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Khalid A, Naidu J, Turin TC. "It's not just about you": International students' vulnerabilities and capacities during the first phase of the COVID-19 pandemic in Canada. PLoS One 2024; 19:e0311514. [PMID: 39361677 PMCID: PMC11449335 DOI: 10.1371/journal.pone.0311514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 09/19/2024] [Indexed: 10/05/2024] Open
Abstract
In Canada, the COVID-19 pandemic was initially characterized by emergency government responses that disrupted daily life, especially for marginalized groups. This study explored the vulnerabilities and capacities of international students studying at a university in Calgary, Canada during the first phase of the pandemic. Guided by the Capacities and Vulnerabilities Analysis framework, we thematically analyzed 11 semi-structured interviews with international students. We found that material vulnerabilities included balancing finances, housing conditions, lack of information, food inaccessibility, reliance on public transport, and poor mental health, social vulnerabilities included lack of social support, culture shock, and racism, and attitudinal vulnerabilities included "nowhere to go", feeling like a burden, and perception of Canada as safe. Material capacities included financial support, knowledge about pandemic, and mental health supports, social capacities included local social support and multilingualism, and attitudinal capacities included resilience, religious and spiritual beliefs, "it's not just about you", and reflexivity. We found overlapping and complex relationships between vulnerabilities and capacities, indicating that while international students' vulnerabilities were exacerbated and introduced challenges during the pandemic, students uniquely leveraged their capacities to offset and recover from challenges. Findings from this study may be informative for stakeholders involved in disaster responses, especially universities and governments, to support international students' capacities and address their vulnerabilities.
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Affiliation(s)
- Ayisha Khalid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Naidu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir C. Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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History Repeating-How Pandemics Collide with Health Disparities in the United States. J Racial Ethn Health Disparities 2022; 10:1455-1465. [PMID: 35595916 PMCID: PMC9122254 DOI: 10.1007/s40615-022-01331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
Across the United States, public health responses to the COVID-19 pandemic have fallen short. COVID-19 has exacerbated longstanding public health shortfalls in disadvantaged communities. Was this predestined? Understanding where we are today requires reflection on our longer journey. Disparities cataloged during COVID-19 reflect the same unequal host exposure and susceptibility risks that shaped previous pandemics. In this review, we provide historical context to better understand current events and to showcase forgotten lessons which may motivate future action to protect our most vulnerable citizens.
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3
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White S, Mutula AC, Buroko MM, Heath T, Mazimwe FK, Blanchet K, Curtis V, Dreibelbis R. How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo. PLoS One 2022; 17:e0266849. [PMID: 35413080 PMCID: PMC9004767 DOI: 10.1371/journal.pone.0266849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour. Methods Cholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households. Results Cholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control. Conclusions Even though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.
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Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Anna C. Mutula
- Independent Consultant, Goma, Democratic Republic of the Congo
| | | | | | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
| | - Val Curtis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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4
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Granade CJ, Lindley MC, Jatlaoui T, Asif AF, Jones-Jack N. Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence. Health Equity 2022; 6:206-223. [PMID: 35402775 PMCID: PMC8985539 DOI: 10.1089/heq.2021.0177] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations. Objective To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination. Search Methods We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles. Selection Criteria Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question. Data Collection and Analysis Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies. Results Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality). Conclusions A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amimah F. Asif
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Atlanta, Georgia, USA
| | - Nkenge Jones-Jack
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Kondo KK, Williams BE, Ayers CK, Kansagara D, Smith M, Advani SM, Young S, Saha S. Factors Associated with Health Inequalities in Infectious Disease Pandemics Predating COVID-19 in the United States: A Systematic Review. Health Equity 2022; 6:254-269. [PMID: 35402773 PMCID: PMC8985532 DOI: 10.1089/heq.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Previous pandemics may offer evidence on mediating factors that contributed to disparities in infection and poor outcomes, which could inform the effort to mitigate potential unequal outcomes during the current COVID-19 pandemic. This systematic review sought to examine those factors. Methods We searched MEDLINE, PsycINFO, and Cochrane to May 2020. We included studies examining health disparities in adult U.S. populations during infectious disease epidemics or pandemics. Two investigators screened abstracts and full text. We assessed study quality using the Newcastle/Ottawa Scale or the Critical Appraisal Skills Programme Checklist for Qualitative Studies. Results Sixteen articles were included, of which 14 focused on health disparities during the 2009 H1N1 influenza pandemic. Studies showed that disparities during the H1N1 pandemic were more related to differential exposure to the virus than to susceptibility or access to care. Overall, pandemic-related disparities emanate primarily from inequalities in social conditions that place racial and ethnic minorities and low socioeconomic status populations at greater risk of exposure and infection, rather than individual-level factors such as health behaviors and comorbidities. Conclusions Policy- and systems-level interventions should acknowledge and address these social determinants of heightened risk, and future research should evaluate the effects of such interventions to avoid further exacerbation of health inequities during the current and future pandemics.
