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Painter MR, Tapp T, Painter JE. Use of the Health Belief Model to identify factors associated with owner adherence to elimination diet trial recommendations in dogs. J Am Vet Med Assoc 2020; 255:446-453. [PMID: 31355724 DOI: 10.2460/javma.255.4.446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To use the Health Belief Model to identify factors associated with owner adherence to elimination diet trial (EDT) recommendations by veterinarians for dogs with suspected cutaneous adverse food reactions (CAFRs). SAMPLE 192 owners of dogs prescribed an EDT between April 1, 2012, and April 1, 2017. PROCEDURES Owners of dogs prescribed an EDT to diagnose CAFRs were identified through review of medical records from a single veterinary dermatology specialty practice. Identified owners were invited to participate in an anonymous online survey that was developed on the basis of the Health Belief Model. Multivariable logistic regression was used to evaluate associations between potential predictor variables and 100% adherence to EDT recommendations. RESULTS 665 owners were invited to participate, and 192 (28.9%) completed the survey. Of the 192 respondents, 77 (40.1%) reported 100% adherence to EDT recommendations, and 115 (59.9%) reported < 100% adherence. Results indicated that the odds of owners reporting 100% adherence to EDT recommendations were significantly decreased by owner perception of barriers (adjusted OR [ORa] = 0.86) and were significantly increased by owner knowledge regarding diets and CAFRs in dogs (ORa = 1.30) and by self-efficacy or confidence in performing an EDT as directed (ORa = 1.18). CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated that most prescribed EDTs were not followed strictly. Interventions to help owners reduce perceived barriers, increase self-efficacy, and improve related knowledge could improve adherence to EDT recommendations and, thereby, increase the diagnostic utility of EDTs.
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Jacobsen KH, McCoy JD, Painter JE. Authors' Response “Perceptions of vaccination within a Christian homeschooling community in Pennsylvania”. Vaccine 2019; 37:5667. [DOI: 10.1016/j.vaccine.2019.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
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Yang C, Krishnan N, Painter JE, Latkin C. The Association Between Disclosure of Same Sex Behavior to Healthcare Providers and PrEP Awareness Among BMSM in Baltimore. AIDS Behav 2019; 23:1888-1892. [PMID: 30666521 DOI: 10.1007/s10461-019-02401-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of this study was to explore the association between disclosure of same sex behavior to a healthcare provider and PrEP awareness in a sample of 192 Black MSM in Baltimore. After adjusting for age, education, sexual identity and employment status, we observed a trend of greater PrEP awareness among Black MSM who disclosed same sex behaviors to healthcare providers (adjusted odds ratio = 2.24, p = 0.08). This study provides new evidence of potential benefit of disclosure of same sex behavior to healthcare providers for awareness of new HIV biomedical interventions. Findings highlight the need to support patient-provider communication on sexual behaviors and PrEP with key populations at risk of HIV.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd FL, Baltimore, MD, 21205, USA.
| | - Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, DC, USA
| | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd FL, Baltimore, MD, 21205, USA
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McCoy JD, Painter JE, Jacobsen KH. Perceptions of vaccination within a Christian homeschooling community in Pennsylvania. Vaccine 2018; 37:5770-5776. [PMID: 30253888 DOI: 10.1016/j.vaccine.2018.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND More than 1.8 million American children ages 5-17 are being educated at home. The percentage of school-aged children in the United States who are homeschooled increased from 1.7% in 1999 to 3.4% in 2012. Every state has established school-entry vaccination requirements for kindergarten students, but most states exempt homeschoolers from these regulations. The goal of this study was to use qualitative methods to examine the vaccination perceptions and practices of Christian homeschooling families in Pennsylvania. METHODS A qualitative study (focus groups) of Christian homeschooling parents representing a diversity of vaccination practices (full, partial/delayed, and no vaccination) was conducted in south-central Pennsylvania in 2017. An analysis using a grounded theory approach identified themes that strongly aligned with constructs from the Health Belief Model. RESULTS Many of the perspectives expressed by the study population aligned with those of the general American population, including uncertainty about the risk from vaccine-preventable diseases, concerns about the efficacy and safety of vaccines, and confusion about conflicting vaccine information. The Christian homeschooling parents expressed two especially prominent perceptions: a belief that they had a very low risk of contracting infectious diseases because God has provided them with the natural tools necessary for health and a stronger-than-typical sense of empowerment related to parental decision-making and autonomy. Participants expressed that they were generally open to honest communication about vaccination with physicians who respect parental authority. CONCLUSIONS Homeschooling families have diverse vaccination practices. Pediatricians and other healthcare practitioners should not make assumptions about health beliefs in this community, and should instead engage parents in conversations about their risk perceptions and vaccine decisions.
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Affiliation(s)
- Jeremiah D McCoy
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA
| | - Julia E Painter
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA
| | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA.
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Painter JE, Viana De O. Mesquita S, Jimenez L, Avila AA, Sutter CJ, Sutter R. Vaccine-related attitudes and decision-making among uninsured, Latin American immigrant mothers of adolescent daughters: a qualitative study. Hum Vaccin Immunother 2018; 15:121-133. [PMID: 30199302 PMCID: PMC6363134 DOI: 10.1080/21645515.2018.1514353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/27/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022] Open
Abstract
Uninsured Latin American immigrant women are at increased risk for vaccine preventable diseases, such as cervical cancer; yet gaps in vaccine coverage persist. The purpose of this study was to explore vaccine-related knowledge, attitudes and decision-making for tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) vaccine among uninsured Latin American immigrant mothers of adolescent daughters. A purposive sample of 30 low-income, uninsured, predominantly Latin-American immigrant mothers of adolescent daughters aged 13-17 were recruited from two academic-community managed health clinics in Virginia. From March-September 2016, data were collected through in-person, semi-structured interviews, in English or Spanish. For data analysis, conventional content analysis was employed. The majority of participants self-identified as Hispanic and had less than a high-school level education. Key themes included: general acceptance of vaccines; associating vaccines with prevention/protection; minimal vaccine hesitancy; and lack of knowledge regarding vaccine-preventable diseases, vaccines recommended for adolescents, and adolescent daughters' vaccination history. Doctors' recommendation, school requirements, and the media were key influencers of vaccination. Mothers were the primary decision-maker regarding vaccine uptake among their adolescent daughters. Findings highlight the need for efforts to help uninsured Latin American immigrant mothers better understand vaccines, and provide linkages to affordable, accessible vaccines among under-resourced populations.
