdc.gov\/covid\/php\/surveillance\/burden-estimates.html"},{"key":"pone.0344258.ref007","unstructured":"CDC. Vaccination Trends. In: Respiratory Illnesses [Internet]. 2025 [cited 13 Aug 2025]. Available from: https:\/\/www.cdc.gov\/respiratory-viruses\/data\/vaccination-trends.html"},{"issue":"4","key":"pone.0344258.ref008","doi-asserted-by":"crossref","first-page":"3376","DOI":"10.3390\/ijerph20043376","article-title":"Spillover of vaccine hesitancy into adult COVID-19 and influenza: the role of race, religion, and political affiliation in the United States","volume":"20","author":"V Zhang","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"29","key":"pone.0344258.ref009","doi-asserted-by":"crossref","first-page":"793","DOI":"10.15585\/mmwr.mm7229a4","article-title":"Use of respiratory syncytial virus vaccines in older adults: recommendations of the advisory committee on immunization practices - United States, 2023","volume":"72","author":"M Melgar","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"32","key":"pone.0344258.ref010","doi-asserted-by":"crossref","first-page":"696","DOI":"10.15585\/mmwr.mm7332e1","article-title":"Use of respiratory syncytial virus vaccines in adults aged \u226560 years: updated recommendations of the advisory committee on immunization practices - United States, 2024","volume":"73","author":"A Britton","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"pone.0344258.ref011","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s40266-015-0258-9","article-title":"Respiratory syncytial virus infection in older adults: an under-recognized problem","volume":"32","author":"AR Branche","year":"2015","journal-title":"Drugs Aging"},{"key":"pone.0344258.ref012","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1001\/jama.2024.15775","article-title":"RSV vaccine effectiveness against hospitalization among US adults 60 years and older","volume":"332","author":"D Surie","year":"2024","journal-title":"JAMA"},{"issue":"3","key":"pone.0344258.ref013","doi-asserted-by":"crossref","first-page":"80","DOI":"10.15585\/mmwr.mm7103a2","article-title":"Use of Recombinant zoster vaccine in immunocompromised adults aged \u226519 years: recommendations of the advisory committee on immunization practices - United States, 2022","volume":"71","author":"TC Anderson","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0344258.ref014","unstructured":"CDC. Shingles Facts and Stats. In: Shingles (Herpes Zoster) [Internet]. 2025 [cited 13 Aug 2025]. Available: https:\/\/www.cdc.gov\/shingles\/data-research\/index.html"},{"key":"pone.0344258.ref015","first-page":"370","article-title":"Shingles Vaccination Among Adults Aged 60 and Over: United States, 2018","author":"EP Terlizzi","year":"2020","journal-title":"NCHS Data Brief"},{"issue":"1","key":"pone.0344258.ref016","doi-asserted-by":"crossref","DOI":"10.2196\/21063","article-title":"Digital health promotion and prevention in settings: scoping review","volume":"24","author":"AL Stark","year":"2022","journal-title":"J Med Internet Res"},{"issue":"8","key":"pone.0344258.ref017","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.4161\/hv.25031","article-title":"Utilizing health information technology to improve vaccine communication and coverage","volume":"9","author":"MS Stockwell","year":"2013","journal-title":"Hum Vaccin Immunother"},{"issue":"7","key":"pone.0344258.ref018","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.3390\/ijerph22071081","article-title":"A mixed methods exploration of social media use for health information in under-resourced communities","volume":"22","author":"N Matangi","year":"2025","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0344258.ref019","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.8217","article-title":"Implementation intention and reminder effects on behavior change in a mobile health system: a predictive cognitive model","volume":"19","author":"P Pirolli","year":"2017","journal-title":"J Med Internet Res"},{"key":"pone.0344258.ref020","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1038\/s41586-021-03843-2","article-title":"Behavioural nudges increase COVID-19 vaccinations","volume":"597","author":"H Dai","year":"2021","journal-title":"Nature"},{"issue":"6","key":"pone.0344258.ref021","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1370\/afm.2120","article-title":"Randomized controlled trial of text message reminders for increasing influenza vaccination","volume":"15","author":"AK Regan","year":"2017","journal-title":"Ann Fam Med"},{"issue":"11","key":"pone.0344258.ref022","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1037\/hea0001400","article-title":"Interventions involving nudge theory for COVID-19 vaccination: a systematic review and meta-analysis","volume":"43","author":"J Zhang","year":"2024","journal-title":"Health Psychol"},{"issue":"9","key":"pone.0344258.ref023","article-title":"Nudging toward vaccination: a systematic review","volume":"6","author":"MDC Re\u00f1osa","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"7","key":"pone.0344258.ref024","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.3390\/vaccines11071274","article-title":"Use of information and communication technology strategies to increase vaccination coverage in older adults: a systematic review","volume":"11","author":"A Buja","year":"2023","journal-title":"Vaccines (Basel)"},{"issue":"3","key":"pone.0344258.ref025","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.vaccine.2019.10.089","article-title":"Effectiveness of email-based reminders to increase vaccine uptake: a systematic review","volume":"38","author":"B Frascella","year":"2020","journal-title":"Vaccine"},{"issue":"5","key":"pone.0344258.ref026","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/0091-7435(86)90025-3","article-title":"Health promotion and the knowledge-attitude-behavior continuum","volume":"15","author":"EP Bettinghaus","year":"1986","journal-title":"Prev Med"},{"key":"pone.0344258.ref027","doi-asserted-by":"crossref","first-page":"973","DOI":"10.3390\/vaccines10060973","article-title":"The health belief model applied to COVID-19 vaccine hesitancy: a systematic review","volume":"10","author":"YB Limbu","year":"2022","journal-title":"Vaccines"},{"issue":"10382","key":"pone.0344258.ref028","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/S0140-6736(23)00349-5","article-title":"Electronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial","volume":"401","author":"ND