Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study

OBJECTIVES

Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months.

METHODS

The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time.

RESULTS

A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up.

CONCLUSION

The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.

Humoral Immune Response to Messenger RNA Coronavirus Disease 2019 Vaccination Among Children Aged 5-11 Years in a Multisite Prospective Cohort Study, September 2021-September 2022

Background

The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 states: Arizona, Florida, exas, and Utah. This study aims to examine vaccine-elicited antibody response against postvaccination SARS-CoV-2 infections.

Methods

Children aged 5-11 years had serum collected 14-59 days after their second dose of monovalent Pfizer-BioNTech coronavirus disease 2019 messenger RNA vaccine. Vaccine-elicited antibodies were measured using the area under the curve (AUC) and end-point titer using enzyme-linked immunosorbent assay (receptor-binding domain [RBD] and S2) and surrogate neutralization assays against ancestral (WA1) and Omicron (BA.2).

Results

79 vaccinated participants (33 [41.7%] female; median age, 8.8 years [standard deviation, 1.9 years]), 48 (60.8%) were from Tucson, Arizona; 64 (81.0%) were non-Hispanic white; 63 (80.8%) attended school in person; 68 (86.1%) did not have any chronic conditions; and 47 (59.5%) were infected after vaccination. Uninfected children had higher AUCs against WA1 (P = .009) and Omicron (P = .02). The geometric mean and surrogate neutralization titer above the limit of detection was 346.0 for WA1 and 39.7 for Omicron, an 8.7-fold decrease (P < .001). After adjustment of covariates in the WA1-specific model, we observed a 47% reduction in the odds of postvaccination infection for every standard deviation increase in RBD AUC (aOR, 0.53 [95% confidence interval, .29-.97) and a 69% reduction in the odds of infection for every 3-fold increase in RBD end titer (0.31 [.06-1.57]).

Conclusions

Children with higher antibody levels experienced a lower incidence of postvaccination SARS-CoV-2 infection.

A How-to Guide to Building a Robust SARS-CoV-2 Testing Program at a University-Based Health System

When South Florida became a hot spot for COVID-19 disease in March 2020, we faced an urgent need to develop test capability to detect SARS-CoV-2 infection. We assembled a transdisciplinary team of knowledgeable and dedicated physicians, scientists, technologists, and administrators who rapidly built a multiplatform, polymerase chain reaction- and serology-based detection program, established drive-through facilities, and drafted and implemented guidelines that enabled efficient testing of our patients and employees. This process was extremely complex, due to the limited availability of needed reagents, but outreach to our research scientists and multiple diagnostic laboratory companies, and government officials enabled us to implement both Food and Drug Administration authorized and laboratory-developed testing–based testing protocols. We analyzed our workforce needs and created teams of appropriately skilled and certified workers to safely process patient samples and conduct SARS-CoV-2 testing and contact tracing. We initiated smart test ordering, interfaced all testing platforms with our electronic medical record, and went from zero testing capacity to testing hundreds of health care workers and patients daily, within 3 weeks. We believe our experience can inform the efforts of others when faced with a crisis situation.

SAT-439 Thyroid Ultrasound Reports and Thyroid Function Tests in Florida Firefighters: Data from the Firefighter Cancer Initiative