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Affiliation(s)
- Julia E. Painter
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | - Lauren Jimenez
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Arturo A. Avila
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | - Rebecca Sutter
- School of Nursing, George Mason University, Fairfax, VA, USA
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Rossheim ME, Krall JR, Painter JE, Thombs DL, Stephenson CJ, Suzuki S, Cannell MB, Livingston MD, Gonzalez-Pons KM, Wagenaar AC. Alcohol retail sales licenses and sexually transmitted infections in Texas counties, 2008-2015. Am J Drug Alcohol Abuse 2018; 44:678-685. [PMID: 29863903 DOI: 10.1080/00952990.2018.1477944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Research suggests that reduced retail alcohol outlet density may be associated with lower prevalence of HIV and other sexually transmitted infections (STIs). On-premise sale of alcohol for immediate consumption is theorized as increasing social interactions that can lead to sexual encounters. OBJECTIVE We examined associations between on- and off-premise retail alcohol sales licenses and number of newly diagnosed HIV and STI cases in Texas counties. METHODS Retail alcohol sales license data were obtained from the Texas Alcoholic Beverage Commission. HIV and bacterial STI data were obtained from the Texas Department of State Health Services. Associations between retail alcohol sales licenses and STIs were estimated using spatial linear models and Poisson mixed effects models for over-dispersed count data. RESULTS Adjusting for county-specific confounders, there was no evidence of residual spatial correlation. In Poisson models, each additional on-premise (e.g., bar and restaurant) alcohol license per 10,000 population in a county was associated with a 1.5% increase (95% CI: 0.4%, 2.6%) in the rate of HIV and a 2.4% increase (95% CI: 1.9%, 3.0%) in the rate of bacterial STIs, adjusting for potential confounders. In contrast, number of off-premise licenses (e.g., take-out stores) was inversely associated with the incidence of STI and HIV, although the association with HIV was not statistically significant. CONCLUSIONS This study adds to the limited literature on the association between retail alcohol availability and STIs. Additional research is needed on the role of alcohol availability (and policies affecting availability) in the spread of HIV and other STIs.
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Affiliation(s)
- Matthew E Rossheim
- a Department of Global and Community Health , George Mason University , Fairfax , VA, USA
| | - Jenna R Krall
- a Department of Global and Community Health , George Mason University , Fairfax , VA, USA
| | - Julia E Painter
- a Department of Global and Community Health , George Mason University , Fairfax , VA, USA
| | - Dennis L Thombs
- b Department of Health Behavior and Health Systems , The University of North Texas Health Science Center, School of Public Health , Fort Worth , TX, USA
| | - Caroline J Stephenson
- c Department of Environmental and Global Health , University of Florida , Gainesville , FL, USA
| | - Sumihiro Suzuki
- d Department of Biostatistics and Epidemiology , The University of North Texas Health Science Center, School of Public Health , Fort Worth , TX, USA
| | - M Brad Cannell
- d Department of Biostatistics and Epidemiology , The University of North Texas Health Science Center, School of Public Health , Fort Worth , TX, USA
| | - Melvin D Livingston
- d Department of Biostatistics and Epidemiology , The University of North Texas Health Science Center, School of Public Health , Fort Worth , TX, USA
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Painter JE, von Fricken ME, Viana de O Mesquita S, DiClemente RJ. Willingness to pay for an Ebola vaccine during the 2014-2016 ebola outbreak in West Africa: Results from a U.S. National sample. Hum Vaccin Immunother 2018; 14:1665-1671. [PMID: 29333950 DOI: 10.1080/21645515.2018.1423928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The 2014-2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30-May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1-50; 174 (20.1%) would pay $51-100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.
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Affiliation(s)
- Julia E Painter
- a Department of Global and Community Health , College of Health and Human Services, George Mason University , Fairfax , VA , USA
| | - Michael E von Fricken
- a Department of Global and Community Health , College of Health and Human Services, George Mason University , Fairfax , VA , USA
| | - Suyane Viana de O Mesquita
- a Department of Global and Community Health , College of Health and Human Services, George Mason University , Fairfax , VA , USA
| | - Ralph J DiClemente
- b Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Painter JE, Temple BS, Woods LA, Cwiak C, Haddad LB, Mulligan MJ, DiClemente RJ. Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation Among African American Women. Health Educ Behav 2017; 45:444-453. [PMID: 29073834 DOI: 10.1177/1090198117736860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Licensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of actual RC in a postlicensure era. This study assessed factors associated with interest in an HIV vaccine for reasons indicative of RC among African American women aged 18 to 55 years, recruited from a hospital-based family planning clinic in Atlanta, Georgia ( N = 321). Data were collected using audio-computer-assisted surveys. Survey items were guided by risk homeostasis theory and social cognitive theory. Multivariable logistic regression was used to assess determinants of interest in an HIV vaccine for reasons indicative of RC. Thirty-eight percent of the sample expressed interest in an HIV vaccine for at least one reason indicative of RC. In the final model, interest in an HIV vaccine for reasons indicative of RC was positively associated with higher impulsivity, perceived benefits of sexual risk behaviors, and perceived benefits of HIV vaccination; it was negatively associated with having at least some college education, positive future orientation, and self-efficacy for sex refusal. Results suggest that demographic, personality, and theory-based psychosocial factors are salient to wanting an HIV vaccine for reasons indicative of RC, and underscore the need for risk-reduction counseling alongside vaccination during the eventual rollout of an HIV vaccine.
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Painter JE, Plaster AN, Tjersland DH, Jacobsen KH. Zika virus knowledge, attitudes, and vaccine interest among university students. Vaccine 2017; 35:960-965. [PMID: 28069360 DOI: 10.1016/j.vaccine.2016.12.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Zika virus vaccine development is underway. We examined interest in receiving a Zika virus vaccine (after one becomes commercially available) among students at a large public university in Northern Virginia. METHODS An online survey of Zika virus-related knowledge, attitudes, and interest in receiving a Zika vaccine was completed by 619 undergraduate students in April, 2016. Stepwise logistic regression with backward elimination was used to identify the variables most strongly associated with interest in being vaccinated against Zika virus. RESULTS More than half of participants (52.8%) reported that they would be likely or very likely to be vaccinated against Zika virus. Vaccination interest was significantly higher among participants who received an influenza vaccine in the past year (p=0.002), had higher levels of knowledge about Zika virus (p=0.046), reported knowing where to access information about Zika virus (p=0.041), had higher perceived susceptibility to Zika virus (p<0.001), and believed that the U.S. Government should prioritize actions to control Zika virus (p=0.001). CONCLUSIONS Communication and intervention strategies encouraging vaccine uptake may benefit from increasing knowledge of Zika virus, addressing perceived susceptibility, and reaching students, travelers, and others who may be seeking information about prevention of Zika virus and other emerging infectious diseases.
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Affiliation(s)
- Julia E Painter
- Department of Global and Community Health, College of Health and Human Services, George Mason University, United States.
| | - Ashley N Plaster
- Department of Global and Community Health, College of Health and Human Services, George Mason University, United States.
| | - Dylan H Tjersland
- Department of Global and Community Health, College of Health and Human Services, George Mason University, United States.
| | - Kathryn H Jacobsen
- Department of Global and Community Health, College of Health and Human Services, George Mason University, United States.
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Painter JE, DiClemente RJ, von Fricken ME. Interest in an Ebola vaccine among a U.S. national sample during the height of the 2014–2016 Ebola outbreak in West Africa. Vaccine 2017; 35:508-512. [DOI: 10.1016/j.vaccine.2016.11.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/18/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Yang YT, Painter JE, Meier BM. Coordinated regulatory efforts needed to strengthen travel related immunization requirements against importation of infectious diseases. Vaccine 2016; 34:3921-2. [PMID: 27344292 DOI: 10.1016/j.vaccine.2016.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States.
| | - Julia E Painter
- Department of Global and Community Health, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States.
| | - Benjamin Mason Meier
- Department of Public Policy, University of North Carolina, Chapel Hill, 103 Abernethy Hall, Chapel Hill, NC 27599-3435, United States.