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Affiliation(s)
- Karli K. Kondo
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Research Integrity, Oregon Health & Science University, Portland, Oregon, USA
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
| | - Beth E. Williams
- Department of Primary Care, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Chelsea K. Ayers
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Devan Kansagara
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Research Integrity, Oregon Health & Science University, Portland, Oregon, USA
| | - Mia Smith
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Shailesh M. Advani
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Sarah Young
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
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6
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Hou Q, Zhao Y, Su X, Rong R, Situ S, Cui Y. Using Sina-Weibo microblogs to inform the development and dissemination of health awareness material about Zika virus transmission, China, 2016–17. PLoS One 2022; 17:e0261602. [PMID: 35085257 PMCID: PMC8794198 DOI: 10.1371/journal.pone.0261602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background
On 1 February 2016, the World Health Organization declared Zika transmission a public health emergency of international concern. Monitoring and responding to community awareness, concern, and possible knowledge gaps are critical during public health emergencies. Here, we describe the review and analysis of micro-blogs posted on Sina-Weibo, China’s largest social media platform, to develop and disseminate a Zika virus education campaign.
Methods
We used CYYUN Voice Express’ Weibo Spider tool and the search terms of "Zhaika" OR "Zika" OR "Zikv” to capture microblogs about Zika virus retrospectively from February 1 to December 31, 2016 and prospectively from June 1 to November 15, 2017. We described microblogs meeting our inclusion criteria by month and Zika virus outbreaks in Asia and by source (e.g., government agency, individual, or other). We identified common misleading or inaccurate content authored by individual micro-bloggers (i.e., not supported by available scientific evidence) through a qualitative review. We used this information to develop and disseminate health awareness material about the Zika virus through China CDC’s 12320 Health Hotline Weibo account. An online survey was conducted to obtain feedback on the material.
Results
We captured 15,888 microblogs meeting our inclusion criteria. Zika-related microblogs peaked in September 2016, corresponding to news reports about the Zika outbreak in Singapore (August to November 2016). Most microblogs (12,994 [82%]) were authored by individual users, followed by media agencies (842 [5%]), businesses (829 [5%]), international organizations (370 [2%]), and Chinese government agencies (235 [1%]). Relevant microblogs primarily focused on clinical symptoms and health risks, modes of transmission, and actions taken by individuals to prevent infection and seek health care. Incorrect and/or mis-leading information from individual users concentrated on modes of transmission and possible treatments. The microblog "#Zika is that far and this close" health campaign was posted on Sina-Weibo and Baidu (Internet search engine in China) on September 18, 2016. Younger respondents (p-value = 0.01), and those with at least a college education (p-value = 0.03), were more likely than other respondents to consider the online campaign reliable and trustworthy.
Conclusion
Routine review of Sina-Weibo and other social media platforms could enhance the ability of public health staff to effectively respond to community concerns and awareness during public health emergencies. Advancements of social media monitoring tools and staff training could help to promote health awareness during emergencies by directly addressing public perceptions and concerns. Various approaches may be needed to reach different at-risk populations, particularly older and less educated populations who may prefer more traditional modes of communication.
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Affiliation(s)
- Qian Hou
- Health Communication Center (Health Hotline Management Office), China Centers for Disease Control and Prevention, Beijing, China
| | - Yueqiao Zhao
- Health Communication Center (Health Hotline Management Office), China Centers for Disease Control and Prevention, Beijing, China
| | - Xiaoge Su
- Health Communication Center (Health Hotline Management Office), China Centers for Disease Control and Prevention, Beijing, China
| | - Rong Rong
- Health Communication Center (Health Hotline Management Office), China Centers for Disease Control and Prevention, Beijing, China
| | - Sujian Situ
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China
| | - Ying Cui
- Health Communication Center (Health Hotline Management Office), China Centers for Disease Control and Prevention, Beijing, China
- * E-mail:
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Sood N, Nasserie T, Joshi S, Bendavid E. Shifting the Demand for Vaccines: A Review of Strategies. Annu Rev Public Health 2022; 43:541-557. [PMID: 35081316 DOI: 10.1146/annurev-publhealth-052620-093049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vaccines prevent millions of deaths, and yet millions of people die each year from vaccine-preventable diseases. The primary reason for these deaths is that a significant fraction of the population chooses not to vaccinate. Why don't people vaccinate, and what can be done to increase vaccination rates besides providing free and easy access to vaccines? This review presents a conceptual framework, motivated by economic theory, of which factors shift the demand for vaccines. Next, it critically examines the literature on these demand shifters and interventions that target these demand shifters. The review concludes with offering directions for future research and lessons for public health decision-making. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Neeraj Sood
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA; .,Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA;
| | - Tahmina Nasserie
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA;
| | - Sushant Joshi
- Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA;
| | - Eran Bendavid
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA;
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8
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Paramanathan P, Abbas M, Huda SA, Huda S, Mortazavi M, Taravati P. Comparing racial health disparities in pandemics a decade apart: H1N1 and COVID-19. Future Healthc J 2021. [PMID: 34888475 DOI: 10.7861/fhj.2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background and aims The Centers for Disease Control and Prevention has reported disproportionate health disparities with respect to disease for Blacks/African Americans (AAs) compared to Whites in the USA. In this paper, we identify and compare the factors involved in creating these disparities among these populations during the 2009 H1N1 and current COVID-19 pandemics. Methods We included studies describing health disparities towards Blacks/AAs in the USA during the H1N1 and COVID-19 pandemics. Only observational empirical studies with free full-text availability in English from PubMed, PubMed Central and Google Scholar were included. Results A total of 31 papers were included: 19 pertaining to the H1N1 pandemic and 12 to the COVID-19 pandemic. Qualitative analysis for health disparities resulted in 43 different factors, which were subdivided into nine overarching themes. Discussion The similarities that exist between the two pandemics indicate that there are many neglected issues in American healthcare that need to be addressed. The listed factors have led to disparities in screening and treating for disease resulting in disparities in infection rates, severity of illness and mortality. This calls for a change in healthcare dynamics to improve access to healthcare, remove any form of possible discrimination, and regain the lost trust with the Black/AA communities, repairing historical damage. Conclusions Effective utilisation of social media and faith-based centres to educate patients, implementation of new policies improving access to healthcare, and culture-sensitive education for healthcare providers are suggested to decrease health disparities and improve health outcomes across the USA.
