Contribution of communication inequalities to disparities in human papillomavirus vaccine awareness and knowledge

Socioeconomic inequalities in human papillomavirus knowledge and vaccine uptake: evidence from a cross-sectional study in China

Objective

Providing the human papillomavirus (HPV) vaccine is effective to eliminate the disparity in HPV-related cancers. It is unknown regarding inequality in the distribution of HPV vaccination in China since the vaccine was licensed and approved for use in 2016. This study aimed to examine socioeconomic inequalities in HPV-related knowledge and vaccination and identified factors associated with such inequalities.

Methods

Self-administered questionnaires measuring HPV-related knowledge and vaccine uptake were completed by 1,306 women through online survey platform. HPV knowledge was assessed using a 12-item question stem that covered the hazards of HPV infection, HPV vaccine dosage, benefits, and protection. Cluster analysis by combining monthly household income, educational level, and employment status was used to identify socioeconomic status (SES) class. The concentration index (CI) was employed as a measure of socioeconomic inequalities in HPV-related knowledge and vaccination. Linear regression and logistic regression were established to decompose the contributions of associated factors to the observed inequalities.

Results

The CI for HPV-related knowledge and vaccine uptake was 0.0442 and 0.1485, respectively, indicating the higher knowledge and vaccination rate were concentrated in groups with high SES. Education and household income made the largest contribution to these inequalities. Age, residency and cervical cancer screening were also important contributors of observed inequalities.

Conclusion

Socioeconomic inequalities in HPV-related knowledge and vaccination uptake are evident in China. Interventions to diffuse HPV-related information for disadvantaged groups are helpful to reduce these inequalities. Providing low or no-cost HPV vaccination and ensuring accessibility of vaccines in rural areas are also considered to be beneficial.

Disparities in HPV and the HPV Vaccine Knowledge Among Non-Hispanic Black Adults in the US - HINTS 2017-2020

Disparities persists in HPV awareness and vaccination among different racial and ethnic groups. We assessed disparities in awareness of HPV and the HPV vaccine among non-Hispanic Black US adults. We analyzed the nationally representative data from the Health Information National Trends Survey of US adults 18 years or older (n = 16,092) administered by the National Cancer Institute (HINTS5-Cycle 1,2,3,4) for the years 2017-2020, of which 2,011 (n = 2,011) were non-Hispanic Black adults. Weighted Poisson regression models were used to estimate disparities in HPV and HPV vaccination awareness among non-Hispanic Black US adults. In the US, 63.2% of non-Hispanic Black adults had heard of HPV and 57.6% were aware of the HPV vaccine. Black females had 1.3 and 1.5 times the prevalence of HPV and the HPV vaccine awareness compared to males (PR = 1.3; 95% CI = 1.2-1.4; P ≤ 0.001) and (PR = 1.5; 95% CI = 1.4-1.6; P ≤ 0.001) respectively. Blacks with a college education had 1.8 and 2.2 times the prevalence of HPV and HPV vaccine awareness (PR = 1.8; 95% CI = 1.4-2.4; P ≤ 0.001) and (PR = 2.2; 95% CI = 1.8-2.7; P ≤ 0.001) respectively, compared to those with less than a high school education. Compared to 2017, Black adults with ≤ $35K income were less aware about HPV in 2020. There was evidence of disparities in HPV and HPV vaccine awareness among non-Hispanic Blacks. To foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers, future interventions must target men and disadvantaged populations, for whom awareness gaps exist.

The eHealth usage during COVID-19 pandemic 2020 year-Case of Poland

According to the DESI 2022 digital economy and society ranking, Poland still ranks in one of the last position. Although, in digitising healthcare Poland has made significant progress over the last five years, some inequities in the usage of eHealth have been recognised. This has become an especially important topic after the COVID-19 pandemic. Suddenly, eHealth innovations were much needed to maintain the accessibility of healthcare. Thus, the aim of this study was to explore determinants of eHealth usage by Poles and identify existing potential barriers. Data was collected from the databases of Statistic Poland and statistical methods were employed in this research. The results showed that five variables such as Internet access, Internet use, Internet skills and average monthly disposable income per capita in PLN, along with the number of practicing physicians per capita were important determinants explaining eHealth usage by the analysed Poles between the age of 16-74. The findings showed to increase the usage of eHealth, health policy makers should ensure that Poles acquire and improve Internet skills. Based on results of the research an extended model of eHealth development in Poland, consisting of a central governmental institution and local facilities coordinating remote electronic services, collecting statistical data and providing educational campaigns, was proposed as well.

Disparities in awareness of the HPV vaccine and HPV-associated cancers among racial/ethnic minority populations: 2018 HINTS

OBJECTIVES

Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults.

DESIGN

Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January-May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis.

RESULTS

About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07-0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35-0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36-0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18-45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine.

CONCLUSION

Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers.

Workplace factors associated with willingness to undergo human immunodeficiency virus testing during workplace health checkups

BACKGROUND

To examine workplace factors associated with willingness to undergo human immunodeficiency virus (HIV) testing during workplace health checkups.

METHODS

This cross-sectional study used an Internet-based self-administered questionnaire to obtain data from a pool of 24,287 Japanese workers. Binary and multiple logistic regression analyses evaluated the association between workplace factors and HIV testing. Data were adjusted for sex, age, marital status, education, and history of HIV testing.

RESULTS

We gathered information from 4,143 (17.1%) respondents, of whom 1,129 (27.3%) were willing to be tested for HIV as part of a workplace health checkup. The participants were 20-59 years old. Approximately half of the participants were male (49.9%), half were married (48.9%), and half had completed higher education (47.6%). Workplace hepatitis testing was offered to 15.6% of the respondents, and most participants underwent health checkups without their colleagues (52.1%) at a medical facility (60.2%). Willingness to undergo HIV testing was positively correlated with having an increased risk of occupational blood exposure (vs. not at risk, adjusted odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.41-2.15) or working in medical and welfare roles (vs. manufacturing, OR: 1.40, 95% CI: 1.07-1.84). The presence of occupational health staff at the workplace (vs. their absence, adjusted OR: 1.35, 95% CI: 1.16-1.59) and hepatitis testing (vs. not testing, adjusted OR: 2.02, 95% CI: 1.66-2.44) increased willingness to undergo HIV testing.

CONCLUSIONS

A pilot HIV-testing program involving individuals at an increased risk of occupational blood exposure and undergoing hepatitis tests in workplaces providing occupational health staff support is recommended.

The association and intervention effect between eHealth literacy and lifestyle behaviors among Chinese university students

OBJECTIVE

Our aim was to evaluate the association between eHealth literacy and lifestyle behaviors to intervene among Chinese university students.

METHOD

The Chinese eHealth Literacy Scale (C-eHEALS) questionnaire was used to investigate the eHealth literacy level and association with lifestyle behaviors among Chinese university students. Independent sample t-test and Pearson's correlation coefficient were used by statistical software SPSS v20.

RESULTS

In the first round, 5,151 university students participated in the study, including 71.46% female and 28.54% male, aged 18-22 (93.13%).The average eHealth literacy score was 26.81 ± 5.83. Four lifestyle behaviors (e.g., exercise, smoking, drinking and sleeping) were all significantly correlated with eHealth literacy scores and demonstrated significant differences. In the second investigation (N = 2,939), the average eHealth literacy score was 31.64 ± 6.44, a notable improvement compared with the first investigation.