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Kobayashi M, Beer KD, Bjork A, Chatham-Stephens K, Cherry CC, Arzoaquoi S, Frank W, Kumeh O, Sieka J, Yeiah A, Painter JE, Yoder JS, Flannery B, Mahoney F, Nyenswah TG. Community Knowledge, Attitudes, and Practices Regarding Ebola Virus Disease - Five Counties, Liberia, September-October, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:714-8. [PMID: 26158352 PMCID: PMC4584843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As of July 1, 2015, Guinea, Liberia, and Sierra Leone have reported a total of 27,443 confirmed, probable, and suspected Ebola virus disease (Ebola) cases and 11,220 deaths. Guinea and Sierra Leone have yet to interrupt transmission of Ebola virus. In January, 2016, Liberia successfully achieved Ebola transmission-free status, with no new Ebola cases occurring during a 42-day period; however, new Ebola cases were reported beginning June 29, 2015. Local cultural practices and beliefs have posed challenges to disease control, and therefore, targeted, timely health messages are needed to address practices and misperceptions that might hinder efforts to stop the spread of Ebola. As early as September 2014, Ebola spread to most counties in Liberia. To assess Ebola-related knowledge, attitudes, and practices (KAP) in the community, CDC epidemiologists who were deployed to the counties (field team), carried out a survey conducted by local trained interviewers. The survey was conducted in September and October 2014 in five counties in Liberia with varying cumulative incidence of Ebola cases. Survey results indicated several findings. First, basic awareness of Ebola was high across all surveyed populations (median correct responses = 16 of 17 questions on knowledge of Ebola transmission; range = 2-17). Second, knowledge and understanding of Ebola symptoms were incomplete (e.g., 61% of respondents said they would know if they had Ebola symptoms). Finally, certain fears about the disease were present: >90% of respondents indicated a fear of Ebola patients, >40% a fear of cured patients, and >50% a fear of treatment units (expressions of this last fear were greater in counties with lower Ebola incidence). This survey, which was conducted at a time when case counts were rapidly increasing in Liberia, indicated limited knowledge of Ebola symptoms and widespread fear of Ebola treatment units despite awareness of communication messages. Continued efforts are needed to address cultural practices and beliefs to interrupt Ebola transmission.
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Affiliation(s)
- Miwako Kobayashi
- Epidemic Intelligence Service, CDC,National Center for Immunization and Respiratory Diseases, CDC,Corresponding author: Miwako Kobayashi, , 404-639-2912
| | - Karlyn D. Beer
- Epidemic Intelligence Service, CDC,National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Adam Bjork
- Division of Global HIV/AIDS, Center for Global Health
| | | | - Cara C. Cherry
- Epidemic Intelligence Service, CDC,National Park Service, Biological Resources Division, Wildlife Health Branch/Office of Public Health, Fort Collins, Colorado
| | | | | | | | | | | | - Julia E. Painter
- Epidemic Intelligence Service, CDC,National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | - Frank Mahoney
- Global Immunization Division, Center for Global Health, CDC
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Painter JE, Gargano JW, Collier SA, Yoder JS. Giardiasis surveillance -- United States, 2011-2012. MMWR Suppl 2015; 64:15-25. [PMID: 25928582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
PROBLEM/CONDITION Giardiasis is a nationally notifiable gastrointestinal illness caused by the protozoan parasite Giardia intestinalis. REPORTING PERIOD 2011-2012. DESCRIPTION OF SYSTEM Forty-four states, the District of Columbia, New York City, the Commonwealth of Puerto Rico, and Guam voluntarily reported cases of giardiasis to CDC through the National Notifiable Diseases Surveillance System (NNDSS). RESULTS For 2011, a total of 16,868 giardiasis cases (98.8% confirmed and 1.2% nonconfirmed) were reported; for 2012, a total of 15,223 cases (98.8% confirmed and 1.3% nonconfirmed) were reported. In 2011 and 2012, 1.5% and 1.3% of cases, respectively, were associated with a detected outbreak. The incidence rates of all reported cases were 6.4 per 100,000 population in 2011 and 5.8 per 100,000 population in 2012. This represents a slight decline from the relatively steady rates observed during 2005-2010 (range: 7.1-7.9 cases per 100,000 population). In both 2011 and 2012, cases were most frequently reported in children aged 1-4 years, followed by those aged 5-9 years and adults aged 45-49 years. Incidence of giardiasis was highest in Northwest states. Peak onset of illness occurred annually during early summer through early fall. INTERPRETATION For the first time since 2002, giardiasis rates appear to be decreasing. Possible reasons for the decrease in rates during 2011-2012 could include changes in transmission patterns, a recent change in surveillance case definition, increased uptake of strategies to reduce waterborne transmission, or a combination of these factors. Transmission of giardiasis occurs throughout the United States, with more frequent diagnosis or reporting occurring in northern states. Geographical differences might suggest actual regional differences in giardiasis transmission or variation in surveillance capacity across states. Six states did not report giardiasis cases in 2011-2012, representing the largest number of nonreporting states since giardiasis became nationally notifiable in 2002. Giardiasis is reported more frequently in young children, which might reflect increased contact with contaminated water or ill persons, or a lack of immunity. PUBLIC HEALTH ACTION Educational efforts to decrease exposure to unsafe drinking and recreational water and prevent person-to-person transmission have the potential to reduce giardiasis transmission. The continual decrease in jurisdictions opting to report giardiasis cases could negatively impact the ability to interpret national surveillance data; thus, further investigation is needed to identify barriers to and facilitators of giardiasis case reporting. Existing state and local public health infrastructure supported through CDC (e.g., Epidemiology and Laboratory Capacity grants and CDC-sponsored Council of State and Territorial Epidemiologists Applied Epidemiology Fellows) could provide resources to enhance understanding of giardiasis epidemiology.
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Painter JE, Hlavsa MC, Collier SA, Xiao L, Yoder JS. Cryptosporidiosis surveillance -- United States, 2011-2012. MMWR Suppl 2015; 64:1-14. [PMID: 25928581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
PROBLEM/CONDITION Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by extremely chlorine-tolerant protozoa of the genus Cryptosporidium. REPORTING PERIOD 2011-2012. DESCRIPTION OF SYSTEM Fifty state and two metropolitan public health agencies voluntarily report cases of cryptosporidiosis through CDC's National Notifiable Diseases Surveillance System. RESULTS For 2011, a total of 9,313 cryptosporidiosis cases (confirmed and nonconfirmed) were reported; for 2012, a total of 8,008 cases were reported; 5.8% and 5.3%, respectively, were associated with a detected outbreak. The rates of reported nonconfirmed cases were 1.0 and 0.9 per 100,000 population in 2011 and 2012, respectively, compared with an average of 0.0 during 1995-2004, and 0.3 during 2005-2010. The highest overall reporting rates were observed in the Midwest; 10 states reported >3.5 cases per 100,000 population in 2011 and in 2012. During 2011-2012, reported cases were highest among children aged 1-4 years (6.6 per 100,000 population), followed for the first time by elderly adults aged ≥80 years (3.4), and 75-79 years (3.3). Overall, cryptosporidiosis rates were higher among females than males during both years. For specific age groups, rates were higher among males than females aged <15 years and higher among females than males aged ≥15 years. Cryptosporidiosis symptom onset increased 4.4 fold during late summer. INTERPRETATION Cryptosporidiosis incidence rates remain elevated nationally, and rates of nonconfirmed cases have increased. Rates remain highest in young children, although rates among elderly adults are increasing. Transmission of Cryptosporidium occurs throughout the United States, with increased reporting occurring in Midwestern states. Seasonal onset peaks coincide with the summer recreational water season and might reflect increased use of communal swimming venues. PUBLIC HEALTH ACTION Future research is needed to address the evolving epidemiology of cryptosporidiosis cases, with a specific focus on the increase in nonconfirmed cases and increasing incidence rates among elderly adults. National systematic genotyping and subtyping of Cryptosporidium isolates could also help elucidate Cryptosporidium transmission and thus cryptosporidiosis epidemiology in the United States.