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Affiliation(s)
- Prathayini Paramanathan
- All Saints University College of Medicine, Saint Vincent and the Grenadines, and clinical research coordinator, McMaster University, Canada
| | | | - Sajjad Ali Huda
- Avalon University School of Medicine, Curacao, and Canadian pharmacist, Kingston University, London, UK
| | | | | | - Parastoo Taravati
- Saint James School of Medicine, Saint Vincent and the Grenadines, and public health extern, Illinois Academy of Family Physicians, Chicago, USA
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Paramanathan P, Abbas M, Huda SA, Huda S, Mortazavi M, Taravati P. Comparing racial health disparities in pandemics a decade apart: H1N1 and COVID-19. Future Healthc J 2021; 8:e722-e728. [PMID: 34888475 PMCID: PMC8651308 DOI: 10.7861/fhj.2021.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The Centers for Disease Control and Prevention has reported disproportionate health disparities with respect to disease for Blacks/African Americans (AAs) compared to Whites in the USA. In this paper, we identify and compare the factors involved in creating these disparities among these populations during the 2009 H1N1 and current COVID-19 pandemics. METHODS We included studies describing health disparities towards Blacks/AAs in the USA during the H1N1 and COVID-19 pandemics. Only observational empirical studies with free full-text availability in English from PubMed, PubMed Central and Google Scholar were included. RESULTS A total of 31 papers were included: 19 pertaining to the H1N1 pandemic and 12 to the COVID-19 pandemic. Qualitative analysis for health disparities resulted in 43 different factors, which were subdivided into nine overarching themes. DISCUSSION The similarities that exist between the two pandemics indicate that there are many neglected issues in American healthcare that need to be addressed. The listed factors have led to disparities in screening and treating for disease resulting in disparities in infection rates, severity of illness and mortality. This calls for a change in healthcare dynamics to improve access to healthcare, remove any form of possible discrimination, and regain the lost trust with the Black/AA communities, repairing historical damage. CONCLUSIONS Effective utilisation of social media and faith-based centres to educate patients, implementation of new policies improving access to healthcare, and culture-sensitive education for healthcare providers are suggested to decrease health disparities and improve health outcomes across the USA.
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Affiliation(s)
- Prathayini Paramanathan
- All Saints University College of Medicine, Saint Vincent and the Grenadines, and clinical research coordinator, McMaster University, Canada
| | | | - Sajjad Ali Huda
- Avalon University School of Medicine, Curacao, and Canadian pharmacist, Kingston University, London, UK
| | | | | | - Parastoo Taravati
- Saint James School of Medicine, Saint Vincent and the Grenadines, and public health extern, Illinois Academy of Family Physicians, Chicago, USA
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10
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Hanratty J, Bradley DT, Miller SJ, Dempster M. Determinants of health behaviours intended to prevent spread of respiratory pathogens that have pandemic potential: A rapid review. Acta Psychol (Amst) 2021; 220:103423. [PMID: 34624664 PMCID: PMC8492069 DOI: 10.1016/j.actpsy.2021.103423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours. This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way. A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing. The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.
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Affiliation(s)
- Jennifer Hanratty
- School of Psychology, Queen's University Belfast, University Road, Belfast BT7 1NN, UK
| | - Declan T Bradley
- Centre for Public Health, Queen's University Belfast, University Road, Belfast BT7 1NN, UK
| | - Sarah J Miller
- School of Social Sciences, Education and Social Work, Queen's University Belfast, University Road, Belfast BT7 1NN, UK
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, University Road, Belfast BT7 1NN, UK.
