: Vaccine hesitancy, defined as delay or refusal of vaccination despite the availability of vaccination services, has been included by WHO among the top 10 global health threats. Individual decision-making process can be strongly affected by communication. The use of metaphors is common in public health communication and increased during the COVID19 pandemic. Although some evidence has supported the persuasive potential of metaphorical language over scientific language, further research is needed. Our study aimed at comparing the effects of neutral scientific talk with war and protective metaphors on health communication. An online survey was conducted on a convenience sample of Italian teenagers randomly allocated to three study arms. Each participant was invited to watch a specific version of an informative video on infections and vaccines (group 1: neutral-scientific approach, group 2: metaphorical-war, and group 3: metaphorical-protective approach). After watching the video, each participant responded to an ad-hoc questionnaire. A total of 2681 subjects were randomly allocated to the three groups. No significant differences regarding age, sex and geographical area were detected between groups. Median age of the sample was 17 years (mean 16,8) and 56.8% were girls. The general attitude towards vaccination in group 2 and 3 was largely positive, with the majority agreeing (strongly or tend to agree) on the fact that vaccination is important (group 2: 89%; group 3: 92%), safe (group 2: 91%; group 3: 92,5%), effective (group 2: 85%; group 3: 88%), and does not generate anxiety (group 2: 80%; group 3: 83%). Higher level of distrust against vaccines was found in group 1, where 32% of participating adolescents are strongly or tend to be anxious about getting vaccinated. The results of our survey suggest that emotional involvement evoked through the use of metaphorical language may have, at least in the short run, some positive effect on vaccine confidence. Key messages: • Use of metaphors can be successfully used in public health communication. • Messages evoking either war or protecting concepts are more efficacious than plain scientific language.

Objectives: To examine the correlation between health literacy (HL) and susceptibility to food-related fake news, and to explore the role of social media and influencers in shaping consumers’ food choices. Design: Cross-sectional survey conducted via an online questionnaire. Setting: Nine community pharmacies located in northern, central and southern Italy. Participants: A total of 2284 consumers recruited between January and March 2024. Results: Lower HL levels were significantly associated with poorer self-reported education, health and economic status, as well as precarious employment. These same variables were linked to a higher likelihood of believing and spreading food-related fake news. Individuals from socioeconomically disadvantaged backgrounds were also more likely to trust influencers who influenced their food choices. Conclusions: HL plays a key role in reducing the susceptibility to food-related misinformation, particularly in lower socioeconomic groups. Targeted interventions aimed at improving HL may help mitigate the spread of fake news and empower individuals to make healthier food choices.

The convergence of emerging infectious diseases, accelerating ecological changes, and increasing global mobility makes Vaccine Literacy (VL) a critical component of contemporary travel medicine. Enhanced VL can facilitate more effective provider-traveler communication, ultimately reducing infectious disease transmission risks associated with international travel. This cross-sectional survey aimed to measure VL levels among Italian travelers through an online survey using the 'Vaccine Literacy Brief Tool' (VLBT), a new three-item instrument assessing functional, interactive, and critical dimensions, derived from previously validated measures. Additional study objectives were to explore VL relationships with antecedents, attitudes, and outcomes, as well as to establish the tool's construct and criterion validity within the traveler population. Enrollment was conducted through a QR code displayed at nine vaccination clinics across five Italian regions, linking to an anonymous questionnaire (Google Forms) that visiting travelers could voluntarily access and complete before receiving vaccination for their trip. In addition to VL skills, the psychological antecedents of Vaccine Hesitancy (VH), the "3Cs" (confidence, complacency, convenience) were assessed. Additional measures included demographic and travel-related variables, as well as behavioral, cognitive and intentional vaccination outcomes. A total of 534 questionnaires were collected between January and July 2025. Participants showed a mean VL score of 3.07 ± 0.66 on a four-point Likert scale, significantly lower than the 3.21 ± 0.42 reported in previous general population studies (p < .001). The mean 3Cs score was 1.92 ± 0.60, indicating relatively high VH levels. VL and 3Cs scores showed a significant negative correlation (r = -0.204, P < .001). Participants consisted primarily of highly educated adults aged 18-40 years. VL scores were negatively associated with younger age (ρ = -0.132, p = .002), and positively with higher educational level (ρ = 0196, p < .001), higher income (ρ = 0.145, p < .001), greater number of information sources consulted (r = 0.104, p = .016), and more favorable vaccination outcomes. Conversely, the 3Cs demonstrated inverse significant relationships with the same demographic and behavioral variables. No significant gender differences emerged for either VL or 3Cs measures. Construct validity of the VLBT was supported by the significant negative correlation between VL and 3Cs scores, and with additional confirmation provided through reliability tests and factor analyses. Criterion validity was demonstrated through significant associations between VL scores and vaccination behaviors: number of vaccines received, vaccination recall accuracy, awareness of destination-specific pre-travel vaccination requirements, and influenza vaccination intention. Mediation analysis revealed that the 3Cs partially mediated the relationship between VL and specific vaccination intention outcomes, while demographic characteristics (age, income) and travel-related factors (number of information sources) significantly moderated these associations. The VLBT assessed travelers' VL levels through three simple questions and demonstrated potential clinical utility in travel medicine. By facilitating identification of individuals with limited literacy levels, the new tool can help providers orientate the discussion for a profitable counseling session. Implementation research is needed to confirm its effectiveness in routine travel clinical practice. The high VH revealed in the traveler population warrants future targeted research.