CONCLUSION

Those in the group with high eHealth literacy scores have a healthier lifestyle than those in the low-score group. Training in eHealth-related resources is a positive measure to improve university students' eHealth literacy.

Cultural Differences in Cancer Information Acquisition: Cancer Risk Perceptions, Fatalistic Beliefs, and Worry as Predictors of Cancer Information Seeking and Avoidance in the U.S. and China

Cancer is one of the most common causes of death in China and the United States. Past studies found that cancer risk perceptions, fatalistic beliefs, and worry were prominent predictors of health-related behaviors. Perceived cancer risks, fatalistic beliefs, and worry were associated with cancer information acquisition in the United States. However, little is known about whether these factors played comparable roles in China. This study investigates the psychological antecedents of cancer information acquisition using data from Health Information National Trends Surveys (HINTS) in both countries. Results showed that cancer worry was negatively related to cancer information avoidance in the U.S. but positively related to information avoidance in China. Also, whereas cancer fatalistic beliefs were negatively associated with cancer information seeking in the U.S., the relationships between fatalistic beliefs and cancer information seeking exhibited more complex patterns in China. Implications for cancer communication in different cultures are discussed.

Is HPV vaccine awareness associated with HPV knowledge level? Findings from HINTS data across racial/ethnic groups in the US

BACKGROUND AND PURPOSE

Human papillomavirus (HPV) is recognized as a leading cause of multiple types of cancer. The current study examined HPV knowledge level and its associated factors, especially its relationship with HPV vaccine awareness, across race/ethnicity, including non-Hispanic White, non-Hispanic African American, and Hispanic.

METHODS

Cross-sectional data were merged from Cycles 1 (2017) and Cycle 2 (2018) of the National Cancer Institute (NCI) Health Information National Trends Survey 5 (HINTS5, total N = 3648), which was collected in the United States. A multiple linear regression was performed across the three race/ethnicity groups to determine potential associated factors with level of HPV knowledge.

FINDINGS

Overall HPV knowledge level among participants was low (Mean = 1.68; SD = 1.44; range 0-4). Among three racial/ethnic groups, non-Hispanic African American had the lowest level of HPV knowledge (Mean = 1.51). Less than 30% answered correctly to each of the three items assessing knowledge of HPV-associated (HPVa) cancers other than cervical (e.g. if HPV can cause penile, anal, and/or oral cancer). The HPV vaccine awareness was significantly associated with HPV knowledge across all three racial/ethnic groups.

CONCLUSIONS AND IMPLICATIONS

The lowest level of HPV knowledge among non-Hispanic African American suggests that HPV education is urgently needed for this population. Specific interventions should emphasize information regarding HPVa cancers other than cervical cancer. Additionally, promoting awareness of the HPV vaccine will help to improve HPV knowledge among general population. Lastly, various factors associated with HPV knowledge across different racial/ethnic groups need to be addressed when implementing HPV education programs.

Cancer awareness & its association with demographic variables & mobile phone usage among the rural population of a district in north India

Background & objectives

Lack of awareness is one of the major reasons for the high morbidity and mortality associated with cancers. The present study was aimed to evaluate the awareness of prevalent cancers among the rural population in a district of north India and its association specifically with mobile phone usage.

Methods

Using a stratified random sampling technique, households in three villages of Gautam Buddh Nagar district of India were selected. A house-to-house survey on cancer awareness was conducted among adults in selected households and data were analyzed to check for the association of such an awareness with sociodemographic factors and internet usage.

Results

The study included 59 males and 145 females, with majority (115) being in the age group of 18-30 yr. Although most (96.5%) of the participants were aware of cancer, the common risk factors and warning signs of cancer were known to only a few. Specific risk factors for cervical and breast cancers were, however, not known to a majority (79.9% and 72.2%). A significant association between the awareness of general risk factors and warning signs as well as specific aspects including risk factors for breast, cervical and oral cancer, HPV vaccine and the education level of the participants (P<0.05 for all). Knowledge of risk factors, warning signs and cancer prevention modalities was higher among mobile phone users who accessed internet for health information. There was no significant association between age group and cancer risk factor awareness, though females were more aware of the risk factors for breast cancer (P=0.002).

Interpretation & conclusions

The findings of this study highlight the existing low level of awareness of cervical and breast cancers among the rural population. The association of cancer awareness with education level and mobile phone-based internet usage suggests the potential utility of internet-based platforms such as m-health programmes for cancer prevention activities.

Effects of the digital divide on the prevention of food risk in Taiwan

Given the frequent occurrence of various food incidents, food safety is a significant public health concern worldwide. Health information plays an important role in risk prevention. As its reach continues to broaden, the Internet is emerging as a major source of health information for the public, although some social groups continue to have limited access. This study investigates the relation between the digital divide and practices for preventing food incidents in Taiwan. Using a nationally representative survey of 2098 adults, the results of our multinomial logistic regression and bootstrapped mediation analysis indicate the existence of second- and third-level digital divides. The association between socioeconomic status and Internet use time and digital skills results in disparities in food risk prevention behaviors and is partially mediated by online food safety information acquisition. Our findings reveal that the digital divide exacerbates health inequalities in food risk prevention. In addition to providing useful food safety information online, communication interventions should address the digital inequality by delivering food safety information through alternative networks for disadvantaged members of the public.

Assessing Human Papillomavirus Awareness and the Role of Oropharyngeal Squamous Cell Carcinoma Education on Improving Intention to Vaccinate

OBJECTIVES/HYPOTHESIS

The current state of the U.S. public's knowledge of the relationship between human papillomavirus (HPV) and HPV vaccinations to oropharyngeal squamous cell carcinoma (OPSCC) is unknown. Our objective was to 1) assess the general population's knowledge of human papillomavirus (HPV) and willingness to vaccinate, and 2) assess whether targeted education on HPV-related OPSCC can change intentions to vaccinate.

STUDY DESIGN

Online cross-sectional survey.

METHODS

An online, cross-sectional survey utilizing U.S. census-derived quotas to represent the U.S. population was distributed and analyzed to 517 adults in 2020.

RESULTS

Exactly 72.7% of participants stated that they had or would vaccinate their child against HPV and were designated as "vaccinators." In multivariate regression, Black individuals were less likely to be vaccinators (OR 0.51 [95% CI 0.27-0.94]), but those who were aware of HPV's role in OPSCC were more likely to vaccinate (OR 2.56 [95% CI 1.47-4.46]). Knowledge about vaccination side-effects, eligibility, and mechanisms of HPV spread was low. Only 30.6% of the sample reported understanding the role of HPV in OPSCC. Of these, 43.0% gained this knowledge exclusively from nonhealthcare professional sources, like television. When presented with four short HPV-OPSCC-centered facts (HPV's role in OPSCC etiology, prevalence of infection, clinically silent course, and vaccine preventative effects), 54.0% of "nonvaccinators" indicated a willingness to change their minds.

CONCLUSIONS

General knowledge about HPV, HPV's role in OPSCC, and the vaccine remains low in the general population. There are racial disparities in willingness to vaccinate within this sample, but these may be overcome by effective education on HPV-related OPSCC.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Social media use and human papillomavirus awareness and knowledge among adults with children in the household: examining the role of race, ethnicity, and gender

BACKGROUND

Though human papillomavirus (HPV) vaccination is a safe and effective method of protecting against associated cancers, uptake rates remain low among adolescents. Few studies have examined how social media use contributes to HPV-related knowledge gaps among parents and caregivers.