Background: Several epidemiological studies suggest firefighters are at risk for numerous site-specific malignancies, including thyroid cancer. However, it is not well known if chronic exposure to carcinogenic compounds or radio frequency radiation, increases the rate of thyroid nodules and/or affect the thyroid function in this high-risk occupational group. To gain a better understanding, we examine the rate of thyroid nodules and assess the presence of thyroid dysfunction in a sample of Florida firefighters. Methods: A cross sectional study design was conducted to evaluate 103 firefighters, with not known thyroid disease, who were assessed by a physician-performed, real time ultrasound protocol followed by a blood collection to evaluate TSH, Free T4, T4, T3, TPO and Tg antibodies. Additional data such as gender, age and race were also collected and analyzed. Results: Among the 103 firefighters who completed the study protocol, the sample mean age was 39.4+-7.6 years (range 26 to 60) 88.4% male, 87.6% Caucasian and 65% Hispanic. 8.7% of men and 33% of women were found to have thyroid nodules. Of the 20 participants with thyroid nodules only three nodules were above 1 cm, and only one was classified as high risk and met criteria for fine needle aspiration. 8.7 % of men and 33% of women were found to have +TPO antibodies. 18.6% of men and 25% of women were found to have isolated low T3. Conclusion: The prevalence of thyroid nodules, and of Hashimoto thyroiditis, among Florida firefighters, is comparable with the rate found in the general population based on previous epidemiological data. Surprisingly, we found that a significant number of subjects have isolated low T3. In this study, the level of Free T3 was not assessed, however since T4 was normal, we can conclude that the low T3 was not related to a low level of TBG. Low T3 is usually found in systemic illness and has been postulated as a prognostic factor in cardiovascular disease, chronic fatigue syndrome, survival after stroke, and Alzheimer’s disease. The clinical significance and the prevalence of Low T3 in a healthy population has not been well described. Further research is needed to fully understand the significance of this finding.

A How-to Guide to Building a Robust SARS-CoV-2 Testing Program at a University-Based Health System

When South Florida became a hot spot for COVID-19 disease in March 2020, we faced an urgent need to develop test capability to detect SARS-CoV-2 infection. We assembled a transdisciplinary team of knowledgeable and dedicated physicians, scientists, technologists, and administrators who rapidly built a multiplatform, polymerase chain reaction- and serology-based detection program, established drive-through facilities, and drafted and implemented guidelines that enabled efficient testing of our patients and employees. This process was extremely complex, due to the limited availability of needed reagents, but outreach to our research scientists and multiple diagnostic laboratory companies, and government officials enabled us to implement both Food and Drug Administration authorized and laboratory-developed testing-based testing protocols. We analyzed our workforce needs and created teams of appropriately skilled and certified workers to safely process patient samples and conduct SARS-CoV-2 testing and contact tracing. We initiated smart test ordering, interfaced all testing platforms with our electronic medical record, and went from zero testing capacity to testing hundreds of health care workers and patients daily, within 3 weeks. We believe our experience can inform the efforts of others when faced with a crisis situation.

Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk

Firefighters are exposed to carcinogens such as volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) during fires and from their personal protective equipment (PPE). Recent research has shown that decontamination processes can reduce contamination on both gear and skin. While firefighter cultures that honor dirty gear are changing, little is known about current attitudes and behaviors toward decontamination in the fire service. Four hundred eighty-five firefighters from four departments completed surveys about their attitudes, beliefs, perceived norms, barriers, and behaviors toward post-fire decontamination processes. Overall, firefighters reported positive attitudes, beliefs, and perceived norms about decontamination, but showering after a fire was the only decontamination process that occurred regularly, with field decontamination, use of cleansing wipes, routine gear cleaning, and other behaviors all occurring less frequently. Firefighters reported time and concerns over wet gear as barriers to decontamination.

Health-related quality of life and nicotine dependence, Florida 2007

OBJECTIVE

To explore the relationship between health-related quality of life (HRQOL) and nicotine dependence in a representative sample of 3560 Florida smokers.

METHODS

Data from the 2007 Behavioral Risk Factor Surveillance System-Florida Tobacco Callback Survey were used. Logistic regression models were conducted to identify factors independently associated with HRQOL measures.

RESULTS

Greater nicotine dependence was associated with poor/fair self-rated health, 1-29 days of poor physical health, and poor mental health, and inactivity in the past 30 days.

CONCLUSIONS

The consequences of long-term smoking, and thus nicotine dependence, may not be confined to traditional morbidity measures but may include poor perceived health and overall well-being.

Menthol cigarette smoking and health, Florida 2007 BRFSS

OBJECTIVE

To examine associations between menthol cigarette smoking and nicotine dependence, quit attempts, and physical and mental health.

METHODS

Data were drawn from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) and a follow-up survey among current smokers (N = 3396). Univariate and multivariate logistic regression analyses were conducted.

RESULTS

In multivariate analyses, menthol cigarette smoking was associated with women, African American and Hispanic race/ethnicity, and greater mental distress.