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Painter JE, Walker AT, Pytell J, Nua MT, Soliai-Lemusu S, Mintz E, Ali I, Parsons M, Martin H, Beach M, Bowen A, Cope J. Notes from the field: outbreak of diarrheal illness caused by Shigella flexneri - American Samoa, May-June 2014. MMWR Morb Mortal Wkly Rep 2015; 64:30. [PMID: 25590684 PMCID: PMC4584797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15-June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0-9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages.
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Affiliation(s)
- Julia E. Painter
- Epidemic Intelligence Service, CDC,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC,Corresponding author: Julia E. Painter, , 404-718-4388
| | - Allison Taylor Walker
- Epidemic Intelligence Service, CDC,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jarratt Pytell
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Ibne Ali
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Michele Parsons
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Haley Martin
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Michael Beach
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Anna Bowen
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jennifer Cope
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Gargano LM, Herbert N, Painter JE, Sales JM, Morfaw C, Rask K, Murray D, DiClemente R, Hughes J. Clarification of "Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines". Hum Vaccin Immunother 2014; 10:2631. [PMID: 25483502 DOI: 10.4161/21645515.2014.972897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lisa M Gargano
- a Department of Medicine ; Emory University ; Atlanta , GA USA
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Herbert N, Painter JE, Sales JM, Morfaw C, Rask K, Murray D, DiClemente R, Hughes J, Gargano LM. Clarification of “Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines”. Hum Vaccin Immunother 2014. [DOI: 10.4161/hv.28625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Gargano LM, Herbert NL, Painter JE, Sales JM, Vogt TM, Morfaw C, Jones LM, Murray D, DiClemente RJ, Hughes JM. Development, theoretical framework, and evaluation of a parent and teacher-delivered intervention on adolescent vaccination. Health Promot Pract 2014; 15:556-67. [PMID: 24440920 DOI: 10.1177/1524839913518222] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Advisory Committee on Immunization Practices recommended immunization schedule for adolescents includes three vaccines (tetanus, diphtheria, and acellular pertussis [Tdap]; human papillomavirus [HPV] vaccine; and meningococcal conjugate vaccine [MCV4]) and an annual influenza vaccination. Given the increasing number of recommended vaccines for adolescents and health and economic costs associated with nonvaccination, it is imperative that effective strategies for increasing vaccination rates among adolescents are developed. This article describes the development, theoretical framework, and initial first-year evaluation of an intervention designed to promote vaccine acceptance among a middle and high school-based sample of adolescents and their parents in eastern Georgia. Adolescents, parents, and teachers were active participants in the development of the intervention. The intervention, which consisted of a brochure for parents and a teacher-delivered curriculum for adolescents, was guided by constructs from the health belief model and theory of reasoned action. Evaluation results indicated that our intervention development methods were successful in creating a brochure that met cultural relevance and the literacy needs of parents. We also demonstrated an increase in student knowledge of and positive attitudes toward vaccines. To our knowledge, this study is the first to extensively engage middle and high school students, parents, and teachers in the design and implementation of key theory-based educational components of a school-based, teacher-delivered adolescent vaccination intervention.
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Affiliation(s)
| | | | | | | | - Tara M Vogt
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Herbert NL, Gargano LM, Painter JE, Sales JM, Morfaw C, Murray D, Diclemente RJ, Hughes JM. Understanding reasons for participating in a school-based influenza vaccination program and decision-making dynamics among adolescents and parents. Health Educ Res 2013; 28:663-672. [PMID: 23727620 PMCID: PMC3708138 DOI: 10.1093/her/cyt060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/25/2013] [Indexed: 06/01/2023]
Abstract
Influenza remains a significant cause of morbidity and mortality in the United States. Vaccinating school-aged children has been demonstrated to be beneficial to the child and in reducing viral transmission to vulnerable groups such as the elderly. This qualitative study sought to identify reasons parents and students participated in a school-based influenza vaccination clinic and to characterize the decision-making process for vaccination. Eight focus groups were conducted with parents and students. Parents and students who participated in the influenza vaccination clinic stated the educational brochure mailed to their home influenced participation in the program. Parents of non-participating students mentioned barriers, such as the lengthy and complicated consent process and suspicions about the vaccine clinic, as contributing to their decision not to vaccinate their child. Vaccinated students reported initiating influenza vaccine discussion with their parents. Parental attitudes and the educational material influenced parents' decision to allow their child to receive influenza vaccine. This novel study explored reasons for participating in a school-based vaccination clinic and the decision-making process between parents and child(ren). Persons running future school-based vaccination clinics may consider hosting an 'information session with a question and answer session' to address parental concerns and assist with the consent process.
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Affiliation(s)
- Natasha L Herbert
- Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Gargano LM, Herbert NL, Painter JE, Sales JM, Morfaw C, Rask K, Murray D, DiClemente RJ, Hughes JM. Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines. Hum Vaccin Immunother 2013; 9:2627-33. [PMID: 23883781 DOI: 10.4161/hv.25823] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Four vaccines are recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices for adolescents. Parental attitudes may play a key role in vaccination uptake in this age group. In 2011, we conducted a cross-sectional survey among parents of adolescents in one county in Georgia to identify parental attitudes toward adolescent vaccination, reasons for vaccine acceptance or refusal, and impact of a physician recommendation for vaccination. Physician recommendation was reported as one of the top reasons for receipt or intent to receive any of the vaccines. Physician recommendation of any of the four vaccines was associated with receipt of Tdap (p<0.001), MCV4 (p<0.001), and HPV (p = 0.03) and intent to receive Tdap (p = 0.05), MCV4 (p = 0.005), and HPV (p = 0.05). Compared with parents who did not intend to have their adolescent vaccinated with any of the vaccines, parents who did intend reported higher perceived susceptibility (3.12 vs. 2.63, p = 0.03) and severity of disease (3.89 vs. 3.70, p = 0.02) and higher perceived benefit of vaccination (8.48 vs. 7.74, p = 0.02). These findings suggest that future vaccination efforts geared toward parents may benefit from addressing the advantages of vaccination and enhancing social norms. Physicians can play a key role by providing information on the benefits of adolescent vaccination.