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11
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Bazan IS, Akgün KM. COVID-19 Healthcare Inequity: Lessons Learned from Annual Influenza Vaccination Rates to Mitigate COVID-19 Vaccine Disparities. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:509-515. [PMID: 34602888 PMCID: PMC8461587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The COVID-19 pandemic has infected 33 million Americans and resulted in more than 600,000 deaths as of late Spring 2021. Black, Indigenous, and Latinx (BIL) people are disproportionately infected, hospitalized, and dying. Effective vaccines were rapidly developed and have been widely available in the United States since their initial rollout in late 2020-early 2021 but vaccination rates in BIL communities have remained low compared with non-BIL communities. Limited access to the vaccine, lack of customized information, and mistrust of the medical system, all contribute to vaccine hesitancy and low vaccination rates. Regrettably, COVID-19 is not the only vaccine-preventable illness with racial/ethnic inequities. Similar inequities are seen with the seasonal influenza vaccine. We review the racial/ethnic health disparities in COVID-19 illness and vaccination rates and what inequities contribute to these disparities. We use evidence from the seasonal influenza vaccination efforts to inform potential strategies to attenuate these inequities. The development of effective and sustainable strategies to improve vaccination rates and reduce factors that result in health inequities is essential in managing current and future pandemics and promoting improved health for all communities.
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Affiliation(s)
- Isabel S. Bazan
- Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Akgün
- Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
- Pulmonary, Critical Care and Sleep Medicine, VA
Connecticut Healthcare System, West Haven, CT, USA
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12
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Ayers CK, Kondo KK, Williams BE, Kansagara D, Advani SM, Smith M, Young S, Saha S. Disparities in H1N1 Vaccination Rates: a Systematic Review and Evidence Synthesis to Inform COVID-19 Vaccination Efforts. J Gen Intern Med 2021; 36:1734-1745. [PMID: 33791935 PMCID: PMC8011776 DOI: 10.1007/s11606-021-06715-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data suggest that there were disparities in H1N1 vaccine uptake, and these may inform COVID-19 vaccination efforts. We conducted a systematic review to evaluate disparities in H1N1 vaccine uptake, factors contributing to disparities, and interventions to reduce them. METHODS We searched English-language articles in MEDLINE ALL, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from database inception through May 8, 2020. Observational studies examining H1N1 vaccine uptake by race/ethnicity, socioeconomic status, rurality, and disability status in US settings were included. Two reviewers independently assessed study eligibility. Single-reviewer data abstraction was confirmed by a second reviewer. We conducted independent dual quality assessment, and collective strength of evidence assessment. RESULTS We included 21 studies. African American/Black, Latino, and low-socioeconomic status participants had disproportionately lower H1N1 vaccination rates (low- to moderate-strength evidence). However, Latinos were more likely than Whites to intend to be vaccinated, and African American/Blacks and participants with lower-socioeconomic status were just as likely to intend to be vaccinated as their White and higher-socioeconomic status counterparts (low-strength evidence). Vaccine uptake for other groups has been insufficiently studied. Factors potentially contributing to disparities in vaccine uptake included barriers to vaccine access, inadequate information, and concerns about vaccine safety and efficacy. Studies were largely cross-sectional. Many of the studies are a decade old and were conducted in the context of a different pandemic. The categorization of racial and ethnic groups was not consistent across studies and not all groups were well-studied. DISCUSSION Efforts to avoid disparities in COVID-19 vaccination uptake should prioritize vaccine accessibility and convenience in African American/Black, Latino, and low-SES communities; engage trusted stakeholders to share vaccine information; and address concerns about vaccine safety and efficacy. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. PROTOCOL REGISTRATION PROSPERO CRD42020187078.
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Affiliation(s)
- Chelsea K Ayers
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
| | - Karli K Kondo
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Beth E Williams
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Devan Kansagara
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Shailesh M Advani
- Georgetown University, Washington, DC, USA
- Social Epidemiology Research Unit, Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mia Smith
- Oregon Health Authority, Portland, OR, USA
| | - Sarah Young
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Somnath Saha
- VA Evidence Synthesis Program, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
- Oregon Health & Science University, Portland, OR, USA
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13
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Public Response, Anxiety and Behaviour during the First Wave of COVID-19 Pandemic in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094628. [PMID: 33925408 PMCID: PMC8123873 DOI: 10.3390/ijerph18094628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
This study aims to investigate public response attitude, anxiety, practices and trust in the authorities' mitigation plan during the first wave of COVID-19 pandemic. A national cross sectional phone survey was conducted among Saudi residents aged 16 years and above. A total of 90,421 (45.2%) individuals participated in the study. Of those, the overall rate of COVID-19 correct knowledge was 82% (mean: 9.84); social media was the most reported source of knowledge. Younger age, low levels of education and foreign residents were associated with poor knowledge. Overall, 49.5% scored 5 or more on the GAD-7 test, indicating anxiety symptoms, 19.2% of them scored 10 and above, suggesting moderate to severe anxiety. Majority of participants (>78%) trusted and supported the interventions implemented by the government to control COVID-19. Social distancing practices among participants was as following, 72.5% stayed at home and avoid going out for nonessential business and 49.5% avoided attending social events and family gatherings. Trust in authorities, being anxious, worry and levels of knowledge about the disease, were the most common factors affecting adoption of the recommended practices. Continuous evaluation of public response about COVID-19, and the effectiveness of protective measures is essential to better inform policy-makers and identify ways of encouraging behaviour change among public during pandemic.