OBJECTIVE

To investigate the association between social media use and HPV-related awareness and knowledge with a focus on differences by gender and race/ethnicity among a nationally representative sample of adults with children in the household.

METHODS

We used data from the Health Information National Trends (HINTS) Survey (2017-2019) (N = 2,720). Multivariate logistic regressions were used to examine the association of social media use on HPV awareness and knowledge outcomes.

RESULTS

Compared to non-users, engaging in one, two, three, or four social media behaviors were associated with greater HPV awareness (aOR: 2.09; 95%CI: 1.18-3.70, aOR: 2.49; 95%CI: 1.40-4.42, aOR: 2.64; 95%CI: 1.15-6.05, and aOR: 2.44; 95%CI: 1.11-5.36, respectively). Increased social media use was associated with increased HPV vaccine awareness. Men, African American, Hispanic, and Asian American respondents were less likely to be aware of HPV or HPV vaccine. Social media use was not associated with cancer knowledge.

CONCLUSIONS

Increased social media use is associated with an increased awareness of HPV and HPV vaccine for adults with children in the household. Social media-based efforts can be utilized to increase knowledge of the benefits of HPV vaccination as cancer prevention, which may be a precursor to reducing HPV vaccine hesitancy and encouraging uptake to decrease cancer incidence rates among vulnerable populations.

The Impact of Internet Use on Health Outcomes of Rural Adults: Evidence from China

Health, as basic human capital, is quite important for rural adults. However, in China, the average level of public health facilities and services is far lower in rural areas than in cities. In recent years, the internet has developed rapidly in China, and is increasingly affecting rural adults in a positive way. The purpose of this paper is to reveal whether internet use can be an effective way to improve the health of rural adults. This study used three rounds of data from the China Family Panel Studies (CFPS) collected in 2014, 2016, and 2018. After eliminating samples due to attrition, the study included 7528 villagers who were at least 16 years old. A panel logit model was employed to conduct an empirical analysis. The results indicate that internet use has a significantly positive impact on health outcomes of rural adults. By using the internet, rural adults can find a large amount of health information, increase their social interaction, and maintain physical exercise to improve their health. Thus, it is important to promote internet use for health purposes in rural areas. In addition, internet use had heterogeneous effects on the health of rural adults of different genders, age groups, and education levels. Attention should be focused on highly educated older men to improve the effects of internet use.

Human Papillomavirus Vaccination Initiation and Completion among Youth Experiencing Homelessness in Seven U.S. Cities

Little is known about human papillomavirus (HPV) vaccination uptake among youth experiencing homelessness (YEH), who may be at higher risk for HPV than their housed counterparts. We examined the prevalence and associations of HPV vaccination initiation and completion among YEH. Guided by the Behavioral Model for Vulnerable Populations, we analyzed cross-sectional data collected from YEH (N = 1074; ages 18-26) in seven U.S. cities to assess HPV vaccination prevalence and to identify predisposing, enabling, and need factors associated with HPV vaccination status. Due to timing differences in the release of HPV vaccine recommendations, we conducted separate logistic regression analyses for men (n = 673) and women (n = 401). Approximately 19% of men and 37% of women had initiated and completed HPV vaccination. Several factors among men (i.e., older age, Latinx ethnicity, San Jose or St. Louis residence compared with New York City, never having had sex, and not previously being tested for STIs) and women (i.e., lower education level, San Jose or Houston residence compared with New York City, and never having had sex) were associated with lower odds of HPV vaccination initiation, completion, or both. Gay men had higher odds of initiating and completing the vaccination series than their heterosexual counterparts. Our findings reveal that HPV vaccination uptake is low among YEH and that there are vaccination disparities among subgroups of YEH. HPV vaccination strategies and resources that are easy-to-understand, facilitate point-of-care services, and address societal and system-level vaccination barriers encountered by YEH are needed.

Central American Immigrant Parents' Awareness, Acceptability, and Willingness to Vaccinate Their Adolescent Children Against Human Papillomavirus: A Pilot Cross-Sectional Study

Despite increasing interest in understanding the factors influencing awareness and acceptability of the human papillomavirus (HPV) vaccine among Latino parents, to date limited information is available specific to Central American parents living in the United States (US). Therefore, this pilot cross-sectional study was designed to explore and assess Central American immigrant parents’ awareness, acceptability, and willingness to vaccinate their children against HPV, and interest in participating in future HPV-associated cancer prevention study. Fifty-six Central American parents, majority immigrant (96.4%; n = 54) from four countries, El Salvador—50% (n = 27); Guatemala—25.9% (n = 14); Honduras—22.2% (n = 12); and Panama—1.9% (n = 1) participated in this study. Participants completed an interviewer-administered questionnaire survey in their preferred language (i.e., Spanish or English). A little over half of the participants were mothers (57.1%; n = 32) and parents’ mean age was 43.2 years (SD = 6.4). The majority was married or cohabitating (76.8%, n = 43), and 39.3% (n = 22) reported having two children. Seventy-five percent (n = 42) of parents reported they had heard of the HPV vaccine. Fewer fathers were aware of the HPV vaccine (58.3%; n = 14 vs.87.5%, n = 28; p = 0.01) than mothers. Among parents who had heard of the HPV vaccine (n = 42), 85.7% (n = 36) reported their children had received at least one dose of the HPV vaccine. Fewer fathers reported their child had been vaccinated against HPV (64.3%, n = 9 vs. 96.4%, n = 27; p = 0.06) than mothers. Moreover, 90% of parents (n = 18) whose children were unvaccinated reported willingness to vaccinate their adolescent children against HPV if recommended by their child’s physician. Findings indicate parents’ low to moderate awareness of the HPV vaccine, and high willingness to vaccinate their adolescent children if recommended by their child’s physician. Findings also demonstrate fathers’ lower awareness and acceptability of the HPV vaccine than mothers. Despite limitations and the need for more research, findings of this pilot study serve as a valuable first step toward building a knowledge foundation that is needed for developing future studies and interventions targeting Central American immigrant parents living in the US. Future studies can build on the findings of this exploratory study with other research designs and address its limitations by having a larger sample size and accounting for additional factors associated with Central American immigrant parents’ HPV awareness, knowledge, beliefs, attitudes, and vaccine acceptability from other communities across the US.

Social Determinants of Health and Human Papillomavirus Vaccination Among Young Adults, National Health Interview Survey 2016

Human papillomavirus (HPV) vaccination has the potential to reduce the burden of anogenital cancers. Vaccine uptake remains suboptimal, especially among young adults. Social determinants of health (SDOH) are societal level conditions that may indirectly influence health behaviors, including HPV vaccination. The purpose of this study was to assess HPV vaccination and SDOH among young adult women and men. The 2016 National Health Interview Survey was restricted to participants ages 18-26 (n = 3593). The Healthy People 2020 SDOH Framework was used to identify variables for economic stability, health and healthcare, education, social and community context, and neighborhood and built environment. Survey-weighted logistic regression models identified SDOH variables significantly associated with HPV vaccination. Reported HPV vaccination occurred for 45.7% of women and 14.5% of men in the sample. Among women, education determinants-highest level of education completed and English language-were significantly associated with HPV vaccination. Men (adjusted OR 0.65, 95% CI 0.54, 0.79) and women (adjusted OR 0.66, 95% CI 0.49, 0.90) who did not use the Internet to look up health information were at lower odds to be vaccinated for HPV. These findings can inform future HPV vaccine uptake efforts by focusing specifically on these SDOH areas-education and health and healthcare. Identifying SDOH leverage points is critical to promoting HPV vaccination and ultimately reducing HPV-associated cancers.