Clinically vulnerable individuals, including the elderly, are at increased risk of adverse health outcomes following infections, due to immunosenescence, chronic inflammation, or underlying medical conditions. Despite measures such as the National Immunisation Prevention Plan and Regional Laws, immunisation coverage for herpes zoster, pneumococcus, and COVID-19 in the Apulia Region has declined in recent years. This study outlines strategic actions to improve vaccination coverage for clinically vulnerable individualss in the region, using methods like the World Café (WoCa) to achieve regional consensus. On 31st May 2023, a working group of Apulian researchers and healthcare workers, supported by the Regional Immunisation Committee, conducted a workshop. The WoCa method facilitated structured discussions across five thematic domains to generate innovative solutions for enhancing immunisation rates. Key actions included active vaccination reminders in all formats of informed consent and during healthcare visits; improved training for healthcare workers conducting outreach; involving pharmacies in patient guidance alongside general practicioners (GPs) and public health operators; establishing vaccination clinics near specialist centres and employing mobile units; launching media campaigns to counteract misinformation using authoritative voices; providing vaccinology and scientific communication training for professionals; implementing a hub-and-spoke logistics system under the governance by the Department of Prevention (DP); and ensuring seamless communication between digital platforms for vaccine data reporting and monitoring. The findings demonstrate the value of WoCa in achieving regional consensus to enhance immunisation for frail individuals. Collaboration among healthcare professionals, institutions, and the public is vital to raise awareness, improve accessibility, and address logistical challenges, ensuring equitable access to vaccination for vulnerable populations.

Influenza vaccination is a key preventive measure, especially for professional athletes exposed to increased infectious risk due to intense physical activity, frequent travel, and close-contact settings. However, data on vaccine uptake and attitudes in this group are limited. This study examined opinions, behaviors, and determinants of influenza vaccination adherence among male athletes in the Italian Serie A volleyball league during the 2024/25 season to inform targeted immunization strategies. Cross-sectional observational study. A self-administered anonymous questionnaire was distributed to 157 athletes between December 2024 and March 2025. Collected variables included socio-demographic characteristics, vaccination history, perceived influenza risk, vaccination importance, and influencing factors such as medical advice and club policy. Of 138 respondents (response rate: 87.9 %), 44.9 % intended to vaccinate in the current season, and 63.8 % had been vaccinated previously. Overall, 76.1 % recognized the importance of vaccination. Key motivations were medical recommendations (61.6 %) and club policies (25.4 %). Significant associations were found between perceived influenza risk and vaccination intention (p < 0.001), and between medical recommendation and perceived importance (OR = 3.45, p < 0.01). Age showed no significant association. Although vaccination is widely regarded as important among professional athletes, adherence is strongly influenced by organizational factors. Medical advice and club support are critical drivers of vaccine acceptance. Tailored communication strategies, integration of vaccination into routine sports medicine, and structured immunization programs are recommended to improve coverage in elite sports and support public health goals.