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Baral P. Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:474-493. [DOI: 10.1177/0020731421997088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This rapid scoping review has informed the development of the November 2020 United Nations Research Roadmap for the COVID-19 Recovery, by providing a synthesis of available evidence on the impact of pandemics and epidemics on (1) essential services and (2) health systems preparedness and strengthening. Emerging findings point to existing disparities in health systems and services being further exacerbated, with marginalized populations and low- and middle-income countries burdened disproportionately. More broadly, there is a need to further understand short- and long-term impacts of bypassed essential services, quality assurance of services, the role of primary health care in the frontline, and the need for additional mechanisms for effective vaccine messaging and uptake during epidemics. The review also highlights how trust—of institutions, of science, and between communities and health systems—remains central to a successful pandemic response. Finally, previous crises had repeatedly foreshadowed the inability of health systems to handle upcoming pandemics, yet the reactive nature of policies and practices compounded by lack of resources, infrastructure, and political will have resulted in the current failed response to COVID-19. There is therefore an urgent need for investments in implementation science and for strategies to bridge this persistent research–practice gap.
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Affiliation(s)
- Prativa Baral
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Miller LMS, Gee PM, Katz RA. The Importance of Understanding COVID-19: The Role of Knowledge in Promoting Adherence to Protective Behaviors. Front Public Health 2021; 9:581497. [PMID: 33889557 PMCID: PMC8055953 DOI: 10.3389/fpubh.2021.581497] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Past research suggests that knowledge supports- but strong illness expectations thwart- adoption of protective behaviors (e.g., handwashing). Strong illness expectations may place COVID-19 essential workers at risk. It is unclear, however, whether knowledge can moderate the negative effects of pessimistic illness expectations on protective behaviors. We test COVID-19 knowledge as a moderator of the effects of (1) pessimistic illness expectations and (2) essential worker status on adherence to protective behaviors. Methods: Participants (n = 350) completed measures of knowledge, illness expectations, and protective behaviors. We used chi-square tests to examine associations between variables and logistic regressions to test the moderation models predicting adherence (low, high) while controlling for demographics. Results: Knowledge, illness expectations, and adherence were significantly associated with each other (p < 0.05). Essential workers had stronger illness expectations and lower knowledge than did non-essential workers (p < 0.001). Logistic regressions showed a non-significant Worker Status × Knowledge interaction (p = 0.59) but a significant Knowledge × Illness Expectations interaction (p < 0.05) indicating that those with strong illness expectations and low knowledge were disproportionately at risk of failing to adhere to recommended behaviors. Conclusions: Knowledge promotes protective behaviors by buffering the negative effects of pessimistic illness expectations. Essential workers are more likely to have low levels of knowledge with strong illness expectations, suggesting that educational policies may be warranted.
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Affiliation(s)
| | - Perry M. Gee
- Intermountain Healthcare, Clinical Operations, Salt Lake City, UT, United States
| | - Rachael A. Katz
- Intermountain Healthcare, Clinical Operations, Salt Lake City, UT, United States
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16
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Barrett C, Cheung KL. Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students. BMC Public Health 2021; 21:426. [PMID: 33648486 PMCID: PMC7919985 DOI: 10.1186/s12889-021-10461-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students. METHODS A cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour. RESULTS Participants reported high levels of social distancing with 88.9% answering "Mostly" or "Always" for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p = 0.001) and time factors (β = 0.28, p = 0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = - 0.13, p = 0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p < 0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = - 0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance. CONCLUSIONS This study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.
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Affiliation(s)
- Christine Barrett
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Kei Long Cheung
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
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17
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Den Daas C, Hubbard G, Johnston M, Dixon D. Protocol of the COVID-19 Health and Adherence Research in Scotland (CHARIS) study: understanding changes in adherence to transmission-reducing behaviours, mental and general health, in repeated cross-sectional representative survey of the Scottish population. BMJ Open 2021; 11:e044135. [PMID: 33602711 PMCID: PMC7896376 DOI: 10.1136/bmjopen-2020-044135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 has unprecedented consequences on population health, with governments worldwide issuing stringent public health directives. In the absence of a vaccine, a key way to control the pandemic is through behavioural change: people adhering to transmission-reducing behaviours (TRBs), such as physical distancing, hand washing and wearing face covering. Non-adherence may be explained by theories of how people think about the illness (the common-sense model of self-regulation) and/or how they think about the TRBs (social cognition theory and protection motivation theory). In addition, outbreaks of infectious diseases and the measures employed to curb them are likely to have detrimental effects on people's mental and general health. Therefore, in representative repeated surveys, we will apply behavioural theories to model adherence to TRBs and the effects on mental and general health in the Scottish population from June to November 2020, following the initial outbreak of COVID-19. METHODS AND ANALYSIS Repeated 20 min structured telephone surveys will be conducted with nationally representative random samples of 500 adults in Scotland. The first 6 weeks the survey will be conducted weekly, thereafter fortnightly, for a total of 14 waves (total n=7000). Ipsos MORI will recruit participants through random digit dialling. The core survey will measure the primary outcomes of adherence to TRBs, mental and general health, and explanatory variables from the theories. Further questions will be added, enabling more detailed measurement of constructs in the core survey, additional themes and questions that align with the evolving pandemic. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Life Sciences and Medicine College Ethics Review Board (CERB) at the University of Aberdeen (CERB/2020/5/1942). Results will be made available to policy makers, funders, interested lay people and other researchers through weekly reports and three bimonthly bulletins placed on the CHARIS website and advertised through social media.