Requiring smartphone ownership for mHealth interventions: who could be left out?

BACKGROUND

Mobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. This raises the question of whether disparities in access to mobile technology could accentuate disparities in mHealth mediated care. This study addresses whether programs planning to implement mHealth interventions risk creating or perpetuating health disparities based on inequalities in smartphone ownership.

METHODS

Video Directly Observed Therapy (VDOT) is an mHealth intervention for monitoring tuberculosis (TB) treatment adherence through videos sent by patients to their healthcare provider using smartphones. We conducted secondary analyses of data from a single-arm trial of VDOT for TB treatment monitoring by San Diego, San Francisco, and New York City health departments. Baseline and follow-up treatment interviews were used to assess participant smartphone ownership, sociodemographics and TB treatment perceptions. Univariate and multivariable logistic regression analyses were used to identify correlates of smartphone ownership.

RESULTS

Of the 151 participants enrolled, mean age was 41 years (range: 18-87 years) and 41.1% were female. Participants mostly identified as Asian (45.0%) or Hispanic/Latino (29.8%); 57.8% had at most a high school education. At baseline, 30.4% did not own a smartphone, which was similar across sites. Older participants (adjusted odds ratio [AOR] = 1.09 per year, 95% confidence interval [CI]: 1.05-1.12), males (AOR = 2.86, 95% CI: 1.04-7.86), participants having at most a high school education (AOR = 4.48, 95% CI: 1.57-12.80), and those with an annual income below $10,000 (AOR = 3.06, 95% CI: 1.19, 7.89) had higher odds of not owning a smartphone.

CONCLUSIONS

Approximately one-third of TB patients in three large United States of America (USA) cities lacked smartphones prior to the study. Patients who were older, male, less educated, or had lower annual income were less likely to own smartphones and could be denied access to mHealth interventions if personal smartphone ownership is required.

Organizational justice and illness reporting among Japanese employees with chronic diseases

Purpose

This study examined the association between perceived organizational justice (i.e., procedural justice and interactional justice) and reporting of illness to one's company (illness reporting) among Japanese employees with chronic diseases.

Methods

This online cross-sectional survey included 1,134 employees (aged 18–65 years) who required workplace support to combine work with disease treatment. Participants were classified into tertiles of perceived organizational justice (low, moderate, and high). Multiple logistic regression analyses were conducted to examine sex differences in the associations between perceived justice and illness reporting.

Results

Males reporting perceived high levels of procedural and interactional justice had significantly higher odds of illness reporting than those with perceived low levels of procedural (odds ratio [OR] 2.62, 95% confidence interval [CI]: 1.47–4.66) and interactional justice (OR 4.34, 95% CI: 2.28–8.27). Females with perceived high levels of interactional justice had significantly higher odds of illness reporting than those with perceived low levels of interactional justice (OR 1.74, 95% CI: 1.08–2.80). There was no significant association between procedural justice and illness reporting among females.

Conclusion

The findings indicate that high perceived organizational justice is positively associated with illness reporting among Japanese employees who require workplace support to combine work and disease treatment.

Knowledge about HPV and vaccination among young adult men and women: Results of a national survey

BACKGROUND

In addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16-25 years who use the public health system in Brazil.

METHODS

This was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire.

RESULTS

Of 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70).

CONCLUSIONS

The results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies.

Links between organizational preparedness and employee action to seek support among a Japanese working population with chronic diseases

Objectives

This study examined the association between workplace rules and training programs regarding combining employees’ work and treatment for chronic diseases, and actions actually taken by employees to manage this issue. These workplace measures (rules and training programs) are consistent with the Japanese Guideline for Workplace Patient Coordination and Disease Treatment.

Methods

In February 2018, we conducted an online, cross‐sectional survey of 1134 employed individuals with chronic diseases who needed workplace support to combine work and disease treatment. All participants were aged 18‐65 years and lived in Japan. We investigated associations between workplace rules and training programs (two items) and employee actions (eight items), using a questionnaire based on the guideline and logistic regression analysis.

Results

In total, 76.5% of the participants said they had reported their chronic disease to their employer (manager, personnel department, or occupational physician). However, less than half (47.5%) had submitted a written report about their job to their doctor. Employees were more likely to take action in workplaces that had rules or training programs than in workplaces without such measures. More actions were taken among employees in workplaces with both rules and training programs than in those with either measure alone.

Conclusion

It is important to establish rules to support employees with chronic diseases and provide training to improve awareness of these rules to encourage employees with chronic diseases to take action to access the support they need.

Mobile Phones May Not Bridge the Digital Divide: A Look at Mobile Phone Literacy in an Underserved Patient Population

Purpose: Mobile health (mHealth) has promise to improve patient access to disease prevention and health promotion services; however, historically underserved populations may have poor access to mobile phones or may not be aware of or comfortable using phone features. Our objectives were to assess mobile phone ownership and mobile phone literacy among low-income, predominately racial and ethnic minority patients.

Materials and methods: We conducted a cross-sectional survey of a convenience sample of primary care patients in a publicly-funded clinic in Houston, TX.

Results: Of 285 participants, 240 owned a mobile phone and 129 owned a smartphone. The most common uses of phones were talk (89%) and text messaging (65%). Only 28% of smartphone owners had health apps. Younger age was significantly associated with smartphone ownership and use of smartphones for Internet browsing, social media, and apps.

Conclusion: Our findings from a safety-net patient population represent trends in mobile phone ownership and literacy. Despite the single-site location of our study, the findings could be helpful to health promotion practitioners working with similar underserved populations. mHealth interventions should employ phone features that are accessible and familiar to the target audience to avoid denying intervention benefits to those with low mobile phone literacy and therefore widen health disparities.

Health Disparities and the Digital Divide: The Relationship between Communication Inequalities and Quality of Life among Women in a Nationwide Prospective Cohort Study in the United States

Background: Communication inequalities can affect health-seeking behaviors yet the relationship between Internet use and overall health is inconclusive. Communication-related inequalities vary by race/ethnicity and SES but existing research primarily includes middle-class Whites. We therefore examined the relationship between communication-related inequalities-measured by daily Internet use-and health-related quality of life (QOL) using a nationwide prospective cohort study in the United States that consists of primarily low income, minority women. Methods: We examined Internet use and QOL among participants in the Women's Interagency HIV Study. Data collection occurred from October 2014-September 2015 in Chicago, New York, Washington DC, San Francisco, Atlanta, Chapel Hill, Birmingham/Jackson and Miami. We used multi-variable analyses to examine the relationship between daily Internet use and QOL. Results: The sample of 1,915 women was 73% African American and 15% Hispanic; 53% reported an annual income of ≤$12,000. Women with daily Internet use reported a higher QOL at six months, as did women with at least a high school diploma, income >$12,000, and non-White race; older women and those with reported drug use, depressive symptoms and loneliness had lower QOL. Conclusions: Overcoming communication inequalities may be one pathway through which to improve overall QOL and address public health priorities. Reducing communication-related inequalities-e.g, by providing reliable Internet access-and thus improving access to health promoting information, may lead to improved health outcomes.

