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Sims JC, Harris JN, Katzman CL, Wong C, Jetelina K, Tiro JA, Rosenthal SL, Francis JKR. Confidence in adolescent contraceptive counseling among residents and fellows training at the University of Texas Southwestern in Dallas, Texas. Contraception 2024:110478. [PMID: 38705505 DOI: 10.1016/j.contraception.2024.110478] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Evaluate trainees' perceptions of past training and confidence in counseling about five contraceptive methods. STUDY DESIGN Trainees completed an online survey in 2020. Logistic regressions evaluated the relationship between participant characteristics and confidence. RESULTS Among 227 respondents (63% response rate), pediatric trainees reported the least confidence in counseling across each contraceptive method. Past training and confidence were associated. CONCLUSIONS Gaps in training should be addressed to improve confidence in contraceptive counseling among pediatricians in reproductively restricted states.
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Affiliation(s)
- Jessica C Sims
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States; Children's Health System of Texas, 935 Medical District Dr, Dallas, TX 75235, United States.
| | - Julen N Harris
- Departments of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, United States
| | - Caroline L Katzman
- Departments of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, United States
| | - Catherine Wong
- Peter O'Donnell School of Public Health, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States
| | - Katelyn Jetelina
- Meadow's Institute, 3003 Swiss Ave, Dallas, TX 75204, United States
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, United States
| | - Jenny K R Francis
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States; Children's Health System of Texas, 935 Medical District Dr, Dallas, TX 75235, United States; Departments of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, United States
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2
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Frantzis I, Levasseur S, Huebner J, Mahida M, Larussa P, James W, Abebe W, Ngwenya C, Mupere E, Rosenthal SL, Patterson J, Johnson J, Strehlau R, Lulseged S, Stanberry LR, Saiman L. Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS). Int J Hyg Environ Health 2024; 259:114357. [PMID: 38564877 DOI: 10.1016/j.ijheh.2024.114357] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. METHODS We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. RESULTS We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DISCUSSION This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.
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Affiliation(s)
- Irene Frantzis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
| | - Stéphanie Levasseur
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jack Huebner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maitry Mahida
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Larussa
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wilmot James
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Workeabeba Abebe
- Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crispen Ngwenya
- Paediatrics department at Midlands State University faculty of Medicine, Gweru, Zimbabwe
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Janna Patterson
- Global Child Health and Life Support, American Academia of Pediatrics, Itasca, IL, USA
| | - Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sileshi Lulseged
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Abbaba, Ethiopia
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Tolleson-Rinehart S, Rosenthal SL, de Roche AM, Laughon M, Sewell TB, Rivera CM, Gozal D, Hirsch R, Orange JS, Davis SD. Supporting Career Transitions of Senior Faculty: Perspectives of Chairs and Full Professors. J Pediatr 2024; 264:113518. [PMID: 37244584 DOI: 10.1016/j.jpeds.2023.113518] [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] [Received: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Taylor B Sewell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Christina M Rivera
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, MO
| | - Raphael Hirsch
- Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco, CA
| | - Jordan S Orange
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
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Ybarra A, Wong C, Gribbons M, DeSilva N, Jetelina K, Rosenthal SL, Francis JKR. Attitudes about the Provision of Sexual Health Services in an Inpatient Setting. J Pediatr Adolesc Gynecol 2023; 36:525-531. [PMID: 37453668 DOI: 10.1016/j.jpag.2023.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To examine the relationship between clinicians' attitudes about the appropriateness of providing sexual health services in the inpatient setting and confidence in providing services METHODS: An online survey was emailed to pediatric hospitalists, adolescent medicine, and pediatric and adolescent gynecology societies and directors. Confidence in managing 8 sexual health situations was measured on a 4-point Likert scale, summed, averaged, and dichotomized into confident and not so confident. Participants were asked to rate on a 5-point Likert scale their belief that providing sexual health services in the inpatient setting would be appropriate. An adjusted, multivariate logistic regression identified associations between participant demographic characteristics, professional characteristics, and confidence and attitudes about the appropriateness of providing inpatient sexual health services. RESULTS Among the 610 participants, the mean age was 40 years. Most were females (79%), non-Hispanic White (71%), and practiced pediatric hospital/general medicine (73%). Most (73%) were not so confident across all 8 confidence items. Overall, 61% "strongly agreed" that providing sexual health services in the inpatient setting was appropriate. Participants who reported younger age, being female, and confidence in providing services were significantly associated with strong agreement that it was appropriate to provide sexual health services in the inpatient setting. Those who identified as Christian non-Catholic were significantly less likely to report strong agreement. CONCLUSION Most providers strongly agreed that providing sexual health services in the inpatient setting was appropriate, yet most were not so confident in managing sexual health situations. Future studies should focus on addressing concerns and barriers to providing sexual health services.
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Affiliation(s)
- Abby Ybarra
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Catherine Wong
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Megan Gribbons
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health System of Texas, Dallas, Texas
| | - Nirupama DeSilva
- Children's Health System of Texas, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katelyn Jetelina
- Department of Population Health Analytics, Meadow Mental Health Policy Institute, Dallas, Texas
| | - Susan L Rosenthal
- Department of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Columbia, New York
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health System of Texas, Dallas, Texas.
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Mergenova G, Rosenthal SL, Myrkassymova A, Bukharbayeva A, Iskakova B, Izekenova A, Izekenova A, Alekesheva L, Yerdenova M, Karibayev K, Zhussupov B, Alimbekova G, Davis A. The COVID-19 pandemic and mental health in Kazakhstan. Glob Ment Health (Camb) 2023; 10:e52. [PMID: 37854418 PMCID: PMC10579662 DOI: 10.1017/gmh.2023.46] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 10/20/2023] Open
Abstract
The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and sociobehavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1-3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11-2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32-4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32-4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91-6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11-4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36-5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist.
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Affiliation(s)
- Gaukhar Mergenova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Susan L. Rosenthal
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Balnur Iskakova
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Assel Izekenova
- Kenzhegali Sagadiyev University of International Business, Almaty, Kazakhstan
| | | | - Maral Yerdenova
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | - Alissa Davis
- Columbia University School of Social Work, New York, NY, USA
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Vora AS, Marroquin M, Rosenthal SL, Broker P, Jetelina K, Tiro JA, Francis JK. Residents and Fellows’ Confidence in Prescribing Pre-exposure Prophylaxis (PrEP). Acad Pediatr 2023; 23:1282-1287. [PMID: 36893907 DOI: 10.1016/j.acap.2023.02.017] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Residents and fellows are often the first health.ßcare providers to discuss sexual health and prevention with adolescents and young adults at academic institutions. This study characterized when learners in Pediatrics, Obstetrics and Gynecology, and Family Medicine believed that one should receive training in pre-exposure prophylaxis (PrEP) and it described confidence in prescribing PrEP. METHODS Learners at a large, urban, southern academic center completed an online survey about adolescent sexual health services. Measures included whether participants were taught how to prescribe PrEP and how to do so in a confidential manner. Confidence in these two behaviors was measured with a Likert scale and dichotomized for bivariate analysis. RESULTS Among the 228 respondents (63% response rate), most learners preferred sexual health communication to be emphasized early in medical school and throughout training. Overall, 44% reported being ..únot confident at all..Ñ in prescribing PrEP, and 22% were ..únot confident at all..Ñ in prescribing in a confidential manner. Those who reported ..únot confident at all" in prescribing PrEP were more likely in pediatrics (51%) than family medicine (23%) or obstetrics-gynecology (35%) (P.ß<.ß.01). Those who had been taught how to prescribe were more confident in prescribing PrEP (P.ß..±.ß.01) and prescribing in a confidential manner (P.ß<.ß.01). CONCLUSIONS Given the continued high rates of new human immunodeficiency virus infections among adolescents, effective communication with patients eligible for PrEP is critical. Future studies should evaluate and inform tailored curricula about the importance of PrEP and build communication skills around confidential prescribing.
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Affiliation(s)
- Anjali S Vora
- Division of Internal Medicine and Pediatrics (AS Vora and P Broker), University of Texas Southwestern Medical Center, Dallas.
| | - Monica Marroquin
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry (SL Rosenthal), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Paul Broker
- Division of Internal Medicine and Pediatrics (AS Vora and P Broker), University of Texas Southwestern Medical Center, Dallas
| | - Katelyn Jetelina
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas; Department of Epidemiology (K Jetelina), Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX
| | - Jasmin A Tiro
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas
| | - Jenny Kr Francis
- Department of Pediatrics (JKR Francis), University of Texas Southwestern Medical Center, Children's Health, Dallas, Texas
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Harris JN, Mauro CM, Morgan TL, de Roche A, Zimet GD, Rosenthal SL. Factors impacting parental uptake of COVID-19 vaccination for U.S. Children ages 5-17. Vaccine 2023; 41:3151-3155. [PMID: 37045680 PMCID: PMC10080272 DOI: 10.1016/j.vaccine.2023.04.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/27/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
COVID-19 vaccination of U.S. children lags behind adult vaccination, but remains critical in mitigating the pandemic. Using a subset of a nationally representative survey, this study examined factors contributing to parental uptake of COVID-19 vaccine for children ages 12-17 and 5-11, stratified by parental COVID-19 vaccination status. Among vaccinated parents, uptake was higher for 12-17-year-olds (78.6%) than 5-11-year-olds (50.7%); only two unvaccinated parents vaccinated their children. Child influenza vaccination was predictive of uptake for both age groups, while side effect concerns remained significant only for younger children. Although parents were more likely to involve adolescents in vaccine decision-making than younger children, this was not predictive of vaccine uptake. These results highlight the importance of addressing the unique and shared concerns parents have regarding COVID-19 vaccination for children of varying ages. Future work should further explore adolescent/child perspectives of involvement in COVID-19 vaccination decision-making to support developmentally appropriate involvement.