CONCLUSIONS

Women, racial/ethnic minorities, and individuals reporting a greater frequency of mental distress are more likely to smoke menthol versus nonmenthol cigarettes. Implications for public health policy and cessation interventions are discussed.

Cancer screening behaviors among smokers and non-smokers

OBJECTIVE

We explored whether smoking is associated with cancer screening behaviors.

METHODS

We used data from the 2007 Florida Behavioral Risk Factor Surveillance System and the Florida Tobacco Callback Survey to examine screening behaviors related to four cancer types (breast, cervical, prostate, and colorectal). Using multiple logistic regression analyses, we examined the association between smoking status and health screening behaviors.

RESULTS

For 10 of the 11 cancer screening variables, being a current smoker was significantly associated with being less likely to ever have been screened and also less likely to be compliant with screening guidelines. For breast and cervical cancer, level of nicotine dependence was also significantly related to compliance with screening recommendations; women with higher levels of dependence were less likely to be compliant.

CONCLUSIONS

Our results support the notion that individuals' actions related to their health are consistent across different types of behaviors. We found that smokers were less likely to engage in cancer screening behaviors. In addition, among smokers, individuals with greater nicotine dependence had lower compliance with some screening tests. Physicians should ensure that their patients who smoke are receiving appropriate and adequate screening for cancer.

Sleep disorders and secondhand smoke exposure in the U.S. population

INTRODUCTION

Sleep disorders in the United States are pervasive and have been linked to increased risk of injury, morbidity, and mortality. Smoking is a known risk factor for sleep disorders; the association between secondhand smoke (SHS) exposure and sleep disorders is less clear. We sought to examine the relationship between SHS exposure and sleep disorders among a representative sample of U.S. adults (n = 4,123).

METHODS

Data were from the 2005-2006 National Health and Nutrition Examination Survey. Multivariable logistic regression models examined the association between both smoking and SHS exposure with two measures of sleep disorder (i.e., self-reported health care provider diagnosis and self-report of two or more sleep symptoms). SHS exposure status was based on a combination of self-report and serum cotinine levels.

RESULTS

Relative to nonsmokers without SHS exposure, smokers were significantly more likely to have been diagnosed with a sleep disorder (odds ratio [OR] = 1.73 [95% CI = 1.16-2.60]) and more likely to report at least two sleep disorder symptoms (OR = 1.42 [95% CI = 1.09-1.84]). SHS-exposed nonsmokers were not significantly more likely to report a sleep disorder or sleep symptoms (OR = 1.43 [95% CI = 0.79-2.57] and OR = 1.03 [95% CI = 0.83-1.27]), respectively.

DISCUSSION

Although smoking appears to play an important role in the prevalence of sleep disorders in the U.S. adult population, the role of SHS exposure is inconclusive and warrants further investigation.

Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007

OBJECTIVE

The public health burden of tobacco-associated diseases in the USA remains high, in part because many people's attempts to quit are unsuccessful. This study examined factors associated with having lifetime or recent attempts to quit smoking among current smokers, based on a telephone survey of Florida adults.

METHODS

Data from the 2007 telephone-based Florida Behavioral Risk Factor Surveillance System (BRFSS) and its follow-up survey, the Tobacco Callback Survey, were used to assess determinants of having ever attempted to quit smoking and attempted to quit smoking in the past 12 months. All analyses were conducted using SAS.

RESULTS

Among 3,560 current smokers, 41.5% reported having tried to quit smoking in the past 12 months while 83.4% reported having ever tried to quit. Having a history of a tobacco-related medical condition was significantly associated with both recent (Adjusted Odds Ratio (AOR) 1.41 [Confidence Interval 1.19-1.65]) and lifetime quit attempts (AOR 1.43 [1.15-1.79]). Greater nicotine dependence and being advised by a physician to quit smoking were also positively associated with lifetime quit attempts. Receipt of healthcare provider advice to quit smoking in the past 12 months and a strong belief that quitting following a long history of regular smoking would not result in health benefits and belief that there are health benefits to quitting smoking were associated with lifetime quit attempts.

CONCLUSION

Targeted smoking cessation interventions are needed for smokers with selected medical conditions and with high nicotine dependence. The importance of physician advice in encouraging individuals to quit is further highlighted.