On surmounting the barriers to HPV vaccination: we can do better

The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages   • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative.   • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer.   • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males.   • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence.   • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s.   • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

Purpose: Gaps remain in the public's knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults.

METHODS

Data from the Health Information National Trends Survey 4 Cycle 3 (September - December 2013) and Cycle 4 (August - November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.

RESULTS

Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 - 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 - 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 - 0.96) and 44% (95% CI: 0.39 - 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 - 1.02) and 53% (95% CI: 0.34 - 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively.

CONCLUSIONS

There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.

Psychosocial factors and colleagues' perceptions of return-to-work opportunities for workers with a psychiatric disorder: a Japanese population-based study

Background

This study examined associations between psychosocial factors and the perception that adequate employment opportunities might not be provided for people with limited work capacity due to psychiatric disorders.

Methods

We conducted an online, cross-sectional survey of 3,710 employed individuals aged 20 to 69 years in Japan. Our survey included the Brief Job Stress Questionnaire and investigated participants’ perception of opportunities in their workplace for individuals with a psychiatric disorder returning to work (colleagues’ negative perception) and psychosocial factors (job demand, job control, and workplace social support). Multiple logistic regression analysis was used to evaluate potential associations between psychosocial factors and colleagues’ negative perception.

Results

Colleagues’ negative perception was associated with low workplace social support (middle tertile: Odds Ratio [OR]: 1.26, 95% Confidence Interval [CI]: 1.12–1.40; low tertile: OR 1.45, 95% CI: 1.32–1.58; p for trend <0.01); low levels of job control (middle tertile: OR 1.22, 95% CI: 1.06–1.38; low tertile: OR 1.64, 95% CI: 1.46–1.81; p for trend <0.01); and no previous experience working with a person with a psychiatric disorder (OR 1.74, 95% CI: 1.60–1.88).

Conclusions

Psychosocial factors may affect colleagues’ perceptions of individuals with a psychiatric disorder returning to work in Japan. Greater consideration of psychosocial factors in the workplace may be necessary to facilitate people with a psychiatric disorder successfully returning to work in Japan, as elsewhere.

E-Health literacy of medical and health sciences university students in Mashhad, Iran in 2016: a pilot study

BACKGROUND

In order to provide a better healthcare education to the society, health care students should have an acceptable electronic health (E-Health) literacy.

OBJECTIVE

The aim of this study was to assess the level of E-Health literacy of Medicine and Health Sciences university students in Mashhad, Iran.

METHODS

This cross-sectional study was performed on 192 students of Mashhad University of Medical Sciences using a validated Persian translate of the E-Health literacy scale (P-EHEALS) questionnaire in 2016. Demographic data including age, monthly income, level of education, preference of website for obtaining health related information and minutes of Internet use per day were obtained from the subjects. Independent-samples t-test and analysis of variance (ANOVA) were used for comparison between groups, and Pearson correlation coefficient and linear regression were used to assess the correlation between study parameters and EHEALS score using SPSS version 21.

RESULTS

A total of 192 (67.2% female and 32.8% male) subjects with mean age of 24.71±5.30 years participated in the study. Mean P-EHEALS score of the subjects was 28.21±6.95. There was a significant difference in P-EHEALS score between genders (p<0.001), department (p=0.001), education level (p<0.001) and health status (p=0.003) as well as monthly income (p=0.03), website preference categories (p=0.02). Male students were significantly more likely to gain higher P-EHEALS scores.

CONCLUSION

The level of E-Health literacy was low in Medical and Health Sciences university students in Mashhad. More studies are needed to assess the contributors to E-Health literacy.

Availability of information in Public Health on the Internet: An analysis of national health authorities in the Spanish-speaking Latin American and Caribbean countries

INTRODUCTION

Access to reliable and quality health information and appropriate medical advice can contribute to a dramatic reduction in the mortality figures of countries. The governments of the Americas are faced with the opportunity to continue working on this challenge, and their institutional presence on their websites should play a key role in this task. In a setting where the access to information is essential to both health professionals and citizens, it is relevant to analyze the role of national health authorities. Given that search engines play such a key role in the access to health information, it is important to specifically know - in connection to national health authorities - whether health information offered is easily available to the population, and whether this information is well-ranked in search engines.

METHODS

Quantitative methods were used to gather data on the institutional presence of national health authorities on the web. An exploratory and descriptive research served to analyze and interpret data and information obtained quantitatively from different perspectives, including an analysis by country, and also by leading causes of death. A total of 18 web pages were analyzed. Information on leading causes of death was searched on websites of national health authorities in the week of August 10-14, 2015.

RESULTS

The probability of finding information of national health authorities on the 10 leading causes of death in a country, among the top 10 results on Google, is 6.66%. Additionally, ten out the 18 countries under study (55%) do not have information ranked among the top results in Google when searching for the selected terms. Additionally, a total of 33 websites represent the sources of information with the highest visibility for all the search strategies in each country on Google for the ten leading causes of death in a country. Two websites, the National Library of Medicine and Wikipedia, occur as a result with visibility in the total of eighteen countries of the sample.

CONCLUSIONS

Taking into consideration that providing reliable and quality information on these topics to the population should be one of the priorities of national health authorities, these results suggest that national health authorities need to take measures to try to better position their contents.

Attitudes of nurses toward HIV-infected colleagues in Japan

BACKGROUND

Nurses may be unwilling to accept HIV-infected colleagues who can continue to work with patients if the provider-to-patient transmission risks have been appropriately assessed.

AIMS

To assess the factors associated with nurses' willingness to accept HIV-infected colleagues as coworkers.

DESIGN

Descriptive and cross-sectional.

METHODS

An anonymous online survey targeting Japanese nurses working in hospitals or clinics (n = 992). Logistic regression analysis was used to evaluate factors associated with their willingness to accept HIV-positive colleagues before or after a risk assessment.

RESULTS

Respondents who avoided contact with, and expressed discriminatory views about, HIV-infected colleagues were less willing to accept them. After undertaking an appropriate risk assessment, a high level of knowledge regarding HIV transmission increased the likelihood of acceptance towards HIV-infected colleagues.

CONCLUSIONS

The use of risk assessment may increase nurses' willingness to accept HIV-infected colleagues, particularly among co-workers with a high level of knowledge about HIV.

Cancer Information Seeking and Cancer-Related Health Outcomes: A Scoping Review of the Health Information National Trends Survey Literature

Cancer is a leading cause of death among adults in the United States. Only 54% of U.S. adults reported seeking cancer information in 2014. Cancer information seeking has been positively associated with cancer-related health outcomes such as screening adherence. We conducted a scoping review of studies that used data from the Health Information National Trends Survey (HINTS) in order to examine cancer information seeking in depth and the relationship between cancer information seeking and cancer-related health outcomes. We searched five databases and the HINTS website. The search yielded a total of 274 article titles. After review of 114 de-duplicated titles, 66 abstracts, and 50 articles, 22 studies met inclusion criteria. Cancer information seeking was the outcome in only four studies. The other 18 studies focused on a cancer-related health outcome. Cancer beliefs, health knowledge, and information seeking experience were positive predictors of cancer information seeking. Cancer-related awareness, knowledge, beliefs, preventive behaviors, and screening adherence were higher among cancer information seekers. Results from this review can inform other research study designs and primary data collection focused on specific cancer sites or aimed at populations not represented or underrepresented in the HINTS data (e.g., minority populations, those with lower socioeconomic status).

Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study

BACKGROUND

Human papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12-13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher. The study's objectives were to explore factors influencing UK based African parents' acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views.

METHODS

A qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing.

RESULTS

HPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it's still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person's disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood.

CONCLUSION

Tailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.

Human Papillomavirus Vaccine Uptake in Adolescent Boys: An Evidence Review

BACKGROUND

Despite evidence-based guidelines recommending routine vaccination against human papillomavirus (HPV) for adolescent boys, ages 11-12 years, vaccine uptake among this population remains low.

AIMS

To examine reasons for low HPV quadrivalent vaccine uptake and methods available to increase vaccine uptake among adolescent males, ages 11-12 years.

METHODS AND RESULTS

Of 341 identified studies, 30 were included from three databases. The 30 studies were grouped into six categories: population-specific, problem-specific, educational interventions, theory-specific, political implications, and foundational guidelines and Websites.

DISCUSSION

Among eight studies, low vaccine uptake was attributed to lack of parental, adolescent, and physician knowledge of HPV4 vaccine availability and recommendations. HPV4 vaccine educational interventions for parents and adolescents were the most effective for promoting vaccine uptake. Theory applications and gain-framed messages were shown to be effective for assessing HPV vaccine attitudes and perceptions. Political implication studies reveal the need for political and financial measures to encourage HPV vaccine acceptability among the population.

IMPLICATIONS FOR CLINICIANS

To promote HPV vaccine uptake among adolescent males, providers must remain current with HPV vaccine recommendations and offer parental and adolescent HPV education focusing on benefits of vaccine acceptance and risks of vaccine refusal.

LINKING EVIDENCE TO ACTION

The results of this review inform our understanding of effective educational strategies to positively impact HPV vaccine uptake in adolescent males. Based on this review, clinicians can employ several evidence-based educational strategies to facilitate HPV vaccine uptake.

Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users

Background

More advanced methods and models are needed to evaluate the participation of patients and citizens in the shared health care model that eHealth proposes.

Objective

The goal of our study was to design and evaluate a predictive multidimensional model of eHealth usage.

Methods

We used 2011 survey data from a sample of 13,000 European citizens aged 16–74 years who had used the Internet in the previous 3 months. We proposed and tested an eHealth usage composite indicator through 2-stage structural equation modelling with latent variables and measurement errors. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage was calculated using health status and sociodemographic independent variables.

Results

The dimensions with more explanatory power of eHealth usage were health Internet attitudes, information health Internet usage, empowerment of health Internet users, and the usefulness of health Internet usage. Some 52.39% (6811/13,000) of European Internet users’ eHealth usage was more intensive (greater than the mean). Users with long-term health problems or illnesses (OR 1.20, 95% CI 1.12–1.29) or receiving long-term treatment (OR 1.11, 95% CI 1.03–1.20), having family members with long-term health problems or illnesses (OR 1.44, 95% CI 1.34–1.55), or undertaking care activities for other people (OR 1.58, 95% CI 1.40–1.77) had a high propensity toward intensive eHealth usage. Sociodemographic predictors showed that Internet users who were female (OR 1.23, 95% CI 1.14–1.31), aged 25–54 years (OR 1.12, 95% CI 1.05–1.21), living in larger households (3 members: OR 1.25, 95% CI 1.15–1.36; 5 members: OR 1.13, 95% CI 0.97–1.28; ≥6 members: OR 1.31, 95% CI 1.10–1.57), had more children <16 years of age (1 child: OR 1.29, 95% CI 1.18–1.14; 2 children: OR 1.05, 95% CI 0.94–1.17; 4 children: OR 1.35, 95% CI 0.88–2.08), and had more family members >65 years of age (1 member: OR 1.33, 95% CI 1.18–1.50; ≥4 members: OR 1.82, 95% CI 0.54–6.03) had a greater propensity toward intensive eHealth usage. Likewise, users residing in densely populated areas, such as cities and large towns (OR 1.17, 95% CI 1.09–1.25), also had a greater propensity toward intensive eHealth usage. Educational levels presented an inverted U shape in relation to intensive eHealth usage, with greater propensities among those with a secondary education (OR 1.08, 95% CI 1.01–1.16). Finally, occupational categories and net monthly income data suggest a higher propensity among the employed or self-employed (OR 1.07, 95% CI 0.99–1.15) and among the minimum wage stratum, earning ≤€1000 per month (OR 1.66, 95% CI 1.48–1.87).

Conclusions

We provide new evidence of inequalities that explain intensive eHealth usage. The results highlight the need to develop more specific eHealth practices to address different realities.

Barriers to the acceptance of work colleagues infected with Hepatitis B and Hepatitis C in Japan

Background:

Healthcare workers infected with Hepatitis B (HBV) or Hepatitis C virus (HCV) may undertake patient care activities if provider-to-patient transmission risks have been assessed in terms of viral load and clinical procedures. The present study investigated potential barriers to the acceptance of colleagues infected with HBV/HCV in healthcare settings after appropriate risk assessment.

Methods:

We conducted an anonymous, internet-based survey of Japanese nurses. Multivariate logistic analysis was used to assess factors associated with willingness to accept colleagues infected with HBV/HCV after risk assessment.

Results:

In total, 992 nurses responded to the survey, with 16% indicating that colleagues infected with HBV/HCV should not have patient contact after risk assessment. Willingness to accept HBV/HCV-infected colleagues was negatively associated with attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues (OR: 0.49; 95% CI: 0.28-0.85). Previous professional contact with HBV/HCV patients (OR: 1.73; 95% CI: 1.36-2.12), experience of accidental injection from or personal exposure to HBV/HCV patients (OR: 2.00; 95% CI: 1.42-2.61), knowledge of HBV/HCV (OR: 2.00; 95% CI: 1.52-2.49), and female sex (OR: 1.60; 95% CI: 1.17-2.09) were positively associated with a willingness to accept HBV/HCV-infected colleagues.

Conclusions:

This study suggests that attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues may be barriers to accepting these colleagues even after risk assessment has been performed. To protect the employment of nurses infected with HBV/HCV, employers should provide comprehensive education for nurses to reduce stigma and improve understanding about the management of staff infected with infectious diseases, such as HBV or HCV.

Co-worker perceptions of return-to-work opportunities for Japanese cancer survivors

PURPOSE

This study examined workplace factors and perceptions of Return-to-Work (RTW) opportunities for colleagues with cancer-related symptoms and/or treatment side effects in Japan.

METHODS

We conducted an online, cross-sectional survey of 3710 employed Japanese individuals of working age. Colleagues' perceptions of RTW opportunities for cancer survivors were examined (using a Japanese questionnaire), along with workplace factors such as job demand, job control and workplace social support (using the Brief Job Stress Questionnaire). Associations between workplace factors and RTW opportunities were evaluated using multiple logistic regression analysis, with participants stratified in tertiles (low, middle and high) according to their levels of workplace social support and job control.