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Affiliation(s)
- Julen N Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA
| | - Christine M Mauro
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, USA
| | - Tucker L Morgan
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, USA
| | - Ariel de Roche
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA; Department of Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center, New York, NY, USA.
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8
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Harris JN, Mauro C, Andresen JA, Zimet GD, Rosenthal SL. COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample. J Behav Med 2023; 46:25-39. [PMID: 35486335 PMCID: PMC9051757 DOI: 10.1007/s10865-022-00317-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Abstract
Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.
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Affiliation(s)
- Julen N Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Christine Mauro
- Department of Biostatistics at the Mailman School of Public Health at, Columbia University Irving Medical Center, New York, NY, USA
| | - Jane A Andresen
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA.
- Department of Psychiatry at Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
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Andresen JA, Harris JN, Mauro C, Zimet GD, Rosenthal SL. The impact of financial incentives on COVID-19 vaccination intention among a sample of U.S. adults. Prev Med Rep 2022; 29:101962. [PMID: 36065257 PMCID: PMC9434908 DOI: 10.1016/j.pmedr.2022.101962] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Financial incentives are one of several strategies that have been explored to enhance COVID-19 vaccine uptake. Although widely discussed, it is unclear how much of an incentive and for which subset of individuals incentives would be effective. This study explored the impact of hypothetical $600 or $1200 incentives on COVID-19 vaccination intention. From a nationally representative panel of U.S. adults, 346 individuals reported hesitance towards COVID-19 vaccination and were then asked about their willingness to accept a vaccine if offered hypothetical incentives. Results indicated 26.89% would get vaccinated if offered $600, and 30.06% if offered $1200. In the multivariable model that included sociodemographic and attitudinal predictors of vaccine uptake, those classified as ‘wait-and-see’ compared to those classified as non-acceptors were more likely to accept COVID-19 vaccines when given financial incentives, and those who believed more strongly in the benefits of COVID-19 vaccines were more likely to accept a vaccine when first offered hypothetical $600 and then $1200 incentives. Individuals unsure if they ever had COVID-19 were significantly less likely to be willing to get the vaccine for $1200 as compared to those who believed they previously had COVID-19. These results suggest that financial incentives can increase intention to receive a COVID-19 vaccine.
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Affiliation(s)
- Jane A Andresen
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Julen N Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, USA
| | - Gregory D Zimet
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center, New York, NY, USA
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Glassman ME, Blanchet K, Andresen J, Lewis RA, Rosenthal SL. Impact of Breastfeeding Support Services on Mothers' Breastfeeding Experiences When Provided by an MD/IBCLC in the Pediatric Medical Home. Clin Pediatr (Phila) 2022; 61:418-427. [PMID: 35369737 DOI: 10.1177/00099228221086375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Addressing breastfeeding issues enables mothers to reach their breastfeeding goals. We embedded a breastfeeding consultation service run by a pediatrician/International Board Certified Lactation Consultant (MD/IBCLC) in a medical home. This mixed-methods study investigated breastfeeding preparedness and the service's perceived benefits. Mothers with breastfeeding issues/concerns identified at well-baby appointments were referred to the service. Telephone interviews and chart reviews were conducted with 28 participating mothers approximately 1 month after the visits. Breastfeeding Self-Efficacy Scale scores improved significantly from the time of the in-person appointment to 1 month later. Most mothers felt unprepared for breastfeeding despite prenatal efforts. Trust in the pediatrician's recommendation, easy access, and insurance coverage were key factors in seeking the service. Reassurance provided by the MD/IBCLC increased mothers' confidence to breastfeed. The COVID-19 pandemic heightened feelings of isolation and anxiety due to lack of hands-on support from friends and family during the birth hospitalization and when at home.
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Affiliation(s)
- Melissa E Glassman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Kelly Blanchet
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jane Andresen
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel A Lewis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Moerdler S, Steinberg DM, Jin Z, Cole PD, Kesselheim J, Levy AS, Roth M, Rosenthal SL. Provider and staff crisis well-being associated with trust in leadership and baseline burnout. Pediatr Blood Cancer 2022; 69:e29497. [PMID: 34890105 DOI: 10.1002/pbc.29497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the coronavirus 2019 (COVID-19) pandemic on the emotional health of health care workers continues to be an area of active research. However, few studies have focused on those working in pediatrics and its subspecialties, as well as ancillary and non-patient-facing staff. The purpose of this study was to determine the prevalence and associated predictors of burnout and emotional well-being of providers and staff. METHODS An anonymous electronic survey was developed evaluating demographics, pandemic experiences, possible predictor variables, and three main outcomes of burnout, psychological distress, and perceived stress. Pediatric hematology oncology (PHO) chiefs and program directors across the country were invited to participate and disseminate the survey to their programs. RESULTS A total of 682/1950 (35% of invited) individuals responded to all predictor and outcome variables. Over half reported high levels of burnout and some reported moderate/high levels of distress. Prepandemic burnout and decreased trust in leadership were associated with all three outcomes. Additional predictors included having a child ≤18 years at home, hospital role, and worrying about patient care or relationship with their patients. The majority (n = 444/682, 65.5%) reported that their institution had made COVID-19-related mental health resources available. However, only 6.5% (n = 44/682) reported utilizing these resources. CONCLUSIONS While the majority of PHO providers and staff were resilient during the early stages of the COVID-19 pandemic, many reported high levels of burnout, yet few are utilizing institutional resources. This study has highlighted several actionable areas to help identify and address factors that are wearing down the emotional well-being of providers and staff.
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Affiliation(s)
- Scott Moerdler
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dara M Steinberg
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Peter D Cole
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Levy
- Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Brons, New York City, New York, USA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L Rosenthal
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
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12
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Steinberg DM, Andresen JA, Pahl DA, Licursi M, Rosenthal SL. "I've Weathered Really Horrible Storms Long Before This…": The Experiences of Parents Caring for Children with Hematological and Oncological Conditions during the Early Months of the COVID-19 Pandemic in the U.S. J Clin Psychol Med Settings 2021; 28:720-727. [PMID: 33492628 PMCID: PMC7831624 DOI: 10.1007/s10880-020-09760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
The societal impact of COVID-19 is vast, thus it is imperative to understand how vulnerable groups, such as children with chronic medical conditions are affected. This understanding can prepare psychologists and other healthcare providers to meet their current and future needs. A convenience sample of 11 parents of children with hematological/oncological conditions was recruited. They participated in semi-structured interviews on the effect of the COVID-19 pandemic on their children. Qualitative analysis identified common themes. Parental responses focused on the pandemic's impact on children's general daily life and healthcare. Themes of caution, uncertainty, adaptation, and the role of the healthcare providers and early medical experiences emerged. Concerns about vulnerability, changes in routine, the importance of virtual connections, and the pivotal role of providers have implications for children with and without medical conditions. The adaptation and resilience of the families provide a sense of hope in an uncertain time.
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Affiliation(s)
- Dara M. Steinberg
- Department of Pediatrics, Division of Hematology, Oncology & Stem Cell Transplantation, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
| | - Jane A. Andresen
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Daniel A. Pahl
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
| | - Maureen Licursi
- Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital, New York, USA
| | - Susan L. Rosenthal
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
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13
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Zhou T, Guan R, Rosenthal SL, Moerdler S, Guan Z, Sun L. Supporting Health-Care Workers and Patients in Quarantine Wards: Evidence From a Survey of Frontline Health-Care Workers and Inpatients With COVID-19 in Wuhan, China. Front Public Health 2021; 9:705354. [PMID: 34733814 PMCID: PMC8558351 DOI: 10.3389/fpubh.2021.705354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: Frontline health-care workers and patients with COVID-19 have been identified as high-risk groups for psychological problems. Experience of working or staying in quarantine wards generated psychological stressors for health-care workers and patients with COVID-19. The present study aimed to investigate the psychological symptoms of hospitalized patients with COVID-19 and the health-care workers treating them during the outbreak period, examine the effects of psychological stressors on mental health in both populations and perceived coping resources for both sides. Methods: Three hundred and eleven health-care workers working in a COVID-19 designated hospital in Wuhan, China, and 148 hospitalized patients with COVID-19 in the same hospital participated in this cross-sectional survey conducted in February 2020. Psychological symptoms, psychological stressors, and perceived coping resources were reported by both groups. Results: Thirty-three percent of health-care workers and 35.2% of patients with COVID-19 had significant psychological symptoms that were indicative of a high risk for psychological disorders. Pandemic-related psychological stressors contributed to psychological symptoms for both populations. Concern about patients was one aspect of psychological stressors of frontline health-care workers and both groups perceived support from the opposite side as an important external coping resource. Conclusion: The results shed light on the need to provide psychological support to both frontline health-care workers and patients with COVID-19 and suggest enhancing the treatment alliance might be effective to improve mental health for both populations during the crisis.