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Affiliation(s)
- Chantal Den Daas
- Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK
| | - Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK
| | - Diane Dixon
- Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK
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18
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Hygienic Risk Exposures Across Ethnic Groups in Rural Areas of Guangxi, China: Prevalence, Associated Factors, and Perceptions of Policy. J Racial Ethn Health Disparities 2020; 8:1054-1066. [PMID: 32948950 DOI: 10.1007/s40615-020-00862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Controlling hygienic risk exposures (HREs) is important for reducing acute respiratory infection or parasitic infection; however, studies across vulnerable ethnicities are limited. This study aimed to identify the prevalence and associated factors of HREs and perception on HRE policies among ethnic groups in Guangxi, China. METHODS A community-based cross-sectional study was conducted in rural areas of Guangxi, China, among Han majority and Zhuang, Yao, Miao, Dong, Mulao, and Maonan minorities. The prevalence of HREs and perceptions concerning the HRE policies were presented using descriptive statistics. Associated factors were analyzed using a logistic regression model, and adjusted prevalence ratios and 95% confidence interval were calculated. RESULTS High prevalence of HREs on hand and soil hygiene were found in all ethnicities. Miao minority had the highest prevalence of HREs, particularly in poor hand washing (74.1%), infrequent nail clipping (90.4%), and outdoor soil contact (92.7%), compared with the others. Prevalence of HREs in some ethnic minority groups were significantly different from those in Han majority after adjusted with other significant factors. Village leaders were more aware of existing national and community regulations related to HREs than household heads. Village leaders and household heads of almost all ethnic groups perceived high policy's compliance in their village or household on avoiding fertilizing with farmyard manure. CONCLUSIONS HREs were prevalent in all ethnic groups, especially in Miao minority. Ethnicity, one of social determinants, was significantly associated with HREs. Raising awareness at both the village and household levels on HREs is needed for all ethnic groups.
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Srivastav A, Santibanez TA, Lu PJ, Stringer MC, Dever JA, Bostwick M, Kurtz MS, Qualls NL, Williams WW. Preventive behaviors adults report using to avoid catching or spreading influenza, United States, 2015-16 influenza season. PLoS One 2018; 13:e0195085. [PMID: 29601610 PMCID: PMC5877873 DOI: 10.1371/journal.pone.0195085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 03/16/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Influenza vaccination can prevent influenza and potentially serious influenza-related complications. Although the single best way to prevent influenza is annual vaccination, everyday preventive actions, including good hygiene, health, dietary, and social habits, might help, too. Several preventive measures are recommended, including: avoiding close contact with people who are sick; staying home when sick; covering your mouth and nose when coughing or sneezing; washing your hands often; avoiding touching your eyes, nose, and mouth; and practicing other good health habits like cleaning and disinfecting frequently touched surfaces, getting plenty of sleep, and drinking plenty of fluids. Understanding public acceptance and current usage of these preventive behaviors can be useful for planning both seasonal and pandemic influenza prevention campaigns. This study estimated the percentage of adults in the United States who reported practicing preventive behaviors to avoid catching or spreading influenza, and explored associations of reported behaviors with sociodemographic factors. METHODS We analyzed data from 2015 National Internet Flu Survey, a nationally representative probability-based Internet panel survey of the non-institutionalized U.S. population ≥18 years. The self-reported behaviors used to avoid catching or spreading influenza were grouped into four and three non-mutually exclusive subgroups, respectively. Weighted proportions were calculated. Multivariable logistic regression models were used to calculate adjusted prevalence differences and to determine independent associations between sociodemographic characteristics and preventive behavior subgroups. RESULTS Common preventive behaviors reported were: 83.2% wash hands often, 80.0% cover coughs and sneezes, 78.2% stay home if sick with a respiratory illness, 64.4% avoid people sick with a respiratory illness, 51.7% use hand sanitizers, 50.2% get treatment as soon as possible, and 49.8% report getting the influenza vaccination. Race/ethnicity, gender, age, education, income, region, receipt of influenza vaccination, and household size were associated with use of preventive behaviors after controlling for other factors. CONCLUSION Many adults in the United States reported using preventive behaviors to avoid catching or spreading influenza. Though vaccination is the most important tool available to prevent influenza, the addition of preventive behaviors might play an effective role in reducing or slowing transmission of influenza and complement prevention efforts.