Johansen","year":"2023","journal-title":"Lancet"},{"key":"pone.0344258.ref029","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/PHH.0000000000001834","article-title":"COVID-19 vaccine information seeking patterns and vaccine hesitancy: a latent class analysis to inform practice","volume":"30","author":"R Piltch-Loeb","year":"2024","journal-title":"J Public Health Manag Pract"},{"issue":"4","key":"pone.0344258.ref030","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1177\/07439156221103860","article-title":"Marketplaces of misinformation: a study of how vaccine misinformation is legitimized on social media","volume":"41","author":"G Di Domenico","year":"2022","journal-title":"J Public Policy Mark"},{"issue":"1","key":"pone.0344258.ref031","doi-asserted-by":"crossref","first-page":"891","DOI":"10.3390\/ijerph20010891","article-title":"COVID-19 news exposure and vaccinations: a moderated mediation of digital news literacy behavior and vaccine misperceptions","volume":"20","author":"Y Wu","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0344258.ref032","doi-asserted-by":"crossref","first-page":"100229","DOI":"10.1016\/j.mcpdig.2025.100229","article-title":"Using social media to combat influenza vaccine misinformation and improve uptake: a social media campaign and repeated cross-sectional survey analysis","volume":"3","author":"JB Steier","year":"2025","journal-title":"Mayo Clin Proc Digit Health"},{"key":"pone.0344258.ref033","article-title":"Lessons learned from dear pandemic, a social media\u2013based science communication project targeting the COVID-19 infodemic","author":"SS Albrecht","year":"2022","journal-title":"Public Health Rep"},{"issue":"3","key":"pone.0344258.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0281773","article-title":"Dear Pandemic: A topic modeling analysis of COVID-19 information needs among readers of an online science communication campaign","volume":"18","author":"AM Golos","year":"2023","journal-title":"PLoS One"},{"issue":"3","key":"pone.0344258.ref035","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1177\/08901171211070956","article-title":"Fight like a nerdy girl: the dear pandemic playbook for combating health misinformation","volume":"36","author":"LJ Leininger","year":"2022","journal-title":"Am J Health Promot"},{"key":"pone.0344258.ref036","unstructured":"Dear Pandemic: Nurses as key partners in fighting the COVID\u201019 infodemic - Ritter. Public Health Nursing. Wiley Online Library; 2021. [cited 8 Aug 2024]. Available from: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/phn.12903"},{"key":"pone.0344258.ref037","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/10810730.2023.2214986","article-title":"What Were the Information Voids? A qualitative analysis of questions asked by dear pandemic readers between August 2020-August 2021","volume":"28","author":"R Piltch-Loeb","year":"2023","journal-title":"J Health Commun"},{"key":"pone.0344258.ref038","volume-title":"Effective Communications Participant Handbook, World Health Organization","author":"G Gamhewage","year":"2015"},{"key":"pone.0344258.ref039","unstructured":"Qualtrics. Provo, UT. Available from: https:\/\/www.qualtrics.com"},{"key":"pone.0344258.ref040","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7242e1","article-title":"Use of updated COVID-19 vaccines 2023\u20132024 formula for persons aged \u22656 months: recommendations of the Advisory Committee on Immunization Practices \u2014 United States, September 2023","volume":"72","author":"JJ Regan","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"12","key":"pone.0344258.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208601","article-title":"Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination","volume":"13","author":"C Betsch","year":"2018","journal-title":"PLoS One"},{"key":"pone.0344258.ref042","volume-title":"Stata Statistical Software: Release 19","author":"StataCorp","year":"2025"},{"key":"pone.0344258.ref043","unstructured":"Cleveland Clinic. When Is the Best Time To Get Your Flu Shot? In: Cleveland Clinic [Internet]. 2025 [cited 12 Jan 2026]. Available: https:\/\/health.clevelandclinic.org\/when-to-get-flu-shot"},{"issue":"4","key":"pone.0344258.ref044","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1177\/109019817400200403","article-title":"Historical origins of the health belief model","volume":"2","author":"IM Rosenstock","year":"1974","journal-title":"Health Educ Monogr"},{"key":"pone.0344258.ref045","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"I Ajzen","year":"1991","journal-title":"Organ Behav Hum Decis Process"},{"issue":"8","key":"pone.0344258.ref046","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.4161\/hv.24657","article-title":"Vaccine hesitancy: an overview","volume":"9","author":"E Dub\u00e9","year":"2013","journal-title":"Hum Vaccin Immunother"},{"key":"pone.0344258.ref047","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1529100618760521","article-title":"Increasing vaccination: putting psychological science into action","volume":"18","author":"NT Brewer","year":"2017","journal-title":"Psychol Sci Public Interest"},{"issue":"3","key":"pone.0344258.ref048","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.vaccine.2014.11.017","article-title":"Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information","volume":"33","author":"B Nyhan","year":"2015","journal-title":"Vaccine"},{"issue":"4","key":"pone.0344258.ref049","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1080\/09581596.2016.1235259","article-title":"The significance of folklore for vaccine policy: discarding the deficit model","volume":"27","author":"A Kitta","year":"2016","journal-title":"Crit Public Health"},{"key":"pone.0344258.ref050","article-title":"Results from a reader impact assessment of Dear Pandemic","volume-title":"Oral Presentation presented at: Interdisciplinary Association of Population Health Scientists","author":"M Jones","year":"2023"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344258","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:40:24Z","timestamp":1773337224000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344258"}},"subtitle":[],"editor":[{"given":"Nicole E.","family":"Basta","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0344258","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}