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Affiliation(s)
- Ting Zhou
- Department of Medical Psychology, School of Health Humanities, Peking University, Beijing, China
| | - Ruiyuan Guan
- Department of Medical Psychology, School of Health Humanities, Peking University, Beijing, China
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Irving Medical Center-Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Scott Moerdler
- Division of Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Ziqi Guan
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Liqun Sun
- Intensive Care Unit, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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14
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Guzman A, Bring R, Master S, Rosenthal SL, Soren K. Improving the Transition of Adolescents from Disadvantaged Backgrounds from Pediatric to Adult Primary Care Providers. J Pediatr Nurs 2021; 61:269-274. [PMID: 34343766 DOI: 10.1016/j.pedn.2021.07.023] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The lack of structured transition interventions for adolescents aging out of pediatric care is associated with poor health outcomes. METHODS We assessed the effectiveness of a transition protocol that aimed to improve the transfer of adolescents to adult primary care. Chart reviews were conducted on 21- and 22-year-old patients seen 18 months before and after protocol implementation. Completion of an adult medicine appointment scheduled within 6 months from the last pediatric visit was the primary outcome of interest. FINDINGS In pre-implementation period, 20.9% of patients versus 39.3% in post-implementation period were transferred. Transfer was higher in patients who had a dedicated transition visit, had a transition order placed, and were tracked during the transfer process. DISCUSSION A transition protocol can increase the number of adolescents who transfer to adult care. Once a patient is ready to transition, a dedicated transition visit is ideal; however, providers should incorporate transition care during any clinical encounter. While an electronic transition order can facilitate appointment scheduling, patient tracking and appointment reminders can help ensure appointment completion. In addition, all clinical staff should receive transition training and clinicians should be frequently reminded about the need to transition their patients. However, even with these efforts to support transition, the majority of patients did not do so, which indicates a continued need to develop and evaluate transition interventions. PRACTICE IMPLICATIONS Implementing a transition protocol in pediatric clinics can improve the transition of adolescents aging out of pediatric care and may diminish gaps in medical care that can be associated with poor health outcomes.
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Affiliation(s)
| | - Rachel Bring
- New York University Grossman School of Medicine, NY, USA.
| | - Samuel Master
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA; NewYork-Presbyterian Hospital 630 W., NY, USA.
| | - Susan L Rosenthal
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA.
| | - Karen Soren
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA; NewYork-Presbyterian Hospital 630 W., NY, USA.
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15
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Francis JKR, Andresen JA, Guzman A, McLeigh JD, Kloster HM, Rosenthal SL. Research Participation of Minor Adolescents in Foster Care. J Pediatr Adolesc Gynecol 2021; 34:190-195. [PMID: 33333259 PMCID: PMC8005475 DOI: 10.1016/j.jpag.2020.12.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE In this study we evaluated published studies about foster care to: (1) determine the types of data used; (2) describe the degree to which a sexual/reproductive health topic was addressed; and (3) describe the consent process. DESIGN Analysis of published literature. SETTING PubMed was searched using "foster care" for English articles published between January 1, 2017 and September 4, 2019. PARTICIPANTS None. INTERVENTIONS None. MAIN OUTCOME MEASURES Articles were coded into 4 data source categories: primary, secondary, peripheral, or perspective data. Articles with a primary data source were coded for participant ages: only 9 years old and younger, 10- to 17-year-olds (minor adolescents), and only 18 years old and older. Articles using a secondary data source were coded for the source of the data registry. All articles were coded for presence of a sexual/reproductive health outcome. The primary data articles that included minor adolescents were coded for the study topic and consent process. RESULTS Of the 176 articles about foster care, 72/176 (41%) used primary data, 53/176 (30%) used secondary data, and 51/176 (29%) used peripheral/perspective data. Forty-eight of the primary data articles included minor adolescents. Secondary data sources included few national research surveys. Sexual/reproductive health outcomes were measured in 17 articles, 4 of which used primary data. The consent process for minor adolescents varied and had no consistent pattern across studies. CONCLUSION Research on best practices for consent processes and use of registries could be developed to increase research on sexual/reproductive health outcomes among adolescents in foster care.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
| | - Jane A Andresen
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Alexis Guzman
- Department of Pediatrics, Stanford Medicine, Stanford, California
| | | | - Heidi M Kloster
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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16
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Moerdler S, Steinberg DM, Jin Z, Cole PD, Levy AS, Rosenthal SL. Well-Being of Pediatric Hematology Oncology Providers and Staff During the COVID-19 Pandemic in the New York and New Jersey Epicenter. JCO Oncol Pract 2021; 17:e925-e935. [PMID: 33596094 DOI: 10.1200/op.20.00882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has significantly affected the well-being of healthcare workers to varying degrees. The aim of the current study was to investigate how the pandemic has affected the burnout, stress, and emotional well-being of pediatric hematology oncology (PHO) providers and staff in the New York and New Jersey epicenter. METHODS The study was conducted in June 2020 during the pandemic through an electronic survey. The survey contained questions surrounding demographics, pandemic experiences, and validated burnout, stress, and emotional well-being measures. RESULTS Two hundred fifty-two PHO providers and staff responded to the survey. Overall, half of the participants reported high levels of burnout, average stress scores were in the mild-moderate range, and the majority scored in the none-to-mild symptomatology range for their well-being. Self-reported burnout levels before the pandemic and geographic work location were statistically significant risk factors for all outcomes. Additional predictors for some outcomes included hospital role, lack of trust in leadership, and deployment. The majority of participants (87.0%) reported that their hospitals had made mental health resources related to COVID-19 available to them but only 8.4% reported having used them. CONCLUSION PHO providers and staff in the NYC/NJ area are experiencing a range of emotional experiences during the COVID-19 pandemic, but the majority are not using current resources. With the continuation of the pandemic, we must continue efforts to improve provider and staff distress to mitigate the degree of potential negative short-term and long-term impact.
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Affiliation(s)
- Scott Moerdler
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dara M Steinberg
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY.,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Peter D Cole
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Adam S Levy
- Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY
| | - Susan L Rosenthal
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University Irving Medical Center, New York, NY.,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
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17
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Affiliation(s)
- Susan L Rosenthal
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,NewYork-Presbyterian Hospital, New York
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18
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Landers SE, Francis JKR, Morris MC, Mauro C, Rosenthal SL. Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials. Ethics Hum Res 2020; 42:2-11. [PMID: 32421948 DOI: 10.1002/eahr.500048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given the burden of HIV and other sexually transmitted infections among adolescents who are legal minors, it is critical that they be included in biomedical sexual health trials to ensure that new prevention and treatment interventions are safe, effective, and acceptable for their use. However, adolescents are often not well represented in clinical trials. We provide an overview of the available evidence regarding adolescent and parent willingness for adolescents to participate in biomedical sexual health trials, parental involvement in the permission-consent process, management of differences and discord among adolescents and parents, and parental involvement throughout the study period. We also outline recommendations for current practice and areas for future research.
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Affiliation(s)
- Sara E Landers
- Research coordinator in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Jenny K R Francis
- Assistant professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center
| | - Marilyn C Morris
- Associate professor in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Christine Mauro
- Assistant professor in the Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center
| | - Susan L Rosenthal
- Professor of medical psychology in the Departments of Pediatrics and Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
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19
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Abstract
Pediatricians caring for patients with child abuse or neglect (CABN) may experience secondary traumatic stress (STS) from traumatized patients, or burnout (BO) from workplace stress. This may be buffered by compassion satisfaction (CS), positive meaning from one's work. For this study, STS, BO, and CS specific to a pediatrician's care of CABN were assessed for residents, hospitalists, intensivists, and outpatient physicians. Using the Professional Quality of Life Scale modified for CABN experiences, participants (n = 62) had a mean STS score at the 84th percentile, a mean BO score at the 66th percentile, and a mean CS score at the 17th percentile. Reporting one CABN patient as most emotionally impactful predicted STS, caring for all types of CABN predicted BO, and perceived knowledge no longer predicted CS when adjusting for the experience of mandated reporting or CABN fatality. These results highlight the need to support pediatricians involved with CABN.
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Affiliation(s)
- Mandy A O'Hara
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Teresa A McCann
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Weijia Fan
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA
| | - Mariellen M Lane
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Steven G Kernie
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
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20
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21
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Bornstein LM, Landers SE, Rosenthal SL, McCann TA. Physicians' Perceptions of Stakeholder Influence on Discharge Timing in a Children's Hospital. Glob Pediatr Health 2019; 6:2333794X19878596. [PMID: 31579686 PMCID: PMC6757495 DOI: 10.1177/2333794x19878596] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
Attending physicians (N = 53) at a nonprofit, university-affiliated academic children's hospital completed a survey about how key stakeholders affect timing of patient discharge beyond attending assessment of medical stability. Physicians perceived families and hospital administration as more often having an impact on discharge timing than they should and perceived members of the care team and peer physicians/consultants as less frequently having an impact than they should. All but one physician reported discharging a patient either earlier or later than they felt was appropriate due to pressure from at least one stakeholder group; almost all physicians had done so in response to pressure from families. When physicians changed discharge timing based on stakeholder pressure, they tended to extend hospital stay except in the case of administrative pressure. These findings highlight the need for improvements in communication regarding discharge goals and for future research on how navigating competing interests affect physician stress.
