The flu shot study: Using multiattribute utility theory to design a vaccination intervention

Differences between the multiattribute utility (MAU) profiles of participants who had previously gotten flu shots and those who had not done so were used to design an informational brochure urging influenza vaccination. The effectiveness of the MAU brochure was evaluated in a VA ambulatory care clinic with a long-standing influenza vaccination program. The target population for the intervention was high-risk clinic patients who had not gotten a shot the previous year. Participants received either a letter urging them to get a flu shot, or a letter plus the informational brochure. A significantly larger proportion of the patients who received the brochure got shots; 36% versus 23% for the letter only. While a 13 percentage point increase is modest, influenza and related complications (preventable through vaccination) are the fourth-leading killers of older persons. Adding a MAU-based brochure to an ongoing vaccination program is inexpensive and may save additional lives.     

Who got vaccinated against H1N1 pandemic influenza? – A longitudinal study in four US cities

The recent H1N1 pandemic influenza stimulated numerous studies into the attitudes and intentions about the H1N1 vaccine. However, no study has investigated prospective predictors of vaccination behaviour. We conducted a two-wave longitudinal study among residents in four US cities during the course of the H1N1 outbreak, using Internet surveys to assess demographic, cognitive and emotional predictors of H1N1 vaccination behaviour. Surveys were conducted at two time points, before (Time 1) and after (Time 2) the H1N1 vaccine was widely available to the public. Results show that Time 2 vaccination rates, but not Time 1 vaccination intentions, tracked H1N1 prevalence across the four cities. Receipt of seasonal influenza vaccine in the previous year, worry, compliance with recommended interventions, household size and education assessed at Time 1 were significant prospective predictors of vaccination behaviour. Perception of the H1N1 vaccine, social influence and prioritised vaccine recipient status assessed at Time 2 also predicted vaccination behaviour. Critically, worry about H1N1 mediated the effects of both objective risk (prevalence at the city level) and perceived risk on vaccination behaviour. These results suggest that H1N1 vaccination behaviour appropriately reflected objective risk across regions, and worry acted as the mechanism by which vaccination behaviour followed objective risk.     

流行性感冒近期会大流行吗?

流行性感冒是为数不多的可能造成世界大流行的急性传染病之一。大流行的基础是人与动物的流感病毒相互接触与不断变异,在复制过程中基因重组而产生新的亚型,并侵袭对新亚型毫无抵抗力的人群,迅速蔓延而成大流行。大流行的结果是人群的高发病率与高致死率,对人类生命财产和社会经济发展带来灾难性打击。目前,H5N1亚型可能巳经具备了从禽鸟直接向人类传播的能力,流感大流行已向我们走来。面对威胁只有加强监测,力争在大流行来到之前,采取有科学依据的综合性措施,随时应对疫情先兆,方有可能遏制流行势头。     

Who got vaccinated against H1N1 pandemic influenza? A longitudinal study in four U.S. cities

The recent H1N1 pandemic influenza stimulated numerous studies into the attitudes and intentions about the H1N1 vaccine. However, no study has investigated prospective predictors of vaccination behaviour. We conducted a two-wave longitudinal study among residents in four U.S. cities during the course of the H1N1 outbreak, using Internet surveys to assess demographic, cognitive and emotional predictors of H1N1 vaccination behaviour. Surveys were conducted at two time points, before (Time 1) and after (Time 2) the H1N1 vaccine was widely available to the public. Results show that Time 2 vaccination rates, but not Time 1 vaccination intentions, tracked H1N1 prevalence across the four cities. Receipt of seasonal influenza vaccine in the previous year, worry, compliance with recommended interventions, household size and education assessed at Time 1 were significant prospective predictors of vaccination behaviour. Perception of the H1N1 vaccine, social influence and prioritised vaccine recipient status assessed at Time 2 also predicted vaccination behaviour. Critically, worry about H1N1 mediated the effects of both objective risk (prevalence at the city level) and perceived risk on vaccination behaviour. These results suggest that H1N1 vaccination behaviour appropriately reflected objective risk across regions, and worry acted as the mechanism by which vaccination behaviour followed objective risk.     

Ethics and public health emergencies: rationing vaccines

There are three broad ethical issues related to handling public health emergencies. They are the three R's-rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.     