RESULTS

Colleagues' perceptions of inadequate RTW opportunities were associated with low workplace social support (middle tertile: Odds Ratio [OR] 1.22, 95% Confidence Interval [CI]: 1.08-1.36; low tertile: OR 1.43, 95%CI: 1.30-1.57; p for trend <0.01); low levels of job control (middle tertile: OR 1.27, 95%CI: 1.06-1.50; low tertile: OR 1.91, 95%CI: 1.64-2.21; p for trend <0.01); and no prior experience working with a cancer survivor (OR 2.08, 95%CI: 1.83-2.31).

CONCLUSIONS

This study suggests that workplace factors and prior experience of working with a cancer survivor may affect a colleagues' perception of RTW opportunities in Japanese workplaces. Consideration of workplace social factors (workplace support and job control), as well as increased openness and awareness of the particular needs of cancer survivors, is therefore essential to facilitate successful RTW in Japan, as elsewhere.Copyright © 2016 John Wiley & Sons, Ltd.

HIV testing and attitudes among the working-age population of Japan: annual health checkups may offer an effective way forwards

In Japan, Voluntary Counselling and Testing (VCT) for HIV has been recommended for people concerned about their infection risk, especially those in high-risk groups. Although HIV awareness has declined in this country somewhat during recent years, the number of newly-infected cases has been increasing. The purpose of the current study therefore, was to determine the prevalence of HIV testing, individuals' reasons for being tested, and the overall acceptance of HIV testing among working-age Japanese. We utilized an anonymous, nationwide survey which was administered to a total of 3,055 participants aged 20-69 yr. The lifetime prevalence of HIV testing was 14% (2% within the past year). A gap was observed between a prior history of HIV testing and willingness to be tested in future (32%) or willingness to be tested during health checkups in the workplace (41%). HIV testing appears to have only been conducted among a limited number of working-age Japanese adults, even though some reported a willingness to be tested. Opportunities for VCT during workplace health checkups might offer an immediate and positive way forwards in the fight against HIV; however, privacy protection for test results and the acceptance of HIV-positive employees should be carefully considered in the workplace.

Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26

OBJECTIVE

To describe knowledge about human papillomavirus (HPV) and HPV vaccination among women ages 19 to 26 seeking a variety of services at reproductive health centers. A secondary objective was to identify common sources of HPV information.

METHODS

Ten reproductive health centers enrolled 365 women ages 19 to 26 in a randomized, controlled trial to determine the effect of automated reminder messages on HPV vaccine completion. Using responses from a 61-item self-administered baseline questionnaire completed before initiating the HPV vaccine, this subanalysis assessed participants' knowledge regarding HPV and the HPV vaccine.

RESULTS

Knowledge of HPV prevention, transmission, and disease outcomes among the study population was highly variable. The mean HPV knowledge score was 11.0 of a possible 19 (SD = 3.8). Most participants (77%) had heard of the HPV vaccine before completing the questionnaire and indicated that their primary sources of information about the vaccine were television ads (61%), health care providers (52%), and friends (45%).

CONCLUSIONS

Despite a relatively high awareness of the vaccine, specific knowledge regarding HPV and the HPV vaccine varied substantially and participant scores highlighted knowledge gaps among vaccine-eligible young women. Media, health care providers, and friends were identified by participants as sources of information and may influence their knowledge of HPV and the HPV vaccine.

A feminist information engagement framework for gynecological cancer patients

Purpose

– The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with medicalization of sexuality and gender power dynamics, situating information behaviors and interactions in women’s socio-health perceptions. Using Kavanagh and Broom’s feminist risk framework, the framework establishes functional and temporal parameters for sense-making and information engagement.

Design/methodology/approach

– This paper employs a structured, reiterative literature review with emergent thematic analysis. Nine indices from medicine, information studies, and sociology were searched using combinations of five terms on cervical cancer (CC) and 14 terms on information engagement in the title, abstract, and subject fields. Results were examined on a reiterative basis to identify emergent themes pertaining to knowledge development and information interactions.

Findings

– Environmentally, social stigma and gender roles inhibit information seeking; normalizing CC helps integrate medical, moral, and sexual information. Internally, living with the dichotomy between “having” a body and “being” a body requires high-trust information resources that are presented gradually. Actively, choosing to make or cede medical decision-making requires personally relevant information delivered in the form of concrete facts and explanations.

Research limitations/implications

– The study covers only one country.

Originality/value

– This study’s information framework and suggestions for future research encourage consideration of gender power dynamics, medicalization of sexuality, and autonomy in women’s health information interactions.

Men's Intentions to Engage in Behaviors to Protect Against Human Papillomavirus (HPV): Testing the Risk Perception Attitude Framework

Guided by the risk perception attitude framework (RPA), this study examined men's perceptions of risk and efficacy beliefs as predictors of their intentions to engage in self-protective behaviors. The results of multiple regression analyses did not provide support for the RPA prediction that efficacy beliefs moderate the relationship between risk perceptions and self-protective behavior. However, the results provide support for the main effects of risk and efficacy on all four behavioral intentions examined (i.e., Internet information seeking, communication with a health provider, HPV vaccination, and condom use). Risk and efficacy were positively related to (and significant individual predictors of) all four behavioral intentions. Scholarly and practical implications of these findings are discussed.

Predictors of human papillomavirus awareness and knowledge in 2013: gaps and opportunities for targeted communication strategies

BACKGROUND

Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical cancers. Greater cervical cancer mortality has been observed among women of lower SES and those living in rural, versus urban, areas. African American and Hispanic women are significantly more likely to die from cervical cancer than non-Hispanic white women.

PURPOSE

To assess current population awareness of and knowledge about HPV and the HPV vaccine, as well as the contribution of sociodemographic characteristics to disparities in HPV awareness and knowledge.

METHODS

Cross-sectional data were obtained from the National Cancer Institute's 2013 Health Information National Trends Survey (HINTS; N=3,185). Multivariable logistic regression was employed to identify gaps in awareness and knowledge by sex, education, income, race/ethnicity, geographic area, and other important sociodemographic characteristics. Analyses were conducted in 2014.

RESULTS

Sixty-eight percent of Americans had heard of HPV and the HPV vaccine. Consistent with the Knowledge Gap Hypothesis, awareness and knowledge were patterned by sex, age, education, and other important sociodemographic factors. Those in rural areas were less likely than those in urban areas to know that HPV causes cervical cancer. Less than 5% of Americans were aware that HPV often clears on its own without treatment.

CONCLUSIONS

Although awareness and knowledge of HPV is increasing, there are opportunities to target communication with populations for whom knowledge gaps currently exist, in order to promote dialogue about the vaccine among patients and their providers.

Partnering against cancer today: a blueprint for coordinating efforts through communication science

One of the hallmarks of the communication revolution over the past decade has been its support for participation, whether that be in the active engagement of patients searching the Web for answers to vital health questions, or in the collective energies of self-organizing communities through social media. At the same time, some of the major obstacles to achieving a full and equitable reach of evidence-based cancer control knowledge have been traced back to discontinuities in communication either within clinical care or the broader public awareness system. Communication scientists from the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society joined forces in 2010 to investigate ways in which communication science can be used to improve coordination and enhance participation in cancer control for the nation. From 2010 to 2013, the three organizations worked together in 1) convening two meetings designed to assess the status of funded research in communication science, 2) completing a systematic review of literature published over the previous 10 years, and 3) authoring a blueprint for coordinated efforts using the implications of communication science. The blueprint consists of three major goals: first, to identify high-yield targets of opportunity using the health impact pyramid articulated by Centers for Disease Control and Prevention Director, Thomas Frieden; second, to leverage opportunities within the new communication environment, including the opportunities catalyzed by national efforts to create an infrastructure for evidence implementation through health information technology; and third, to assist in coordinating efforts across collaborative entities through participative media.

Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012

Background

Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease.

Objective

The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex.

Methods

We drew data from National Cancer Institute’s 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information–seeking, and user-generated content/sharing).

Results

Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information–seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information–seeking.

Conclusions

This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health.

Sociodemographic factors and prejudice toward HIV and hepatitis B/C status in a working-age population: results from a national, cross-sectional study in Japan

BACKGROUND

In many countries, HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infected individuals may face discrimination and mistreatment from coworkers. Effective interventions to reduce workplace discrimination are therefore needed to protect these vulnerable populations. The current study investigated potential associations between sociodemographic factors and prejudice toward HIV and HBV/HCV infected colleagues within a Japanese working population.

METHODS

An online anonymous, nationwide internet survey was administered to a cross-section of approximately 3,000 individuals in Japan. The survey comprised 14 questions focusing on demographics (five items), basic HIV or HBV/HCV knowledge (eight items), and potential prejudice toward HIV or HBV/HCV infected colleagues (one item). The sociodemographic characteristics evaluated were sex, age, educational level, employment status, and individual income; with multiple logistic regression used for the analysis.

RESULTS

In total, 3,055 individuals were recruited for the HIV related survey and 3,129 for the HBV/HCV related survey. Older age was significantly and positively associated with prejudice toward HIV infected colleagues (p<0.01) and negatively associated with prejudice toward HBV/HCV infected colleagues (p<0.01). Statistically significant associations were not observed between other sociodemographic characteristics and potential prejudice toward HIV and HBV/HCV infected coworkers.

CONCLUSION

Overall, this study suggests that age may be associated with prejudice toward HIV and HBV/HCV infected colleagues among the working age population of Japan. As such, policy makers should consider the age of participants when formulating efforts to reduce prejudice toward HIV and HBV/HCV infected workers.

Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature

IMPORTANCE

Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines.

OBJECTIVE

To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage.

EVIDENCE REVIEW

We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males.

FINDINGS

Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine's effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children.

CONCLUSIONS AND RELEVANCE

Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.

Health information seeking partially mediated the association between socioeconomic status and self-rated health among Hong Kong Chinese

Background

Poor self-rated health (SRH) is socially patterned with health communication inequalities, arguably, serving as one mechanisms. This study investigated the effects of health information seeking on SRH, and its mediation effects on disparities in SRH.

Methods

We conducted probability-based telephone surveys administered over telephone in 2009, 2010/11 and 2012 to monitor health information use among 4553 Chinese adults in Hong Kong. Frequency of information seeking from television, radio, newspapers/magazines and Internet was dichotomised as <1 time/month and ≥1 time/month. Adjusted odds ratios (aOR) for poor SRH were calculated for health information seeking from different sources and socioeconomic status (education and income). Mediation effects of health information seeking on the association between SES and poor SRH was estimated.

Results

Poor SRH was associated with lower socioeconomic status (P for trend <0.001), and less than monthly health information seeking from newspapers/magazines (aOR = 1.23, 95% CI 1.07–1.42) and Internet (aOR = 1.13, 95% CI 0.98–1.31). Increasing combined frequency of health information seeking from newspapers/magazines and Internet was linearly associated with better SRH (P for trend <0.01). Health information seeking from these two sources contributed 9.2% and 7.9% of the total mediation effects of education and household income on poor SRH, respectively.

Conclusions

Poor SRH was associated with lower socioeconomic status, and infrequent health information seeking from newspapers/magazines and Internet among Hong Kong Chinese. Disparities in SRH may be partially mediated by health information seeking from newspapers/magazines and Internet.

Internet use and cancer-preventive behaviors in older adults: findings from a longitudinal cohort study

BACKGROUND

The Internet is a key provider of health information, but little is known about its associations with cancer-preventive behaviors. This study investigated the associations between Internet use and cancer-preventive behaviors among older adults.

METHODS

Data were taken from Waves 1 to 5 (2002-2011) of the English Longitudinal Study of Aging, a cohort study of men and women 50 years or older in England, United Kingdom. Internet use was recorded at each wave. Breast and colorectal screening, fruit and vegetable consumption, physical activity, and smoking were recorded at Wave 5. Social, cognitive, and physical function variables recorded at Wave 1 were analyzed as predictors of Internet use and included as covariates in analyses linking Internet use to behavior.

RESULTS

Of 5,943 respondents, 41.4% did not report any Internet use, 38.3% reported using it in one to three waves ("intermittent users"), and 20.3% used it in all waves ("consistent users"). Internet use was higher in younger, male, White, wealthier, more educated respondents, and those without physical limitations. Multivariable analysis showed that consistent users were more likely than "never users" to report CRC screening, weekly moderate/vigorous physical activity, and five or more daily servings of fruit and vegetables, and less likely to report smoking. There was no significant association between Internet use and breast screening.

CONCLUSIONS

Internet use showed a quantitative association with cancer-preventive behaviors even after controlling for various social, cognitive, and physical correlates of Internet use.

IMPACT

Promoting Internet use among older adults from all backgrounds could contribute to improving cancer outcomes and reducing inequalities.

Knowledge of HBV and HCV and individuals' attitudes toward HBV- and HCV-infected colleagues: a national cross-sectional study among a working population in Japan

Prejudice and discrimination in the workplace regarding the risk of transmission of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are increased by excess concerns due to a lack of relevant knowledge. Education to increase knowledge about HBV and HCV and their prevention could be the first step to reduce prejudice and discrimination. This study aimed to determine the association between the level of knowledge and negative attitudes toward HBV- and HCV-infected colleagues among the Japanese working population. An online anonymous nationwide survey involving about 3,000 individuals was conducted in Japan. The questionnaire consisted of knowledge of HBV and HCV, and attitudes toward HBV- and HCV-infected colleagues in the workplace. Knowledge was divided into three categories: "ensuring daily activities not to be infected"; "risk of infection"; and "characteristics of HBV/HCV hepatitis", based on the result of factor analysis. Multiple logistic regression analysis was applied. A total of 3,129 persons responded to the survey: 36.0% reported they worried about the possibility of transmission of HBV and HCV from infected colleagues; 32.1% avoided contact with infected colleagues; and 23.7% had prejudiced opinions about HBV and HCV infection. The participants were classified into tertiles. A higher level of knowledge of HBV and HCV was significantly associated with these three negative attitudes (P for trend < 0.005). This study suggests that increasing knowledge may decrease individuals' negative attitudes towards HBV- and HCV-infected colleagues. Thus, we should promote increased knowledge of HBV and HCV in stages to reduce negative attitudes toward HBV- and HCV-infected colleagues.

Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents' H1N1 vaccination of their children

During the H1N1 pandemic in 2009-10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents' health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents' health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n=639) to investigate Parents' H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents' H1N1-related knowledge. In addition, the parents' degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.