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Affiliation(s)
| | | | | | - Teresa A. McCann
- Columbia University Medical Center, New York, NY, USA
- Teresa A. McCann, Columbia University Medical Center, Vanderbilt Clinic Floor 4, Room 417, 622 West 168th Street, New York, NY 10032-3784, USA.
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22
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Affiliation(s)
- Melanie A Gold
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Mailman School of Public Health, Heilbrunn Department of Population & Family Health, Columbia University Medical Center, New York, New York
| | - Susan L Rosenthal
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Vagelos College of Physicians and Surgeons, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Milton L Wainberg
- Vagelos College of Physicians and Surgeons, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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23
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Skinner SR, Marino J, Rosenthal SL, Cannon J, Doherty DA, Hickey M. Prospective cohort study of childhood behaviour problems and adolescent sexual risk-taking: gender matters. Sex Health 2019; 14:492-501. [PMID: 28610653 DOI: 10.1071/sh16240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
Background Externalising (delinquent, aggressive) and internalising (anxious/depressed, withdrawn) behaviour problems are prevalent in childhood. Few studies have prospectively measured relationships between childhood behaviour problems and adolescent health risk behaviour, a major predictor of morbidity and mortality. This study sought to determine relationships, by gender, between childhood behaviour problems and adolescent risky sexual behaviours and substance use. METHODS In a population-based birth cohort [The Western Australian Pregnancy Cohort (Raine) Study], total, externalising and internalising behaviour problems (domain-specific T≥60) were calculated from parent-reported Child Behavior Checklist at ages 2, 5, 8, 10 and 14 years. At age 17 years, 1200 (49% male) participants reported sexual and substance use activity Results: For both genders, those with earlier externalising behaviour problems were more likely to be sexually active (oral sex or sexual intercourse) by age 17 years. Males with childhood externalising behaviour problems were more likely to have multiple sexual partners by age 17 years than those without such problems [adjusted odds ratio (aOR) 2.96, 95% confidence interval (CI) 1.49-5.86]. Females with childhood externalising behaviour problems were more likely to have had unwanted sex (aOR 1.91, 95% CI 1.04-3.53). Externalising behaviour problems were associated with substance use for both genders. No association was found between internalising behaviour problems and risky behaviour. CONCLUSIONS Externalising behaviour problems from as early as 5 years old in boys and 8 years old in girls predict a range of risky sexual behaviour in adolescence, which has important implications for targeting interventions in adolescence.
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Affiliation(s)
- S Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, the Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Jennifer Marino
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Susan L Rosenthal
- Columbia University College of Physicians and Surgeons and New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Jeffrey Cannon
- Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia
| | - Dorota A Doherty
- Biostatistics and Research Design Unit, Women and Infants Research Foundation, Perth, WA 6008, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic. 3010, Australia
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24
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Francis JKR, Fraiz LD, Catallozzi M, deRoche AM, Mauro C, Rosenthal SL. Pregnant young women's attitudes about microbicides: the anticipated influence of the grandmother and father of the baby on microbicide use. Sex Health 2019; 14:581-583. [PMID: 28514991 DOI: 10.1071/sh16179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/19/2017] [Indexed: 11/23/2022]
Abstract
Grandmothers and fathers of the baby may influence pregnant women's microbicide use. Pregnant young women's attitudes about grandmothers' and fathers' role in decision-making and their involvement in microbicide use were assessed. Participants (n=108) had a mean age of 20.2 years. The majority anticipated that the grandmother, father or both would have a decision-making role. Greater grandmother involvement in microbicide use was significantly associated with being younger, having no reproductive tract infection or contraceptive-ring-use history. Greater father involvement in use was associated with being in a relationship with him. Strategies for engaging grandmothers and fathers in microbicide use should be developed.
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Affiliation(s)
- Jenny K R Francis
- Department of Paediatrics, Columbia University Medical Centre, College of Physicians and Surgeons, 622 West 168th Street, PH 17, New York, NY, 10032, USA
| | - Lauren Dapena Fraiz
- Department of Paediatrics, Columbia University Medical Centre, College of Physicians and Surgeons, 622 West 168th Street, PH 17, New York, NY, 10032, USA
| | - Marina Catallozzi
- Department of Paediatrics, Columbia University Medical Centre, College of Physicians and Surgeons, 622 West 168th Street, PH 17, New York, NY, 10032, USA
| | - Ariel M deRoche
- Department of Paediatrics, Columbia University Medical Centre, College of Physicians and Surgeons, 622 West 168th Street, PH 17, New York, NY, 10032, USA
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Centre, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Susan L Rosenthal
- Department of Paediatrics, Columbia University Medical Centre, College of Physicians and Surgeons, 622 West 168th Street, PH 17, New York, NY, 10032, USA
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25
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Francis JKR, Landers SE, Radecki Breitkopf C, Mauro C, Chang J, Catallozzi M, Rosenthal SL. Research participation provides adolescents and parents a launching pad for conversations. Sex Health 2019; 16:198-199. [PMID: 30678749 DOI: 10.1071/sh18195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022]
Abstract
Little is known about whether adolescent participation in sexual health research prompts adolescents and parents to have conversations about sensitive topics. One year after being presented with a hypothetical microbicide safety study, 248 adolescent-parent dyads were asked about conversations they may have had after their initial study visit. Sixty-three per cent of adolescents and 82% of parents reported having a conversation about the study. A launching conversation about broader topics (e.g. risk behaviours) was reported by 8% of adolescents and 17% of parents. Because there is evidence that conversations are occurring, researchers could provide guidance to help facilitate potentially sensitive discussions.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University - Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA; and Present address: Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Mail Code 9063, Dallas, TX, 75390-9063, USA; and Corresponding author.
| | - Sara E Landers
- Department of Pediatrics, Columbia University - Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
| | - Carmen Radecki Breitkopf
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center - Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10065, USA
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University - Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University - Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
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Abstract
Despite having a medical home, pediatric patients continue emergency department (ED) utilization for various reasons. This study examines parental reasons associated with the decision to seek ED care in a group of low-income, inner-city, publicly insured children. Surveys were conducted with parents of children (age = 0-19 years) presenting to a community-based clinic, which has an established medical home model with enhanced access. Most patients (88.3%) had a pediatrician, and nearly all (93.3%) reported a visit to the ED; most (75.7%) were aware of clinic walk-in hours, but less than half (42.6%) were aware of an after-hours phone line. There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child's medical problem was serious. In addition to providing enhanced efforts, medical homes should strive to make families aware of increased access.
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Affiliation(s)
- Kalpana Pethe
- 1 Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY, USA.,2 NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Susan L Rosenthal
- 1 Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY, USA.,3 Department of Psychiatry,Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Melissa S Stockwell
- 1 Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY, USA.,2 NewYork-Presbyterian Hospital, New York, NY, USA.,4 Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Francis JKR, de Roche AM, Mauro C, Landers SE, Chang J, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyadic Retention in an Interview Study and Changes in Willingness to Participate in a Hypothetical Microbicide Safety Study. J Pediatr Adolesc Gynecol 2018; 31:592-596. [PMID: 29906513 PMCID: PMC6218291 DOI: 10.1016/j.jpag.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/17/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE In this study we describe adolescent and parent retention and changes in willingness to participate (WTP) in research among adolescents, parents, and adolescent-parent dyads. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study to assess research participation attitudes using simultaneous individual interviews of the adolescent and parent with a return visit 1 year later using the same interview. PARTICIPANTS Adolescents (14-17 years old) and their parents. INTERVENTIONS None. MAIN OUTCOME MEASURES The relationship between participant characteristics and dyad retention was assessed. WTP was measured on a Likert scale and dichotomized (willing/unwilling) to assess changes in WTP attitudes over time for adolescents, parents, and dyads. RESULTS Eighty-three percent of the 300 dyads were retained. Dyads in which there was successful contact with the parent before follow-up were more likely to be retained (odds ratio, 4.88; 95% confidence interval, 2.57-9.26). For adolescents at baseline, 59% were willing to participate and 55% were willing to participate at follow-up (McNemar S = 0.91; P = .34). For parents at baseline, 51% were willing to participate and 57% were willing to participate at follow-up (McNemar S = 5.12; P = .02). For dyads at baseline, 57% were concordant (in either direction) and 70% of dyads were concordant at follow-up (McNemar S = 10.56; P = .001). CONCLUSION Over 1 year, parent contact might positively influence successful adolescent retention. Parents become more willing to let their adolescents participate over time, with dyads becoming more concordant about research participation.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | - Sara E Landers
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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Auslander BA, Meers JM, Short MB, Zimet GD, Rosenthal SL. A qualitative analysis of the vaccine intention-behaviour relationship: parents' descriptions of their intentions, decision-making behaviour and planning processes towards HPV vaccination. Psychol Health 2018; 34:271-288. [PMID: 30406692 DOI: 10.1080/08870446.2018.1523408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/27/2022]
Abstract
OBJECTIVE The objective of this study is to identify factors influencing the vaccine intention-behaviour relationship. DESIGN A total of 445 parents who received a brief intervention to promote HPV vaccination were categorized based on their intentions post-intervention (yes/unsure/eventually/never) and subsequent adolescents' vaccine status (yes/no). Fifty-one of these parents participated in qualitative interviews. MAIN OUTCOME MEASURES Parents described their intentions, decision-making and planning processes towards vaccination. Framework analysis was used to analyse the data. RESULTS Parents in the 'Yes/Yes' category were knowledgeable about HPV/vaccine, described strong, stable intentions, considered themselves the primary decision-makers about vaccination and said they vaccinated immediately. 'Yes/No' parents described strong intentions and thought their adolescent was vaccinated OR described hesitant intentions, seeking advice/agreement from others and noting barriers to vaccination without solutions. 'Unsure/Yes' parents described their intentions as strengthening with information from credible sources and identified strategies for overcoming barriers. 'Unsure/No' and 'Eventually/No' parents had misinformation/negative beliefs regarding vaccination, described being ambivalent or non-supportive of vaccination and cited barriers to vaccination. 'Never/No' parents held negative beliefs about vaccination, described strong, stable intentions to NOT vaccinate, deferring the decision to others, and reported no planning towards vaccination. CONCLUSIONS Intention characteristics and planning processes could moderate the vaccine intention-behaviour relationship, potentially serving as targets for future vaccine strategies.