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Affiliation(s)
| | | | | | | | - Christopher Morfaw
- East Central Health District; Georgia Department of Public Health; Augusta, GA USA
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Painter JE, Wingood GM, DiClemente RJ, Depadilla LM, Simpson-Robinson L. College graduation reduces vulnerability to STIs/HIV among African-American young adult women. Womens Health Issues 2012; 22:e303-10. [PMID: 22555218 DOI: 10.1016/j.whi.2012.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.
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Affiliation(s)
- Julia E Painter
- Vaccinology Training Program, Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia, USA.
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Berg CJ, Painter JE, Sales JM, Mays D, Rose E, Wingood GM, Diclemente RJ. Smoking as a risk factor for STI diagnosis among African American females. Am J Health Behav 2012; 36:505-12. [PMID: 22488400 DOI: 10.5993/ajhb.36.4.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the relationship of smoking to sexual risk outcomes among African American adolescent females. METHODS We analyzed baseline data from an HIV intervention trial, including sexual risk (older sex partners, number of vaginal sex partners, sex while high on drugs/alcohol, STI diagnosis) and smoking status among 715 participants. RESULTS Smoking prevalence was 23.1%. Controlling for covariates, smoking predicted having older partners (P=.001), having sex while high on alcohol or drugs (P<.001), and STI diagnosis (P=.046), after including other sexual risk outcomes in the model. CONCLUSIONS Smoking is an independent risk factor for sexual risk behaviors and STI diagnosis.
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Affiliation(s)
- Carla J Berg
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA.
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DiClemente RJ, Painter JE, Sales JM, Gargano LM. "Build it and they will come. Or will they?" Overcoming barriers to optimizing delivery of seasonal influenza vaccine to US adolescents. Expert Rev Vaccines 2012; 11:387-9. [PMID: 22551021 DOI: 10.1586/erv.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Frew PM, Painter JE, Hixson B, Kulb C, Moore K, del Rio C, Esteves-Jaramillo A, Omer SB. Factors mediating seasonal and influenza A (H1N1) vaccine acceptance among ethnically diverse populations in the urban south. Vaccine 2012; 30:4200-8. [PMID: 22537991 DOI: 10.1016/j.vaccine.2012.04.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 04/09/2012] [Accepted: 04/14/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examined the acceptability of the influenza A (H1N1) and seasonal vaccinations immediately following government manufacture approval to gauge potential product uptake in minority communities. We studied correlates of vaccine acceptance including attitudes, beliefs, perceptions, and influenza immunization experiences, and sought to identify communication approaches to increase influenza vaccine coverage in community settings. METHODS Adults ≥18 years participated in a cross-sectional survey from September through December 2009. Venue-based sampling was used to recruit participants of racial and ethnic minorities. RESULTS The sample (N=503) included mostly lower income (81.9%, n=412) participants and African Americans (79.3%, n=399). Respondents expressed greater acceptability of the H1N1 vaccination compared to seasonal flu immunization (t=2.86, p=0.005) although H1N1 vaccine acceptability was moderately low (38%, n=191). Factors associated with acceptance of the H1N1 vaccine included positive attitudes about immunizations [OR=0.23, CI (0.16, 0.33)], community perceptions of H1N1 [OR=2.15, CI (1.57, 2.95)], and having had a flu shot in the past 5 years [OR=2.50, CI (1.52, 4.10). The factors associated with acceptance of the seasonal flu vaccine included positive attitudes about immunization [OR=0.43, CI (0.32, 0.59)], community perceptions of H1N1 [OR=1.53, CI (1.16, 2.01)], and having had the flu shot in the past 5 years [OR=3.53, CI (2.16, 5.78)]. Participants were most likely to be influenced to take a flu shot by physicians [OR=1.94, CI (1.31, 2.86)]. Persons who obtained influenza vaccinations indicated that Facebook (χ(2)=11.7, p=0.02) and Twitter (χ(2)=18.1, p=0.001) could be useful vaccine communication channels and that churches (χ(2)=21.5, p<0.001) and grocery stores (χ(2)=21.5, p<0.001) would be effective "flu shot stops" in their communities. CONCLUSIONS In this population, positive vaccine attitudes and community perceptions, along with previous flu vaccination, were associated with H1N1 and seasonal influenza vaccine acceptance. Increased immunization coverage in this community may be achieved through physician communication to dispel vaccine conspiracy beliefs and discussion about vaccine protection via social media and in other community venues.
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Affiliation(s)
- Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA.
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Sales JM, Painter JE, Pazol K, Gargano LM, Orenstein W, Hughes JM, DiClemente RJ. Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention. Hum Vaccin 2011; 7:1146-52. [PMID: 22048112 DOI: 10.4161/hv.7.11.17891] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. METHODS Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline N=324; follow-up N=327). Data were collected pre- and post-intervention from phone surveys with parents' with children attending middle- and high-school. Attitudes, beliefs, vaccination history, and intention to vaccinate were assessed. RESULTS Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared to control parents. Significant differences were observed post intervention in perceived barriers and benefits of vaccination. CONCLUSIONS These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination.
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Affiliation(s)
- Jessica M Sales
- Emory University, Rollins School of Public Health, Atlanta, GA USA
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Gargano LM, Pazol K, Sales JM, Painter JE, Morfaw C, Jones LM, Weiss P, Buehler JW, Murray DL, Wingood GM, Orenstein WA, DiClemente RJ, Hughes JM. Multicomponent interventions to enhance influenza vaccine delivery to adolescents. Pediatrics 2011; 128:e1092-9. [PMID: 21987709 PMCID: PMC3387882 DOI: 10.1542/peds.2011-0453] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia. METHODS We used a nonrandomized, 3-armed design: (1) a middle- and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents. RESULTS During the 2008-2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR](school): 2.4 [95% confidence interval (CI): 1.7-3.2]; RR(provider): 1.9 [95% CI: 1.4-2.5]). During 2009-2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RR(school): 2.3 [95% CI: 1.9-2.9]; RR(provider): 1.2 [95% CI: 0.97-1.5]). CONCLUSIONS Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.
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Affiliation(s)
| | | | - Jessica M. Sales
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Julia E. Painter
- School of Medicine and ,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Christopher Morfaw
- Department of Community Health, East Central Health District, Augusta, Georgia; and
| | - LaDawna M. Jones
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paul Weiss
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - James W. Buehler
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dennis L. Murray
- Department of Pediatrics, Medical College of Georgia, Augusta, Georgia
| | - Gina M. Wingood
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Painter JE, Gargano LM, Sales JM, Morfaw C, Jones LM, Murray D, DiClemente RJ, Hughes JM. Correlates of 2009 H1N1 influenza vaccine acceptability among parents and their adolescent children. Health Educ Res 2011; 26:751-760. [PMID: 21536717 PMCID: PMC3202907 DOI: 10.1093/her/cyr025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 03/15/2011] [Indexed: 05/30/2023]
Abstract
School-aged children were a priority group for receipt of the pandemic (2009) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-school students and their parents in two counties in rural Georgia. Multivariable logistic regression analyses were conducted to assess correlates of parental acceptance of H1N1 influenza vaccination for their children and adolescents' acceptance of vaccination for themselves. Concordance analyses were conducted to assess agreement between parent-adolescent dyads regarding H1N1 influenza vaccine acceptance. Parental acceptance of H1N1 influenza vaccination for their children was associated with acceptance of the vaccine for themselves and feeling motivated by the H1N1 influenza pandemic to get a seasonal influenza vaccine for their child. Adolescents' acceptance was associated with receipt of a seasonal influenza vaccine in the past year, fear of getting H1N1 influenza, feeling comfortable getting the vaccine and parental acceptance of H1N1 influenza vaccine. Half (50%) of parent-adolescent pairs included both a parent and child who expressed H1N1 influenza vaccine acceptance, and 19% of pairs would not accept the vaccine. This research highlights the need for interventions that target factors associated with H1N1 influenza vaccine acceptance among both parents and adolescents.