Judging Public Health Research: Epistemology,Public Health and the Law

There are three broad ethical issues related to handling public health emergencies. They are the three R's—rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.     

Mandating vaccination: what counts as a "mandate" in public health and when should they be used?

Recent arguments over whether certain public health interventions should be mandatory raise questions about what counts as a "mandate." A mandate is not the same as a mere recommendation or the standard of practice. At minimum, a mandate should require an active opt-out and there should be some penalty for refusing to abide by it. Over-loose use of the term "mandate" and the easing of opt-out provisions could eventually pose a risk to the gains that truly mandatory public health interventions, such as childhood vaccines, have provided over the last 50 years. Already, confusion about what counts as a mandate, and about what criteria should be used to determine when a public health intervention should be implemented as a mandate, has led to some inappropriate public policy decisions. For instance, by any reasonable criteria, the yearly influenza vaccine should be mandatory for health care workers. To enforce this mandate, those who refuse vaccination should be required to sign a waiver, and patients - especially those at high risk from flu - should be informed when they receive care from unvaccinated practitioners.     

Application of a CBPR Framework to Inform a Multi-level Tobacco Cessation Intervention in Public Housing Neighborhoods

African American women in urban, high poverty neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco-related health disparities. Prior research utilizing conventional "outsider driven" interventions targeted to individuals has failed to show effective cessation outcomes. This paper describes the application of a community-based participatory research (CBPR) framework to inform a culturally situated, ecological based, multi-level tobacco cessation intervention in public housing neighborhoods. The CBPR framework encompasses problem identification, planning and feasibility/pilot testing, implementation, evaluation, and dissemination. There have been multiple partners in this process including public housing residents, housing authority administrators, community health workers, tenant associations, and academic investigators. The advisory process has evolved from an initial small steering group to our current institutional community advisory boards. Our decade-long CBPR journey produced design innovations, promising preliminary outcomes, and a full-scaled implementation study in two states. Challenges include sustaining engagement with evolving study partners, maintaining equity and power in the partnerships, and long-term sustainability of the intervention. Implications include applicability of the framework with other CBPR partnerships, especially scaling up evolutionary grassroots involvement to multi-regional partnerships.     

Formation and use of covariation assessments in the real world

In this study we examined covariation assessments made using real‐world information held by individual participants about an important preventive health behaviour: receiving an influenza vaccine (‘flu shot’). Four hundred and seventy‐seven healthy adult participants completed a questionnaire, indicating both their personal experience and vicarious experience (knowledge of other people's experiences) with the flu shot and the flu. Additionally, participants provided a covariation assessment by indicating how effective they thought the flu shot is in preventing the flu. We examined whether the experience information was related to the covariation assessment, and whether it in turn was related to the decision to receive a flu shot. Our results indicated that people use a simple intuitive strategy to combine their personal experience information. For vicarious experience information, we found evidence for use of a normative strategy, as well as simpler intuitive strategies. Consistent with our hypothesis, both types of experience information were associated with the effectiveness judgement, which was subsequently related to the decision to obtain a flu shot. Practical applications of these findings are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Reliability and construct validity of the psychopathy checklist - revised for Latino, European American, and African American male inmates

The utility of the psychopathy construct in predicting laboratory deficits, criminal behavior, response to intervention, and recidivism has been well documented in European American populations. However, less is known about the manifestation and correlates of psychopathy in Latino and African American populations. The present study examined the reliability and construct validity of the Psychopathy Checklist - Revised (PCL-R; R. D. Hare, 2003) in 83 Latino inmates compared with matched samples of African Americans and European Americans. Results provide preliminary evidence that the PCL-R provides a reliable and valid measure of psychopathy in Latinos, with generally similar patterns emerging across external correlates; however, some ethnic group differences were noted for relationships between psychopathy indicators and some external correlates.     