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Affiliation(s)
- Beth A Auslander
- a Division of Adolescent and Behavioral Health, Department of Pediatrics , University of Texas Medical Branch , Galveston , TX , USA
| | - Jessica M Meers
- a Division of Adolescent and Behavioral Health, Department of Pediatrics , University of Texas Medical Branch , Galveston , TX , USA
| | - Mary B Short
- b Department of Psychology , University of Houston-Clear Lake , Houston , TX , USA
| | - Gregory D Zimet
- c Division of Adolescent Medicine, Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Susan L Rosenthal
- d Division of Child and Adolescent Health, Department of Pediatrics , Columbia College of Physician and Surgeons and New York Presbyterian Morgan Stanley Children's Hospital , New York , NY , USA
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Robinson M, Doherty DA, Cannon J, Hickey M, Rosenthal SL, Marino JL, Skinner SR. Comparing adolescent and parent reports of externalizing problems: A longitudinal population-based study. Br J Dev Psychol 2018; 37:247-268. [PMID: 30394545 DOI: 10.1111/bjdp.12270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/16/2018] [Revised: 10/09/2018] [Indexed: 11/26/2022]
Abstract
Adolescent and parent reports of adolescent mental health problems often correlate poorly, and understanding this discrepancy has clinical importance. Yet contextual factors have only been inconsistently explained. At the 14- and 17-year follow-ups of the Western Australian Pregnancy Cohort (Raine) Study, 1,596 parent-child dyads completed the parent-reported Child Behaviour Checklist (CBCL) and the adolescent-rated Youth Self-Report (YSR). Maternal, family, adolescent, and parent factors were examined as potential predictors of discrepancies. When adolescent YSR scores were in the clinical range but parents' CBCL ratings were not, adolescents were more likely to report alcohol intoxication in the last 6 months, illicit drug use, low school motivation, and depression. When parents reported externalizing behaviour in the clinical range but adolescents did not, the characteristics associated with this were a younger maternal age, receiving social security benefit, stress related to parenting, depression, and poor family functioning. These new results will inform clinical management and research with adolescents who present with behavioural disorders. Statement of contribution What is already known on this subject? We know that adolescent and parent reports of adolescent mental health problems often correlate poorly, but little is known about which contextual factors lead to disagreement. Understanding the factors that influence agreement is clinically relevant for predicting and identifying externalizing behavioural disorders. This is a large-scale study with the ability to assess the impact of numerous psychosocial factors on instrument disagreement. What the present study adds We found that substance use, depression and low school motivation impacted on discrepancy in externalizing behaviour scores for 14-year-old male adolescents and their parents. Parental depression, stress, low family income, and family dysfunction also led to a higher likelihood of discrepancy in scores.
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Affiliation(s)
- Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation, Perth, Western Australia, Australia
| | - Jeffrey Cannon
- Women and Infants Research Foundation, Perth, Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne and Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan L Rosenthal
- Department of Pediatrics and Psychiatry, Columbia University Medical Center and Morgan Stanley Children's Hospital, NewYork Presbyterian Hospital, New York, USA
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, The University of Melbourne and Royal Women's Hospital, Parkville, Victoria, Australia
| | - S Rachel Skinner
- Discipline of Paediatrics and Child Health, The University of Sydney, New South Wales, Australia
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Tsevat RK, Breitkopf CR, Landers SE, de Roche AM, Mauro C, Ipp LS, Catallozzi M, Rosenthal SL. Adolescents' and Parents' Attitudes Toward Adolescent Clinical Trial Participation: Changes Over One Year. J Empir Res Hum Res Ethics 2018; 13:383-390. [PMID: 30103655 PMCID: PMC6146060 DOI: 10.1177/1556264618790889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
Little is known about how adolescents' and parents' thoughts about participation in clinical trials change over time. In this study, adolescent (14-17 years)-parent dyads were asked about willingness to participate in a hypothetical reproductive health study. A year later, they were asked how their thoughts about the study had changed. Qualitative responses were coded and analyzed using framework analysis. Thirty-two percent of adolescents and 18% of parents reported changes in thoughts; reasons included general changes in perception, clearer understanding, new knowledge or experiences, increased maturity/age of adolescents, and changes in participants independent of the study. Adolescents and parents may benefit from learning about studies multiple times, and investigators should account for development and new experiences to optimize adolescent research enrollment.
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Affiliation(s)
- Rebecca K. Tsevat
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Sara E. Landers
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | - Ariel M. de Roche
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Lisa S. Ipp
- NewYork-Presbyterian Hospital (USA)
- Weill Cornell Medical College (USA)
| | - Marina Catallozzi
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- Columbia University Mailman School of Public Health (USA)
- NewYork-Presbyterian Hospital (USA)
| | - Susan L. Rosenthal
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- NewYork-Presbyterian Hospital (USA)
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31
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Affiliation(s)
- Jane Chang
- Department of Pediatrics, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital
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Rosenthal SL, Morris MC, Hoffman LF, Zimet GD. Inclusion of Adolescents in STI/HIV Biomedical Prevention Trials: Autonomy, Decision Making, and Parental Involvement. Clin Pract Pediatr Psychol 2018; 6:299-307. [PMID: 30393589 DOI: 10.1037/cpp0000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,Department of Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,NewYork Presbyterian Hospital, New York, New York, United States
| | - Marilyn C Morris
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,NewYork Presbyterian Hospital, New York, New York, United States
| | - Lily F Hoffman
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Garbers S, Bell DL, Ogaye K, Marcell AV, Westhoff CL, Rosenthal SL. Advance provision of emergency contraception to young men: An exploratory study in a clinic setting. Contraception 2018; 98:S0010-7824(18)30141-0. [PMID: 29678366 DOI: 10.1016/j.contraception.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/14/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To explore the acceptability of advance provision of emergency contraceptive pills (ECPs) to young men seeking health care. METHODS For this exploratory study in a clinic setting, we approached young men aged 16-35 to participate in a survey eliciting socio-demographics, sexual and contraceptive history, and knowledge about ECPs. We offered young men advance provision of ECPs and compared characteristics of 126 young men who did and did not accept the ECPs. RESULTS Most (76%) of the participants accepted advance provision and left with an ECP pack, with even higher proportions among males whose sexual histories were suggestive of increased risk of involvement in an unintended pregnancy. CONCLUSIONS This study holds promise to inform scale up of advance provision of ECPs among young men.