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Affiliation(s)
- Julia E Painter
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Room 558, Atlanta, GA 30322, USA.
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Gargano LM, Painter JE, Sales JM, Morfaw C, Jones LM, Weiss P, Murray D, DiClemente RJ, Hughes JM. Correlates of 2009 pandemic H1N1 influenza vaccine acceptance among middle and high school teachers in rural Georgia. J Sch Health 2011; 81:297-303. [PMID: 21592124 DOI: 10.1111/j.1746-1561.2011.00594.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Teachers play an essential role in the school community, and H1N1 vaccination of teachers is critical to protect not only themselves but also adolescents they come in contact within the classroom through herd immunity. School-aged children have a greater risk of developing H1N1 disease than seasonal influenza. The goal of this study was to assess the relationship between attitudes toward H1N1 vaccination and vaccine acceptance among middle and high school teachers in rural Georgia. METHODS Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention in rural Georgia. Data were collected from surveys distributed to middle and high school teachers in participating counties in September 2009 prior to implementing the interventions to increase vaccination against seasonal influenza. Multivariate logistic regression was used to assess the association between teachers' attitudes toward H1N1 vaccination and H1N1 vaccine acceptance, controlling for demographic variables. RESULTS Among participants, 52.9% indicated that they would get the H1N1 vaccine. In multivariate analyses, H1N1 vaccine acceptance was associated with male gender (odds ratio[OR] = 3.67, p = .016), fear of contracting H1N1 (OR = 3.18, p = .025), and receipt of a seasonal influenza vaccine in the past year (OR = 3.07, p = .031). H1N1 vaccine acceptance was not significantly associated with age, race, perceived severity of H1N1, belief that the H1N1 vaccine would cause illness, or talking about H1N1 with friends. CONCLUSIONS Teachers may play a pivotal role in school-based H1N1 vaccinations. Understanding and addressing teachers' attitudes toward H1N1 vaccination may assist in future immunization efforts.
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Affiliation(s)
- Lisa M Gargano
- Emory University, 1462 Clifton Road, Atlanta, GA 30322, USA.
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29
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Painter JE, Sales JM, Pazol K, Wingood GM, Windle M, Orenstein WA, DiClemente RJ. Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention: a mediation analysis. J Sch Health 2011; 81:304-312. [PMID: 21592125 DOI: 10.1111/j.1746-1561.2011.00595.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake. METHODS Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between study condition and influenza vaccine uptake. RESULTS Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow-up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. CONCLUSION Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.
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Affiliation(s)
- Julia E Painter
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health and Emory Vaccine Center, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Gargano LM, Painter JE, Sales JM, Morfaw C, Jones LM, Murray D, Wingood GM, DiClemente RJ, Hughes JM. Seasonal and 2009 H1N1 influenza vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination among secondary school teachers and staff. Hum Vaccin 2011; 7:89-95. [PMID: 21263225 PMCID: PMC3062243 DOI: 10.4161/hv.7.1.13460] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 08/17/2010] [Accepted: 08/27/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Teachers, like healthcare workers, may be a strategic target for influenza immunization programs. Influenza vaccination is critical to protect both teachers and the students they come into contact with. This study assessed factors associated with seasonal and H1N1 influenza vaccine uptake among middle- and high-school teachers. METHODS Participants were recruited from two counties in rural Georgia. Data were collected from surveys in September 2009 and May 2010. Multivariate logistic regression was used to assess the association between teachers' attitudes toward seasonal and H1N1 influenza vaccination and vaccine uptake. RESULTS Seventy-eight percent of teachers who planned to receive seasonal influenza vaccine and 36% of those who planned to receive H1N1 influenza vaccine at baseline reported that they did so. Seasonal vaccine uptake was significantly associated with perceived severity (odds ratio [OR] 1.57, P = 0.05) and self-efficacy (OR 4.46, P = 0.006). H1N1 vaccine uptake was associated with perceived barriers (OR 0.7, P = 0.014) and social norms (OR 1.39, P = 0.05). The number one reason for both seasonal and H1N1 influenza vaccine uptake was to avoid getting seasonal/H1N1 influenza disease. The number one reason for seasonal influenza vaccine refusal was a concern it would make them sick and for H1N1 influenza vaccine refusal was concern about vaccine side effects. CONCLUSIONS There is a strong association between the intention to be vaccinated against influenza (seasonal or 2009 H1N1) and actual vaccination uptake. Understanding and addressing factors associated with teachers' influenza vaccine uptake may enhance future influenza immunization efforts.
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Painter JE, Sales JM, Pazol K, Wingood GM, Windle M, Orenstein WA, DiClemente RJ. Psychosocial correlates of intention to receive an influenza vaccination among rural adolescents. Health Educ Res 2010; 25:853-864. [PMID: 20603385 DOI: 10.1093/her/cyq037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently expanded annual influenza vaccination recommendations to include all children 6 months through 18 years of age. Adolescent attitudes toward influenza vaccination may play a key role in reaching this newly added age group. This study examined the association between attitudes toward influenza vaccination and intention to be vaccinated among rural adolescents. Data were collected from baseline surveys distributed to adolescents in September/October 2008, prior to the H1N1 influenza pandemic, in two counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Survey items were based on constructs from the Health Belief Model and the Integrated Behavioral Model. Approximately one-third of participants (33.8%) intended to receive an influenza vaccination, 33.5% did not intend to be vaccinated and 28.8% were unsure. Controlling for background factors, intention to receive an influenza vaccination was associated with low perceived barriers [odds ratio (OR) = 0.77, P < 0.001], injunctive norms (OR = 1.23, P = 0.002) and receipt of influenza vaccination in the past year (OR =6.21, P < 0.001). Findings suggest that perceived barriers and injunctive social norms may influence vaccination acceptance among rural adolescents. Future influenza vaccination efforts geared toward rural middle and high school students may benefit from addressing adolescent attitudes toward influenza vaccination.
