It is well established that people who use complementary and alternative medicines (CAM) are, on the whole, more vaccine hesitant. One possible conclusion that can be drawn from this is that trusting CAM results in people becoming more vaccine hesitant. An alternative possibility is that vaccine hesitancy and use of CAM are both downstream consequences of a third factor: distrust in conventional treatments. To examine this, we measured vaccine hesitancy and CAM use in a representative sample of Spanish residents (N = 5200). We also measured their trust in three CAM interventions (acupuncture, reiki, homeopathy) and two conventional medical interventions (chemotherapy and antidepressants). Results showed that vaccine hesitancy was strongly associated with (dis)trust in conventional medicine, and this relationship was particularly strong among CAM users. In contrast, trust in CAM was a relatively weak predictor of vaccine hesitancy, and the relationship was equally weak regardless of whether or not participants themselves had a history of using CAM. The implication for practitioners and policy makers is that CAM is not necessarily a major obstacle to people's willingness to vaccinate, and that the more proximal obstacle is people's mistrust of conventional treatments.

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Several studies have investigated the motivations driving the use of complementary and alternative medicines (CAM). Nevertheless, the general public view of these therapies remains relatively unexplored. Our study identifies the social factors that determine a person's trust in alternative therapies, like homeopathy or acupuncture, drawing conclusions from the results of the Spanish National Survey on the Social Perception of Science and Technology (N=6,357).We show that trust in the effectiveness of CAM therapies is not mutually exclusive with a belief in science for the general public, pointing to a certain level of disinformation. The comparison with superstitions confirms a clear differentiation with the drivers of trust in analyzed CAM therapies. We argue that scientific appearance of these alternative therapies, in terms of prescription, communication and marketing, may play an important role in determining trust in them for a large part of the population. Furthermore, we confirm that women and those with higher socio-economic status are more likely to express trust in the effectiveness of CAM therapies. Additionally, distrust of the influence of big pharma on health policies seems to have an effect on viewing CAM therapies as more effective. Finally, we argue that media and pharmacies may have an effect on the scientific-like perception of CAM therapies, contributing to the social construction of trust in its effectiveness. Therefore, widespread confusion about the scientific validation of homeopathy may be among the main factors driving its successful extension as a practice.

Understanding the factors associated with vaccine scepticism is challenging because of the 'small-pockets' problem: The number of highly vaccine-sceptical people is low, and small subsamples such as these can be missed using traditional regression approaches. To overcome this problem, the current study (N = 5,200) used latent profile analysis to uncover six profiles, including two micro-communities of vaccine-sceptical people who have the potential to jeopardize vaccine-led herd immunity. The most vaccine-sceptical group (1.14%) was highly educated and expressed strong liberal tendencies. This group was also the most sceptical about genetically modified crops and nuclear energy, and most likely to receive news about science from the Internet. The second-most vaccinesceptical group (3.4%) was young, poorly educated, and politically extreme (both left and right). In resolving the small-pockets problem, the current analyses also help reconcile competing theoretical perspectives about the role of education and political ideology in shaping anti-vaccination views.Vaccines are one of the most effective population health interventions in history (Ehreth, 2003;Plotkin, 2014). Unsurprisingly, then, the majority of the public views vaccines positively (Larson, de Figueiredo, Karafillakis, & Rawal, 2018). However, it only takes a small proportion of the population to not vaccinate to undermine herd immunity and trigger public health crises. This is why anti-vaccination movements arouse so much concern, even though there are relatively few anti-vaccination advocates. Indeed, in 2019 the World Health Organization listed vaccine hesitancy as one of the top 10 threats to global health in 2019 (WHO, 2019). This urgency has intensified since, as evidence mounts of fear and resistance towards COVID-19 vaccines (Rigby, 2020;Roozenbeek et al., 2020).Gaining a nuanced, quantitative understanding of the factors associated with antivaccination attitudes is challenging because of what we refer to here as the 'small-pockets' problem: The number of people with strong anti-vaccination attitudes represents a small

Recent studies suggest that new parties display new patterns of digital mobilization. We shed light on this debate: do new party supporters engage in online political activities to a greater extent during electoral campaigns? Do they share political images or quotes on social media, participate in political forums, or exchange political messages with their friends more often than supporters of traditional parties? No. Drawing on a post-electoral survey dataset in Spain, we find that offline extra-institutional political activities are key predictors of the level of online political engagement. Even in the context of a polarized electoral campaign and the emergence of new electoral forces such as Podemos, extrainstitutional political participation drives digital activism to the detriment of institutional variables, such as turnout or partisan preferences. Thus, all parties depend on extrainstitutional activists to boost their online campaigns. Since grassroots activists increasingly influence the communicative strategy of all political parties, we interpret this process within a long-term digital-based post-material transformation of the political culture, with major implications for partisan organization, mobilization, and polarization in many democracies. We contend that the overrepresentation of grassroots activists in producing and disseminating political content in social media may have favored an increase of the visibility and public support of political outsiders in several countries.