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Affiliation(s)
- Samantha Garbers
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY, USA.
| | - D L Bell
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY, USA; Columbia University College of Physicians and Surgeons, Department of Pediatrics, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - K Ogaye
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY, USA
| | - A V Marcell
- Johns Hopkins School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - C L Westhoff
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA; Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | - S L Rosenthal
- Columbia University College of Physicians and Surgeons, Department of Pediatrics, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA; Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
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Bell DL, Garbers S, Catallozzi M, Hum RS, Nechitilo M, McKeague IW, Koumans EH, House LD, Rosenthal SL, Gold MA. Computer-Assisted Motivational Interviewing Intervention to Facilitate Teen Pregnancy Prevention and Fitness Behavior Changes: A Randomized Trial for Young Men. J Adolesc Health 2018; 62:S72-S80. [PMID: 29455722 PMCID: PMC6518409 DOI: 10.1016/j.jadohealth.2017.06.015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Despite recent declines, teen unintended pregnancy and sexually transmitted infections in the United States remain at levels higher than comparable nations. Initiatives to prevent teen pregnancy have focused primarily on female adolescents; how to effectively engage young men to reduce their risk of fathering a teen pregnancy has not been well studied. We proposed to adapt an innovative computer-assisted motivational interviewing (CAMI) intervention, originally designed and tested with young women, for use with young men, aged 15-24 years, to reduce their risk of fathering a teen pregnancy. This manuscript describes the design of a CAMI intervention for young men aimed at preventing teen pregnancy and improving fitness. METHODS This randomized controlled trial will recruit 945 sexually active young men between the ages of 15 and 24 years from three health centers in New York City. Participants will be assigned by permuted block randomization to two study arms: one aimed at reducing involvement in unintended teen pregnancy (CAMI-teen pregnancy prevention) and the other at improving overall fitness (CAMI-Fitness). Except for topic, both intervention arms will provide four sessions of Motivational Interviewing coaching and use a mobile app to track behavior and set goals. We will assess young men's sexual and reproductive health behaviors and fitness at baseline, 12, 24, 36, and 64 weeks using a mobile device app created for the study. RESULTS Pending ongoing study. CONCLUSIONS Results from the study are expected to enhance our understanding of the efficacy of CAMI to enhance young men's reproductive health and fitness behaviors.
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Affiliation(s)
- David L Bell
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - R Stanley Hum
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Meredith Nechitilo
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Ian W McKeague
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L Duane House
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan L Rosenthal
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York
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Mullins TLK, Rosenthal SL, Zimet GD, Ding L, Morrow C, Huang B, Kahn JA. Human Papillomavirus Vaccine-Related Risk Perceptions Do Not Predict Sexual Initiation Among Young Women Over 30 Months Following Vaccination. J Adolesc Health 2018; 62:164-169. [PMID: 29198772 PMCID: PMC5803391 DOI: 10.1016/j.jadohealth.2017.09.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE We examined longitudinally the relationship between human papillomavirus (HPV) vaccine-related risk perceptions and initiation of sexual activity among adolescent women over 30 months after HPV vaccination. METHODS Participants included 91 sexually inexperienced women aged 13-21 years receiving the HPV vaccine who completed at least three of five study visits. At every visit, participants completed surveys assessing HPV vaccine-related risk perceptions (perceived risk of sexually transmitted infections [STIs] other than HPV, perceived need for safer sexual behaviors), and sexual initiation. Outcomes were sexual initiation and age of sexual initiation. Associations between risk perceptions and outcomes were examined using ordered logistic regression models for sexual initiation and interval censored survival analyses for age of sexual initiation. RESULTS Mean age at baseline was 14.9 years (standard deviation [SD] 1.4). Most participants perceived themselves to be at risk of STIs other than HPV (mean scale score = 4.0/10; SD 2.1) and perceived a need for safer sexual behaviors (mean scale score = 1.5/10; SD 1.5). By 30 months, 65 participants (78%) initiated sex. Perceived risk of STIs and perceived need for safer sexual behaviors were not associated with sexual initiation or age of sexual initiation. Older age at baseline was associated with sooner sexual initiation (p = .02) and older age at sexual initiation (p < .001). Results of ordered logistic regression and survival analyses were unchanged when controlling for baseline age. CONCLUSIONS HPV vaccine-related risk perceptions were not associated with sexual initiation or age of sexual initiation, providing further support that HPV vaccine-related risk perceptions are unlikely to lead to riskier sexual behaviors.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
| | - Susan L. Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University and New York Presbyterian Morgan Stanley Children’s Hospital, 622 West 168 Street, PH17th floor, room 102a, New York, NY 10032, USA
| | - Gregory D. Zimet
- Division of Adolescent Medicine, Indiana University, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Charlene Morrow
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH, 45229, USA,University of Cincinnati College of Medicine, 3235 Eden Avenue, CARE/Crawley Building Suite E-870, Cincinnati, OH 45267, USA
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36
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Chang J, Ipp LS, de Roche AM, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyad Descriptions of the Decision to Start the HPV Vaccine Series. J Pediatr Adolesc Gynecol 2018; 31:28-32. [PMID: 29037930 PMCID: PMC5785551 DOI: 10.1016/j.jpag.2017.10.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE To examine how adolescent-parent dyads describe decision-making regarding initiation of the human papillomavirus (HPV) vaccine series, specifically who they viewed as making the final decision. DESIGN Semistructured interviews with adolescent-parent dyads were audio-recorded and transcribed. Responses to the question: "How did you make a decision about whether or not to receive the HPV vaccine series?" were content-coded for each individual member of the dyad. SETTING Adolescent medicine clinics of 2 large urban medical centers and through snowball sampling. PARTICIPANTS Adolescents 14-17 years of age and a parent (N = 262). Qualitative analyses were conducted for those who agreed that they were offered and started the HPV vaccine series (n = 109). INTERVENTIONS None. MAIN OUTCOME MEASURES Descriptions of the decision-making included 1 person (adolescent or parent) making the decision or joint decision-making by the adolescent and parent together. RESULTS More than half of the dyads did not agree on who made the decision to start the vaccine. Most adolescents and parents described a similar account about when they were offered the HPV vaccine, although the interpretation of the event in terms of the decision-maker might have differed. More than half of adolescents and parents individually mentioned the health care provider in their description of the HPV vaccine decision-making process even though they were not queried about the role of the provider. CONCLUSION Understanding the range of descriptions of these dyads is helpful to guide interventions to promote vaccine uptake in a manner that balances provider expertise, adolescent autonomy, and parental involvement.
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Affiliation(s)
- Jane Chang
- Department of Pediatrics, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York.
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
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Francis JKR, Dapena Fraiz L, de Roche AM, Catallozzi M, Radecki Breitkopf C, Rosenthal SL. Management of Adolescent-Parent Dyads' Discordance for Willingness to Participate in a Reproductive Health Clinical Trial. J Empir Res Hum Res Ethics 2017; 13:42-49. [PMID: 29226745 DOI: 10.1177/1556264617745409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 01/17/2023]
Abstract
The objective of this study is to understand the resolution of discordance between adolescent-parent dyads about participation in research. Adolescent (14-17 years) and parent dyads were recruited from NYC pediatric clinics to assess attitudes toward research participation. A subset of dyads participated in videotaped discussions about participation in a hypothetical study. Videos from dyads that held strongly discordant opinions about participation ( n = 30) were content-coded and analyzed using a thematic framework approach. Strategies used to resolve discordance included asserting authority, granting autonomy, or recognizing inaccurate assumptions using a variety of communication behaviors. Missed opportunities to enroll initially discordant dyads may be avoided by allowing time for adolescents and parents to elicit information, clarify a situation, or convince the other.
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Affiliation(s)
| | | | | | - Marina Catallozzi
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
| | | | - Susan L Rosenthal
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
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Boswood A, Gordon SG, Häggström J, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Schummer C, Watson P. Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study. J Vet Intern Med 2017; 32:72-85. [PMID: 29214723 PMCID: PMC5787203 DOI: 10.1111/jvim.14885] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac‐related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan‐treated dogs differ from dogs receiving placebo at onset of CHF. Animals Three hundred and fifty‐four dogs with MMVD and cardiomegaly. Materials and Methods Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4–0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart‐size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short‐term changes in echocardiographic variables and time to CHF or CRD were explored. Results At day 35, heart size had reduced in the pimobendan group: median change in (Δ) LVIDDN −0.06 (IQR: −0.15 to +0.02), P < 0.0001, and LA:Ao −0.08 (IQR: −0.23 to +0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in ΔLVIDDN was 1.26, P = 0.0003. Hazard ratio for a 0.1 increase in ΔLA:Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo.
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Affiliation(s)
- A Boswood
- department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic., Australia
| | - V Szatmári
- Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Y Fujii
- Surgery 1, Azabu University, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Gallarate, Varese, Italy
| | - M Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - C Schummer
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - P Watson
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
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Fraiz LD, de Roche A, Mauro C, Catallozzi M, Zimet GD, Shapiro GK, Rosenthal SL. U.S. pregnant women's knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition. Vaccine 2017; 36:165-169. [PMID: 29157958 DOI: 10.1016/j.vaccine.2017.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Zika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women's attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae. METHODS Pregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination. RESULTS Most women (91%) were married/living with the baby's father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated. CONCLUSIONS Pregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.