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Affiliation(s)
- Julia E Painter
- Department of Behavioral Sciences and Health Education Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Painter JE, Sales JM, Pazol K, Grimes T, Wingood GM, DiClemente RJ. Development, Theoretical Framework, and Lessons Learned From Implementation of a School-Based Influenza Vaccination Intervention. Health Promot Pract 2010; 11:42S-52S. [DOI: 10.1177/1524839909360171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Advisory Committee on Immunization Practices (ACIP) recently recommended that all children 6 months to 18 years old be vaccinated annually against influenza. School-based influenza vaccination interventions may potentially increase influenza vaccination rates among hard-to-reach populations, particularly rural adolescents. This article describes the theoretical framework, intervention development, and lessons learned from 1st-year implementation of a multicomponent intervention aimed to promote influenza vaccine acceptance among multiethnic (predominantly African American) adolescents attending middle and high school in rural Georgia. Adolescents, parents, and school administrators were active participants in the development and implementation of the intervention. The educational intervention, which consisted of a brochure and a school skit/ presentation, was guided by constructs from the Health Belief Model and social norms. Process evaluation results indicated that our intervention development methods were successful in creating a low-cost, theory-based educational intervention that garnered community investment and met the cultural relevance and literacy needs of our target audience. To our knowledge, this study is the first to extensively engage middle- and high-school students and parents in the design and implementation of key educational components of a theory-based influenza vaccination intervention.
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Affiliation(s)
- Julia E. Painter
- Behavioral Sciences and Health Education at the Rollins
School of Public at Emory University in Atlanta, Georgia,
| | - Jessica M. Sales
- Rollins School of Public at Emory University in Atlanta,
Georgia
| | - Karen Pazol
- Research Programs, Emory University School of Medicine
in Atlanta, Georgia
| | | | - Gina M. Wingood
- Department of Behavioral Sciences and Health Education
at the Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ralph J. DiClemente
- Center for AIDS Research at the Rollins School of Public
Health, Atlanta, Georgia
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Painter JE, Borba CPC, Hynes M, Mays D, Glanz K. The use of theory in health behavior research from 2000 to 2005: a systematic review. Ann Behav Med 2008; 35:358-62. [PMID: 18633685 DOI: 10.1007/s12160-008-9042-y] [Citation(s) in RCA: 310] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Theory-based health behavior change programs are thought to be more effective than those that do not use theory. No previous reviews have assessed the extent to which theory is used (that is, operationalized and tested) in empirical research. PURPOSE The purpose of this study was to describe theory use in recent health behavior literature and to assess the proportion of research that uses theory along a continuum from: informed by theory to applying, testing, or building theory. METHODS A sample of empirical research articles (n = 193) published in ten leading public health, medicine, and psychology journals from 2000 to 2005 was coded to determine whether and how theory was used. RESULTS Of health behavior articles in the sample, 35.7% mentioned theory. The most-often-used theories were The Transtheoretical Model, Social Cognitive Theory, and Health Belief Model. Most theory use (68.1%) involved research that was informed by theory; 18% applied theory; 3.6% tested theory; and 9.4% sought to build theory. CONCLUSIONS About one third of published health behavior research uses theory and a small proportion of those studies rigorously apply theory. Patterns of theory use are similar to reports from the mid-1990s. Behavioral researchers should strive to use theory more thoroughly by applying, testing, and building theories in order to move the field forward.
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Affiliation(s)
- Julia E Painter
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Rm 530, Atlanta, GA 30322, USA
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Abstract
OBJECTIVE AND PURPOSE Although there is increasing interest in how environmental factors influence food intake, there are mixed results and misunderstandings of how proximity and visibility influence consumption volume and contribute to obesity. The objective of this paper is to examine two questions: first, how does the proximity and salience of a food influence consumption volume? Second, are proximate foods consumed more frequently because they are proximate, or are they consumed more frequently because people lose track of how much they eat? RESEARCH METHODS AND PROCEDURES The 4-week study involved the chocolate candy consumption of 40 adult secretaries. The study utilized a 2 x 2 within-subject design where candy proximity was crossed with visibility. Proximity was manipulated by placing the chocolates on the desk of the participant or 2 m from the desk. Visibility was manipulated by placing the chocolates in covered bowls that were either clear or opaque. Chocolates were replenished each evening, and placement conditions were rotated every Monday. Daily consumption was noted and follow-up questionnaires were distributed and analyzed. RESULTS There were main effects for both proximity and visibility. People ate an average of 2.2 more candies each day when they were visible, and 1.8 candies more when they were proximately placed on their desk vs 2 m away. It is important to note, however, that there was a significant tendency for participants to consistently underestimate their daily consumption of proximately placed candies (-0.9) and overestimate their daily consumption of less proximately placed candies (+0.5). DISCUSSION These results show that the proximity and visibility of a food can consistently increase an adult's consumption of it. In addition, these results suggest that people may be biased to overestimate the consumption of foods that are less proximate, and to underestimate those that are more proximate. Knowing about these deviation tendencies is important for those attempting effectively monitor their consumption of fat and sugar.
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Affiliation(s)
- B Wansink
- Cornell Food and Brand Laboratory, Cornell University, Ithaca, NY 14853, USA.
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Affiliation(s)
- J E Painter
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, 61801, USA.
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Abstract
BACKGROUND This study investigated the hypothesis that circulating levels of insulin-like growth factor (IGF) I and its main binding protein (IGFBP-3) predict for the presence of colorectal adenomas, surrogate markers of colorectal cancer risk. METHODS Within the Flexi-Scope Trial (healthy volunteers aged 55-64 years), at one study centre, IGF-I and IGFBP-3 levels in serum samples collected prospectively from 442 attendants were measured. Of these, 100 individuals underwent a complete screening colonoscopy. There were 47 normal examinations, while in 11 examinations low-risk adenomas and in 42 examinations high-risk adenomas were identified. Estimates of relative risk (RR) for the adenomatous stages were calculated by means of unconditional logistic regression, adjusting for known risk factors. RESULTS Mean serum IGF-I and IGFBP-3 levels were similar in individuals with a normal colonoscopy finding and in those with low-risk adenomas. By contrast, the mean(s.d.) serum IGF-I level was increased (190(53) versus 169(54) microg/l; P = 0.06) and the serum IGFBP-3 concentration was significantly decreased (3.22(0.60) versus 3.47(0.62) mg/l; P = 0.05) in individuals with high-risk adenomas compared with levels in those with normal colonoscopy and low-risk adenomas combined. Levels were unaffected by removal of the adenomas. With high-risk adenoma as the dependent factor, regression models demonstrated a significant positive association with IGF-I after controlling for IGFBP-3 (RR per one standard deviation (1s.d.) change 4.39 (95 per cent confidence interval (c.i.) 1.31-14.7); P = 0.02) and, independently, an inverse association with IGFBP-3 after adjustment for IGF-I (RR per 1s.d. change 0.41 (95 per cent c.i. 0. 20-0.82); P = 0.01). CONCLUSION These findings suggest that circulating IGF-I and IGFBP-3 levels are related to future colorectal cancer risk and, specifically, may predict adenoma progression.
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Affiliation(s)
- A G Renehan
- Department of Surgery, Cancer Research Campaign Department of Epithelial Biology, Paterson Institute for Cancer Research, Manchester, UK.