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Affiliation(s)
- Anup Srivastav
- Leidos Inc, Atlanta, Georgia, United States of America
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Tammy A. Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - M. Christopher Stringer
- Demographic Statistical Methods Division, U.S. Census Bureau, Durham, North Carolina, United States of America
| | - Jill A. Dever
- Division for Statistical and Data Sciences, RTI International, Washington, D.C., United States of America
| | - Michael Bostwick
- Statistics and Operation Research, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Marshica Stanley Kurtz
- Statistics and Operation Research, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Noreen L. Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Walter W. Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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20
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Shamarina D, Stoyantcheva I, Mason CE, Bibby K, Elhaik E. Communicating the promise, risks, and ethics of large-scale, open space microbiome and metagenome research. MICROBIOME 2017; 5:132. [PMID: 28978331 PMCID: PMC5628477 DOI: 10.1186/s40168-017-0349-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/20/2017] [Indexed: 05/07/2023]
Abstract
The public commonly associates microorganisms with pathogens. This suspicion of microorganisms is understandable, as historically microorganisms have killed more humans than any other agent while remaining largely unknown until the late seventeenth century with the works of van Leeuwenhoek and Kircher. Despite our improved understanding regarding microorganisms, the general public are apt to think of diseases rather than of the majority of harmless or beneficial species that inhabit our bodies and the built and natural environment. As long as microbiome research was confined to labs, the public's exposure to microbiology was limited. The recent launch of global microbiome surveys, such as the Earth Microbiome Project and MetaSUB (Metagenomics and Metadesign of Subways and Urban Biomes) project, has raised ethical, financial, feasibility, and sustainability concerns as to the public's level of understanding and potential reaction to the findings, which, done improperly, risk negative implications for ongoing and future investigations, but done correctly, can facilitate a new vision of "smart cities." To facilitate improved future research, we describe here the major concerns that our discussions with ethics committees, community leaders, and government officials have raised, and we expound on how to address them. We further discuss ethical considerations of microbiome surveys and provide practical recommendations for public engagement.
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Affiliation(s)
- Daria Shamarina
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, S10 2TN UK
| | - Iana Stoyantcheva
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, S10 2TN UK
| | - Christopher E. Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021 USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, New York, NY 10021 USA
- The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10021 USA
| | - Kyle Bibby
- University of Notre Dame Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, Notre Dameᅟ, IN 46556 USA
| | - Eran Elhaik
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, S10 2TN UK
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21
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Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017. [PMID: 28426646 DOI: 10.15585/mmwr.rr6601a1externalicon] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
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Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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22
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Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A. Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. MMWR Recomm Rep 2017; 66:1-34. [PMID: 28426646 PMCID: PMC5837128 DOI: 10.15585/mmwr.rr6601a1] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
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Affiliation(s)
- Noreen Qualls
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | - Neha Kanade
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Eagle Medical Services, San Antonio, Texas
| | - Narue Wright-Jegede
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.,Karna, Atlanta, Georgia
| | - Stephanie Dopson
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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23
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Tuohetamu S, Pang M, Nuer X, Mahemuti, Mohemaiti P, Qin Y, Peng Z, Zheng J, Yu H, Feng L, Feng Z. The knowledge, attitudes and practices on influenza among medical college students in Northwest China. Hum Vaccin Immunother 2017; 13:1688-1692. [PMID: 28362546 DOI: 10.1080/21645515.2017.1293769] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objective This study aimed to understand the knowledge, attitudes and practices (KAP) on seasonal influenza among medical college students in a low-income multiethnic society. Methods A cross-sectional questionnaire survey collected information of KAP related to influenza. A knowledge score was calculated according to the total number of correct points out of 9 questions. Logistic regression was used to identify factors associated with influenza vaccine uptake. Results 856 valid questionnaires were obtained. The average knowledge score was 14.8 ± 3.1 out of 22 correct points. Han Chinese got higher score than minorities (p < 0.001). Knowledge score increased with grade (p < 0.001). Students majoring in pharmacy had lower score than others. Questions on mode of transmission, symptoms, precautions, high risk groups and vaccination schedule had a correct rate lower than 50%. Hand hygiene was practiced by less than 40% of students after touching objects in public areas or sneezing. The proportion of participants received influenza vaccine in the past 3 y was 4.1%, 9.2% and 6.1% respectively. Willingness to receive free vaccine (OR = 2.49, 95% CI 1.31∼4.28), and awareness of the vaccine effectiveness (OR = 1.67, 95% CI 1.08∼2.56) were significantly associated with vaccine uptake, while the general knowledge about influenza, perceived susceptibility and severity, and demographic factors were not. The top 3 reasons for not being vaccinated were poor knowledge of the vaccine (46%), no perceived need due to good health (45%) and worry about adverse reactions (33%). Conclusion Health education is needed to improve the awareness of basic facts about influenza and vaccine, and more attention should be paid to minority groups. The coverage of seasonal influenza vaccine is quite low. Besides individual level behavior change, social and structural factors should be considered to increase the uptake of influenza vaccine.
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Affiliation(s)
- Shabiremu Tuohetamu
- a Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention , Urumqi , China
| | - Mingfan Pang
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | | | - Mahemuti
- a Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention , Urumqi , China
| | - Patamu Mohemaiti
- d School of Public Health, Xinjiang Medical University , Urumqi , China
| | - Ying Qin
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Zhibin Peng
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Jiandong Zheng
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Hongjie Yu
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Luzhao Feng
- b Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Zijian Feng
- e Office of the Director, Chinese Center for Disease Control and Prevention , Beijing , China
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Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016. PLoS One 2017; 12:e0170550. [PMID: 28125629 PMCID: PMC5268454 DOI: 10.1371/journal.pone.0170550] [Citation(s) in RCA: 748] [Impact Index Per Article: 106.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/06/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake. OBJECTIVE This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area. METHODS Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination. RESULTS Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups. CONCLUSION Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.