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Affiliation(s)
- Lauren Dapena Fraiz
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Ariel de Roche
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Christine Mauro
- Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States.
| | - Marina Catallozzi
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, United States.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada; Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd., Ste. 400, Chicago, IL 60612, United States.
| | - Susan L Rosenthal
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
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Stupiansky NW, Liau A, Rosenberger J, Rosenthal SL, Tu W, Xiao S, Fontenot H, Zimet GD. Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health: Results from a US National Sample of Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:342-347. [PMID: 28753396 DOI: 10.1089/apc.2017.0011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 11/12/2022] Open
Abstract
Many men who have sex with men (MSM) do not disclose their same sex behaviors to healthcare providers (HCPs). We used a series of logistic regression models to explore a conceptual framework that first identified predictors of disclosure to HCPs among young MSM (YMSM), and subsequently examined young men's disclosure of male-male sexual behaviors to HCPs as a mediator between sociodemographic and behavioral factors and three distinct health outcomes [HIV testing, sexually transmitted infection (STI) testing, and human papillomavirus (HPV) vaccination]. We determined the predictors of disclosure to HCPs among YMSM and examined the relationship between disclosure and the receipt of appropriate healthcare services. Data were collected online through a US national sample of 1750 YMSM (ages 18-29 years) using a social and sexual networking website for MSM. Sexual history, STI/HIV screening history, sexual health, and patient-provider communication were analyzed in the logistic regression models. Participants were predominantly white (75.2%) and gay/homosexual (76.7%) with at least some college education (82.7%). Young men's disclosure of male-male sexual behaviors to HCPs was associated with the receipt of all healthcare outcomes in our model. Disclosure was a stronger mediator in HPV vaccination than in HIV and STI testing. Disclosure to non-HCP friends and family, HCP visit in the past year, and previous STI diagnosis were the strongest predictors of disclosure. Young men's disclosure of male-male sexual behaviors to HCPs is integral to the receipt of appropriate healthcare services among YMSM. HPV vaccination is more dependent on provider-level interaction with patients than HIV/STI testing.
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Affiliation(s)
- Nathan W. Stupiansky
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Adrian Liau
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joshua Rosenberger
- Pennsylvania State University College of Health and Human Development, State College, Pennsylvania
| | | | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Shan Xiao
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Holly Fontenot
- Boston College William F. Connell School of Nursing, Boston, Massachusetts
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Morris MC, Rosenthal SL. Pregnancy Testing of Adolescents during Clinical Research: Managing the Process. IRB 2017; 39:14-17. [PMID: 30148333 PMCID: PMC6345158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Catallozzi M, de Roche AM, Hu MC, Breitkopf CR, Chang J, Ipp LS, Francis JKR, Rosenthal SL. Adolescent and Parent Willingness to Participate in Microbicide Safety Studies. J Pediatr Adolesc Gynecol 2017; 30:82-87. [PMID: 27381236 PMCID: PMC5863908 DOI: 10.1016/j.jpag.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE To understand adolescents' and parents' willingness to participate (WTP) in a hypothetical phase I prevention study of sexually transmitted infections, discordance within adolescent-parent dyads, and expectations of each other during decision-making. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study about research participation attitudes. PARTICIPANTS Adolescents (14-17 years old) and their parents (n = 301 dyads) participated. INTERVENTIONS None. MAIN OUTCOME MEASURES Individual interviews at baseline assessed WTP on a 6-level Likert scale. WTP was dichotomized (willing/unwilling) to assess discordance. RESULTS WTP was reported by 60% (182 of 301) of adolescents and 52% (156 of 300) of parents. In bivariate analyses, older adolescent age, sexual experience, and less involvement of parents in research processes were associated with higher level of WTP for adolescents; only sexual experience remained in the multivariable analysis. For parents, older adolescent age, perceived adolescent sexual experience, and conversations about sexual health were significant; only conversations remained. Dyadic discordance (44%, 132 of 300) was more likely in dyads in which the parent reported previous research experience, and less likely when parents reported higher family expressiveness. Adolescents (83%, 248 of 299) and parents (88%, 263 of 300) thought that the other would have similar views, influence their decision (adolescents 66%, 199 of 300; parents 75%, 224 of 300), and listen (adolescents 90%, 270 of 300; parents 96%, 287 of 300). There were no relationships between these perceptions and discordance. CONCLUSION Inclusion of adolescents in phase I clinical trials is necessary to ensure that new methods are safe, effective, and acceptable for them. Because these trials currently require parental consent, strategies that manage adolescent-parent discordance and support adolescent independence and parental guidance are critically needed.
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Affiliation(s)
- Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center-Mailman School of Public Health, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | | | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
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Hofstetter AM, Lappetito L, Stockwell MS, Rosenthal SL. Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists. J Pediatr Adolesc Gynecol 2017; 30:88-95. [PMID: 27542999 PMCID: PMC5279719 DOI: 10.1016/j.jpag.2016.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/06/2016] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Many adolescents with chronic medical conditions (CMCs) are at risk of human papillomavirus (HPV) infection, associated complications, and underimmunization and often identify a pediatric subspecialist as their main provider. This study aimed to assess the HPV-related understanding, beliefs, and practices of pediatric subspecialists, which are largely unknown. DESIGN AND SETTING National cross-sectional study. PARTICIPANTS Pediatric endocrinologists, hematologist/oncologists, pulmonologists, and rheumatologists identified using the American Medical Association Physician Masterfile (n = 418). INTERVENTIONS Subspecialists who care for adolescents with CMCs in the outpatient setting were recruited to complete a Web-based survey on their HPV-related knowledge, attitudes, comfort, and practices. MAIN OUTCOME MEASURES HPV vaccination recommendation. RESULTS Over half of respondents (50.4%; n = 196/389) reported sometimes or always recommending HPV vaccination to adolescent patients with CMCs. Factors positively associated with recommendation included hematology/oncology (adjusted odds ratio [AOR], 4.69; 95% confidence interval [CI], 1.86-11.81) or rheumatology (AOR, 6.55; 95% CI, 1.67-25.74) specialization, seeing more adolescent patients with CMCs (AOR, 1.01; 95% CI, 1.00-1.02), and sometimes or always discussing sexual health (AOR, 2.53; 95% CI, 1.05-6.08) or checking vaccine status (AOR, 3.83; 95% CI, 1.59-9.20) with these patients. Those who thought it was important, but were uncomfortable discussing sexual health when recommending HPV vaccination (AOR, 0.28; 95% CI, 0.12-0.70) or who reported insufficient HPV vaccine information (AOR, 0.45; 95% CI, 0.23-0.88) or lack of primary-subspecialty care provider communication (AOR, 0.38; 95% CI, 0.16-0.93) as barriers to HPV vaccination were less likely to recommend HPV vaccination. CONCLUSION This study revealed that many subspecialists fail to recommend HPV vaccination to adolescents with CMCs and highlights potential targets for future interventions.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University, New York, New York; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Lauren Lappetito
- Department of Pediatrics, Columbia University, New York, New York
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Mailman School of Public Health, Columbia University, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University, New York, New York
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Doherty M, Schmidt-Ott R, Santos JI, Stanberry LR, Hofstetter AM, Rosenthal SL, Cunningham AL. Vaccination of special populations: Protecting the vulnerable. Vaccine 2016; 34:6681-6690. [PMID: 27876197 DOI: 10.1016/j.vaccine.2016.11.015] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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: 06/14/2016] [Revised: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
One of the strategic objectives of the 2011-2020 Global Vaccine Action Plan is for the benefits of immunisation to be equitably extended to all people. This approach encompasses special groups at increased risk of vaccine-preventable diseases, such as preterm infants and pregnant women, as well as those with chronic and immune-compromising medical conditions or at increased risk of disease due to immunosenescence. Despite demonstrations of effectiveness and safety, vaccine uptake in these special groups is frequently lower than expected, even in developed countries with vaccination strategies in place. For example, uptake of the influenza vaccine in pregnancy rarely exceeds 50% in developed countries and, although data are scarce, it appears that only half of preterm infants are up-to-date with routine paediatric vaccinations. Many people with chronic medical conditions or who are immunocompromised due to disease or aging are also under-vaccinated. In the US, coverage among people aged 65years or older was 67% for the influenza vaccine in the 2014-2015 season and 55-60% for tetanus and pneumococcal vaccines in 2013, while the coverage rate for herpes zoster vaccination among those aged 60years or older was only 24%. In most other countries, rates are far lower. Reasons for under-vaccination of special groups include fear of adverse outcomes or illness caused by the vaccine, the inconvenience (and in some settings, cost) of vaccination and lack of awareness of the need for vaccination or national recommendations. There is also evidence that healthcare providers' attitudes towards vaccination are among the most important influences on the decision to vaccinate. It is clear that physicians' adherence to recommendations needs to be improved, particularly where patients receive care from multiple subspecialists and receive little or no care from primary care providers.
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Affiliation(s)
- Mark Doherty
- GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, B-1300 Wavre, Belgium.
| | | | | | - Lawrence R Stanberry
- Columbia University College of Physicians and Surgeons, New York, NY, USA; New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA.
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Susan L Rosenthal
- Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Anthony L Cunningham
- Westmead Institute, The Centre for Virus Research, 176 Hawkesbury Road, NSW 2145, Australia.
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Catallozzi M, Fraiz LD, Hargreaves KM, Zimet GD, Stanberry LR, Ratner AJ, Gelber SE, Rosenthal SL. Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy. Int J STD AIDS 2016; 28:881-886. [PMID: 27815549 DOI: 10.1177/0956462416679067] [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: 11/17/2022]
Abstract
We sought to understand pregnant women's product preference and likelihood of use of topical microbicides for bacterial vaginosis (BV) prevention and treatment. Pregnant women (N = 196) in a obstetrics clinic completed a survey between June 2014 and January 2015 about vaginal product use for BV. This cross-sectional study explored product preferences, likelihood of product use for BV management and father of the baby (FOB) involvement. Most participants were under 30 (68%) and underrepresented minorities (47% Hispanic, 21% African-American). Most women preferred the gel (69%). Only 30% were likely to use either product for prevention of BV; 76% if high risk for BV; 83% treatment of BV. Anticipated FOB involvement in decision-making included that 46% would ask his opinion, 38% would inform him of the decision and 7% would need approval. Most (87%) would ask the FOB for reminders and 66% for insertion help. Those under 30 were more likely to agree to ask the FOB for reminders (p < 0.01) and insertion help (p = 0.05). African-American women were less likely to have their FOB help with insertion (p < 0.01). Product preferences may be less critical than risk perception. Involvement of the FOB in decision-making may be vital.