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Renehan AG, Bhaskar P, Painter JE, O'Dwyer ST, Haboubi N, Varma J, Ball SG, Shalet SM. The prevalence and characteristics of colorectal neoplasia in acromegaly. J Clin Endocrinol Metab 2000; 85:3417-24. [PMID: 10999843 DOI: 10.1210/jcem.85.9.6775] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An increased prevalence of colorectal neoplasia has been reported in acromegalic patients, and recommendations have been made for early colonoscopic screening and regular surveillance. This assumption, however, is frequently drawn from studies using selected control populations. To clarify colonoscopic management in these patients, we undertook a 2-center prospective screening colonoscopy study in 122 acromegalics (age range, 25-82 yr). In the absence of ideal age-matched controls, we calculated prevalence rates of occult adenocarcinomas and adenomas in the general population using cumulative data in the published literature from 8 autopsy studies (model 1, n = 3,559) and 4 screening colonoscopy studies (model 2, n= 810), applying linear regression models. Of the 115 patients with complete examinations, adenocarcinomas were discovered in 3 (2.6%), and at least 1 adenoma was found in 11, giving an overall prevalence of neoplasia of 12% (14 of 115). Prevalence rates for age bands 30-40, 40-49, 50-59, 60-69, and 70+ yr were 0%, 8%, 12%, 20%, and 21%, respectively. Compared with the 2 control models, the prevalence of occult colorectal cancer was not significantly increased (acromegalics vs. models 1 and 2, 2.6% vs. 2.3% and 0.9%), nor was there an increase in the prevalence of adenomas in any age band. Pathological characteristics showed some differences, in that adenomas in acromegalics tended to be right sided (68% vs. 57% and 56%), larger (for > or =10 mm, 27% vs. 13% and 9%), and of advanced histology (for tubulovillous, 27% vs. 4% and 22%). No associations were found between the presence of colonic neoplasia and the duration of disease, total GH exposure, cure status, and serum insulin-like growth factor I. This study has failed to demonstrate an increased prevalence of neoplasia in acromegalic patients compared with the expected prevalence in the general population and questions the need for an aggressive colonoscopic screening policy.
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Affiliation(s)
- A G Renehan
- Department of Surgery, Christie Hospital National Health Service Trust, Manchester, United Kingdom.
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Abstract
Circulating insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) may be risk factors for the development of colorectal cancer. On the other hand, IGF-II and IGFBP-2 are overexpressed in colorectal carcinomas. These contrasting backgrounds led us to investigate the relationship between serum IGF-I, IGF-II, IGFBP-2, and IGFBP-3 and the presence of colorectal adenomas, known precursors of colorectal carcinoma, in 345 volunteers attending a screening flexible sigmoidoscopy trial (entry criteria: healthy, aged 55-64 yr). The most striking finding was an elevated mean serum IGF-II in individuals with adenomas (n = 52) compared with controls (mean difference, 139 ng/mL; 95% confidence intervals, 82, 196; P < 0.0001). Logistic regression adjusting for confounding factors confirmed the significant association between IGF-II and adenoma occurrence (P < 0.0001) and revealed an additional positive association with serum IGFBP-2 (P < 0.0001). However, there was no association found between either serum IGF-I and/or IGFBP-3 and the presence of adenomas. Additionally, in 31 individuals with adenomas in whom levels were determined pre- and postpolypectomy, there was a significant fall in mean IGF-II (P < 0.001) and IGFBP-2 (P < 0.001) after adenoma removal, but no difference in IGF-II and IGFBP-2 concentrations between repeated samples in 20 individuals without adenomas. Immunohistochemical studies demonstrated IGF-II expression in 83% of all adenomas, which contrasted with absent expression in normal colonic expression and hyperplastic polyps. This study has shown for the first time that serum IGF-II may be a tumor marker in individuals with colorectal adenomas. Further studies are needed to validate these relationships in larger populations, including individuals undergoing colonoscopy.
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Affiliation(s)
- A G Renehan
- Department of Surgery, Christie Hospital National Health Service Trust, Manchester, United Kingdom
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McClung CR, Hsu M, Painter JE, Gagne JM, Karlsberg SD, Salomé PA. Integrated temporal regulation of the photorespiratory pathway. Circadian regulation of two Arabidopsis genes encoding serine hydroxymethyltransferase. Plant Physiol 2000; 123:381-92. [PMID: 10806255 PMCID: PMC59012 DOI: 10.1104/pp.123.1.381] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/1999] [Accepted: 01/18/2000] [Indexed: 05/18/2023]
Abstract
The photorespiratory pathway is comprised of enzymes localized within three distinct cellular compartments: chloroplasts, peroxisomes, and mitochondria. Photorespiratory enzymes are encoded by nuclear genes, translated in the cytosol, and targeted into these distinct subcellular compartments. One likely means by which to regulate the expression of the genes encoding photorespiratory enzymes is coordinated temporal control. We have previously shown in Arabidopsis that a circadian clock regulates the expression of the nuclear genes encoding both chloroplastic (Rubisco small subunit and Rubisco activase) and peroxisomal (catalase) components of the photorespiratory pathway. To determine whether a circadian clock also regulates the expression of genes encoding mitochondrial components of the photorespiratory pathway, we characterized a family of Arabidopsis serine hydroxymethyltransferase (SHM) genes. We examined mRNA accumulation for two of these family members, including one probable photorespiratory gene (SHM1) and a second gene expressed maximally in roots (SHM4), and show that both exhibit circadian oscillations in mRNA abundance that are in phase with those described for other photorespiratory genes. In addition, we show that SHM1 mRNA accumulates in light-grown seedlings, although this response is probably an indirect consequence of the induction of photosynthesis and photorespiration by illumination.
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Affiliation(s)
- C R McClung
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire 03755-3576, USA.
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Martin JP, Saunders BP, Painter JE. Small, depressed lesions of the large bowel: a normal finding at endoscopy. Gut 1999; 45:147. [PMID: 10369719 PMCID: PMC1727584 DOI: 10.1136/gut.45.1.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J P Martin
- Wolfson Endoscopy Unit St Mark's Hospital Harrow Middlesex HA1 3UJ, UK
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Zhong HH, Painter JE, Salomé PA, Straume M, McClung CR. Imbibition, but not release from stratification, sets the circadian clock in Arabidopsis seedlings. Plant Cell 1998; 10:2005-17. [PMID: 9836741 PMCID: PMC143968 DOI: 10.1105/tpc.10.12.2005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Circadian rhythms in the abundance of the CAT2 catalase mRNA were not seen in etiolated seedlings but developed upon illumination. These circadian oscillations were preceded by a rapid and transient induction of CAT2 mRNA abundance that varied strikingly according to the timing (circadian phase) of the onset of illumination. This variation oscillated with a circadian periodicity of approximately 28 hr, indicating that the circadian oscillator is running in etiolated seedlings and regulates (gates) the induction of CAT2 by light. Moreover, because we assayed populations of seedlings, we infer that the individual clocks among populations of etiolated seedlings were synchronized before the onset of illumination. What developmental or environmental signals synchronized the clocks among seedlings? Varying the phase of the onset of illumination relative to release from stratification failed to affect the acute induction of CAT2, indicating that the temperature step from 4 to 22 degrees C associated with release from stratification did not reset the circadian clock. However, the acute induction of CAT2 mRNA varied with time after imbibition, demonstrating that imbibition provides a signal capable of resetting the circadian clock and of synchronizing the clocks among populations of seedlings.
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Affiliation(s)
- H H Zhong
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire 03755, USA
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