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Affiliation(s)
- Philipp Schmid
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Dorothee Rauber
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Gianni Lidolt
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Marie-Luisa Denker
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
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Moran KR, Del Valle SY. A Meta-Analysis of the Association between Gender and Protective Behaviors in Response to Respiratory Epidemics and Pandemics. PLoS One 2016; 11:e0164541. [PMID: 27768704 PMCID: PMC5074573 DOI: 10.1371/journal.pone.0164541] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022] Open
Abstract
Respiratory infectious disease epidemics and pandemics are recurring events that levy a high cost on individuals and society. The health-protective behavioral response of the public plays an important role in limiting respiratory infectious disease spread. Health-protective behaviors take several forms. Behaviors can be categorized as pharmaceutical (e.g., vaccination uptake, antiviral use) or non-pharmaceutical (e.g., hand washing, face mask use, avoidance of public transport). Due to the limitations of pharmaceutical interventions during respiratory epidemics and pandemics, public health campaigns aimed at limiting disease spread often emphasize both non-pharmaceutical and pharmaceutical behavioral interventions. Understanding the determinants of the public’s behavioral response is crucial for devising public health campaigns, providing information to parametrize mathematical models, and ultimately limiting disease spread. While other reviews have qualitatively analyzed the body of work on demographic determinants of health-protective behavior, this meta-analysis quantitatively combines the results from 85 publications to determine the global relationship between gender and health-protective behavioral response. The results show that women in the general population are about 50% more likely than men to adopt/practice non-pharmaceutical behaviors. Conversely, men in the general population are marginally (about 12%) more likely than women to adopt/practice pharmaceutical behaviors. It is possible that factors other than pharmaceutical/non-pharmaceutical status not included in this analysis act as moderators of this relationship. These results suggest an inherent difference in how men and women respond to epidemic and pandemic respiratory infectious diseases. This information can be used to target specific groups when developing non-pharmaceutical public health campaigns and to parameterize epidemic models incorporating demographic information.
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Affiliation(s)
- Kelly R. Moran
- Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- * E-mail:
| | - Sara Y. Del Valle
- Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
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Joshi A, Ocanto R, Jacobs RJ, Bhoopathi V. Florida child care center directors' intention to implement oral health promotion practices in licensed child care centers. BMC Oral Health 2016; 16:100. [PMID: 27659715 PMCID: PMC5034571 DOI: 10.1186/s12903-016-0298-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background To determine the factors associated with child care center directors’ (CCCDs) intention to implement oral health promotion practices (OHPPs) in licensed childcare centers (CCCs) within the next year, and their self-perceived barriers in successfully implementing those practices. Methods For this cross-sectional study, a pretested 45-item online survey was sent to 5142 CCCDs assessing pediatric oral health knowledge, attitudes towards oral health, intention to implement OHPPs, and self-perceived barriers to implementing OHPPs. An adjusted logistic regression model determined the factors associated with CCCDs intention to implement OHPPs within the next year. Results Participants were 877 CCCDs, with mean age of 48.5 ± 10.5 years, of whom 96 % were women, and 74 % were whites (Response rate = 19.4 %). The majority (67 %) of respondents reported that they intended to implement OHPPs in their center within a year. Insufficient funding, lack of enough training in oral health, and limited time to promote oral health were the most frequently cited barriers to implementing OHPPs. CCCDs of non-White race (p = 0.02), with a college degree or above (p = 0.05), and with positive attitudes (p < 0.0001), were more likely to report that they will implement OHPPs within the next year compared to their counterparts. Conclusions CCCDs reported fewer barriers to implementing OHPPs within the next year, indicating that CCCs can be a suitable setting to promote oral health. CCCDs race, educational status and attitudes towards oral health strongly predicted their intention to implement OHPPs. Though this study assessed the intention of CCCDs to implement OHPPs in CCCs, it did not access the actual implementation of OHPPs by them. Therefore future research could longitudinally assess predictors for true implementation of OHPPs. In addition, researchers should adopt a more comprehensive, multi-level approach to assess the actual dental health needs of children attending these centers, along with parental, staff and center level characteristics, and other relevant factors related to implementing OHPPs.
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Affiliation(s)
- Ajay Joshi
- Pediatric Dentistry Department, Indiana University School of Dentistry, 1121 W. Michigan Street, Indianapolis, IN, 46202, USA
| | - Romer Ocanto
- Department of Pediatric Dentistry, Nova Southeastern University College of Dental Medicine, 3200 S University Drive, Fort Lauderdale, FL, 33328, USA
| | - Robin J Jacobs
- Psychiatry and Behavioral Medicine, College of Osteopathic Medicine, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, FL, 33328, USA
| | - Vinodh Bhoopathi
- Department of Pediatric Dentistry and Community Oral Health Sciences, Temple University Maurice H. Kornberg School of Dentistry, 3223 N Broad Street, Philadelphia, PA, 19140, USA.
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