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Affiliation(s)
- Marina Catallozzi
- 1 Department of Pediatrics, Columbia University Medical Center, New York, NY USA.,2 New York-Presbyterian Hospital, New York, NY USA.,3 Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY USA
| | - Lauren Dapena Fraiz
- 1 Department of Pediatrics, Columbia University Medical Center, New York, NY USA.,2 New York-Presbyterian Hospital, New York, NY USA
| | - Katharine M Hargreaves
- 1 Department of Pediatrics, Columbia University Medical Center, New York, NY USA.,2 New York-Presbyterian Hospital, New York, NY USA
| | - Gregory D Zimet
- 4 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lawrence R Stanberry
- 1 Department of Pediatrics, Columbia University Medical Center, New York, NY USA.,2 New York-Presbyterian Hospital, New York, NY USA
| | - Adam J Ratner
- 5 Department of Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Shari E Gelber
- 6 Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Susan L Rosenthal
- 1 Department of Pediatrics, Columbia University Medical Center, New York, NY USA.,2 New York-Presbyterian Hospital, New York, NY USA.,7 Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
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Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine 2016; 34:6700-6706. [PMID: 27810314 DOI: 10.1016/j.vaccine.2016.10.042] [Citation(s) in RCA: 467] [Impact Index Per Article: 58.4] [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: 06/30/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.
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Affiliation(s)
- Pauline Paterson
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - François Meurice
- GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, B-1300 Wavre, Belgium.
| | - Lawrence R Stanberry
- Columbia University College of Physicians and Surgeons and New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA.
| | - Steffen Glismann
- GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, B-1300 Wavre, Belgium.
| | - Susan L Rosenthal
- Columbia University College of Physicians and Surgeons and New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA.
| | - Heidi J Larson
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Department of Global Health, University of Washington, Seattle, USA.
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Francis JKR, Fraiz LD, Catallozzi M, Rosenthal SL. Qualitative Analysis of Sexually Experienced Female Adolescents: Attitudes about Vaginal Health. J Pediatr Adolesc Gynecol 2016; 29:496-500. [PMID: 27133374 PMCID: PMC5003631 DOI: 10.1016/j.jpag.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Received: 11/20/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To explore adolescent's perceptions of vaginal health, practices, and vaginally-placed products. DESIGN Semistructured interviews were audio-recorded and transcribed until theoretical saturation was achieved. SETTING Adolescent medicine clinics in New York City. PARTICIPANTS Female adolescents (N = 22) who were sexually experienced, predominately Hispanic (73%, n = 16) with a mean age of 17.7 years (range, 15-20 years). INTERVENTIONS None. MAIN OUTCOME MEASURES Interviews were used to assess perspectives on vaginal health, specific vaginal hygiene practices, and attitudes about vaginally-placed products (contraceptive rings, intrauterine devices), and proposed multipurpose technologies administered as ring or gel). The interviews were transcribed and coded for relevant themes. RESULTS Overlapping themes included young women's view of their vagina as a space that needed to be healthy for sexual partners and future fertility. The vagina could not be presumed to be healthy and conversations about vaginal health were limited to include only specific individuals. All reported a variety of practices to maintain their vaginal health, including showering 1-5 times a day and using soaps specifically for the vagina. Attitudes about vaginally-placed products revealed concerns about the sensory experience of having a product in the vagina, safety concerns and interest in the product's objective (prevention of pregnancy or infection). CONCLUSION Adolescents have very specific views and practices about their vaginas. Clinicians should initiate conversations about vaginal health and hygiene with adolescents and focus on the normalcy of the vagina. Development of vaginally-placed products should focus on the sensory experience, safety, and purpose of the product.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Lauren Dapena Fraiz
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center - Mailman School of Public Health, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York
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48
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Boswood A, Häggström J, Gordon SG, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Watson P. Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial. J Vet Intern Med 2016; 30:1765-1779. [PMID: 27678080 PMCID: PMC5115200 DOI: 10.1111/jvim.14586] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/08/2016] [Accepted: 08/23/2016] [Indexed: 11/27/2022] Open
Abstract
Background Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives Administration of pimobendan (0.4–0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac‐related death, or euthanasia. Animals 360 client‐owned dogs with MMVD with left atrial‐to‐aortic ratio ≥1.6, normalized left ventricular internal diameter in diastole ≥1.7, and vertebral heart sum >10.5. Methods Prospective, randomized, placebo‐controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac‐related death, or euthanasia. Results Median time to primary endpoint was 1228 days (95% CI: 856–NA) in the pimobendan group and 766 days (95% CI: 667–875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47–0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952–NA) in the pimobendan group and 902 days (95% CI: 747–1061) in the placebo group) (P = .012). Conclusions and Clinical Importance Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit.
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Affiliation(s)
- A Boswood
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic, Australia
| | - V Szatmári
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, Utrecht, Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Deptartment of Clinical Studies, University of Guelph, Ontario Veterinary College, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
| | - Y Fujii
- Azabu University, Chuo-ku, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Viale Marconi, Varese, Italy
| | - M Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - P Watson
- Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany
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Teplow-Phipps RL, Papadouka V, Benkel DH, Holleran S, Ramakrishnan R, Rosenthal SL, Soren K, Stockwell MS. Influence of Gender and Gender-Specific Recommendations on Adolescent Human Papillomavirus Vaccination. Am J Prev Med 2016; 51:161-169. [PMID: 27032464 DOI: 10.1016/j.amepre.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) vaccine was introduced for female adolescents prior to male adolescents. Understanding coverage patterns related to gender-specific recommendations and factors associated with early adoption and timely completion may be important for future vaccines. METHODS Retrospective analysis of HPV vaccine initiation (one or more dose) and completion (three or more doses) patterns in adolescents aged 11-18 years using 2009-2013 New York Citywide Immunization Registry data. Log binomial models assessed patient-specific (age, insurance) and practice-specific (facility type, number of adolescents, poverty level) variables on early adoption (within 1 year of recommendation) and timely completion (within 12 months) by gender. RESULTS Of 1,494,767 adolescents, 50.2% were male, 57.5% were vaccinated in private practices, 58.7% in practices with more adolescents, and 48.8% in highest poverty locations. More female (54.0%) than male (33.5%) adolescents initiated vaccination (p<0.001). Of those, 56.1% received three or more doses, 34.1% within 12 months (30.0% male, 36.8% female, p<0.001). In 2009-2012, the proportion of still-eligible male adolescents who newly initiated increased from 0.1% to 17.0%; rates for female adolescents increased from 15.4% to 17.3%. Vaccination initiation within 1 year of gender-specific recommendations was similar (27.4% female, 27.3% male). For both genders, the uninsured were less likely to have early adoption and timely completion. Being publicly insured was associated with early adoption in both genders, but with timely completion in male adolescents only. Being seen in a public facility and in a practice with more adolescents was also associated with early adoption. CONCLUSIONS Changing HPV vaccine recommendations had minimal cross-gender impact. Early adoption and timely completion patterns were mostly similar across genders.
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Affiliation(s)
- Randi L Teplow-Phipps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Vikki Papadouka
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denise H Benkel
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephen Holleran
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Rajasekhar Ramakrishnan
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Susan L Rosenthal
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Karen Soren
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
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50
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Auslander BA, Rosenthal SL, Succop PA, Mills LM, Stanberry LR, Bernstein DI. Gender-specific predictors of genital herpes vaccine acceptance in a college population. Int J STD AIDS 2016; 16:27-30. [PMID: 15705269 DOI: 10.1258/0956462052932593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vaccines represent one promising method for reducing the sexually transmitted disease (STD) epidemic. This study evaluated whether influences on the decision to accept a genital herpes vaccine differed by gender. In all, 518 college students completed a questionnaire on sexual history, health beliefs, and acceptance of a potential genital herpes vaccine. Each predictor variable plus a gender interaction term were analysed in separate logistic regression models. Follow-up analyses were performed by gender for outcomes that displayed significant interactions. Results indicated that a prior history of an STD and increased perception of risk for acquiring genital herpes were significant predictors of vaccine acceptance for men, while younger age and concerns about vaccine safety were significant predictors for women. Endorsement of a vaccine strategy targeting sexually experienced people was an influential factor for both genders, but was a much stronger one for women. Results suggest that gender-specific strategies may be crucial to genital herpes vaccine acceptance.
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Affiliation(s)
- B A Auslander
- Department of Pediatrics, University of Texas Medical Branch at Galveston, 301 Universtiy Boulevard, Galveston, TX 77555-0319, USA.
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