甲流了解程度、疫苗安全感知、接种行为及其影响机制

采用问卷调查的方法, 对甲流了解程度、疫苗安全感知、接种行为及其影响机制进行了研究, 并运用结构方程对提出的模型进行了验证和调整。结果表明：(1)民众对甲流疫情基本情况、疫苗接种要求和传播途径等方面有较高的了解程度, 但对预防措施和疫苗信息了解较少。(2)交流卷入对了解程度不存在显著影响; 而新闻卷入对了解程度有显著正向影响, 并且新闻卷入对感知疫苗安全程度的正向影响受到了解程度的部分中介。(3)感知甲流疫苗越安全, 越倾向于选择接种疫苗。(4)人格对疫苗的风险认知存在显著影响, 个人随和性(Agreeableness)程度越高, 则感知疫苗的安全程度越高, 而年龄和性别对其均没有显著影响。     

Toward a narrative conceptualization of stereotypes: contextualizing perceptions of public housing residents

Expansion of policies aimed at empowering disenfranchised groups, for example, resident/tenant participation in public housing, have been greeted with a great deal of enthusiasm. However, negative beliefs about the intelligence, ability, and morality of these groups, may interfere with the implementation of these policies. A greater understanding of social perceptions may lead to interventions that diminish interference. Traditional stereotyping research methods rely on trait conceptualizations that have been criticized as inadequate to fully describe social perceptions. This study examines the utility of a narrative approach to studying stereotypes about public housing residents. A group of college students (authors) wrote stories about a public housing resident and described the resident using trait objectives. Two readers, one given the story and the other the trait list, predicted how the author responded on various public housing belief and attitude instruments. Results indicate that stories and traits convey unique information not expressed by the other and offer preliminary support for the added usefulness, especially contextual information, of a narrative framework for studying stereotypes. The relevance of a narrative approach for understanding how stereotypes may undermine empowerment-based policies, in this case tenant participation in public housing, will also be explored. Copyright © 2000 John Wiley & Sons, Ltd.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Depressed nursing home residents' activity participation and affect as a function of staff engagement

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8 to 45 weeks, 5 minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity; however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.     

Extreme Social Isolation, Use of Community-Based Senior Support Services, and Mortality Among African American Elderly Women

The effect of extreme social isolation and use of community-based senior services on longevity was examined in a national sample of African American elderly women (ages 55–96). Consistent with previous research on the social integration/mortality link, African American elderly women who were extremely socially isolated were hypothesized to have a higher 5-year mortality rate. It was also hypothesized that use of community senior services would be negatively associated with 5-year mortality. Results of logistic regression analysis controlling for age, education, income, and health status found that extremely socially isolated African American elderly women were three times more likely than the nonisolated women to die within the 5-year period from the initial survey. Use of community senior services did not have a relationship on mortality. Results are discussed in terms of directions for future research and intervention.     

Evaluating the Impact of Elder Cottage Housing on Residents and Their Hosts

Family members who wish to have their older relatives live with them often encounter obstacles that make such an arrangement unworkable. Proponents of the Elder Cottage, and its variant, the Homecare Suite, suggest that many of these obstacles can be avoided with Elder Cottage use. The purpose of this study was to evaluate the impact of Elder Cottages on a variety of resident and host outcomes. A nonequivalent comparison group design was used. Thirty-one treatment group residents and their hosts received Elder Cottages whereas 24 comparison group residents and their hosts remained on a waiting list. Results showed that residents using Elder Cottages reported significantly greater satisfaction with their housing, increased independence, more telephone contacts with friends and family, improved relationships with hosts, more accessible housing, and less formal service use than those in the comparison group. Similarly, hosts in the treatment group reported significantly greater satisfaction with the residents' housing and less stress in their caregiving roles than those in the comparison group. In addition, fewer Elder Cottage hosts than comparison group hosts engaged in caregiver-related driving. Answers to short-answer questions mirrored the quantitative findings. These results provide substantial optimism with respect to the Elder Cottage as a housing option for older adults, although interviews with housing specialists suggested that families will need financial and caregiving assistance for this option to be viable.     

Risk perceptions: assessment and relationship to influenza vaccination.

OBJECTIVE: Accurate measurement of beliefs about risk probability is essential to determine what role these beliefs have in health behavior. This study investigated the ability of several types of risk perception measures and of other constructs from health behavior theories to predict influenza vaccination. DESIGN: Prospective study in which students, faculty, and staff at 3 universities (N = 428) were interviewed in the fall, before influenza vaccine was available, and again early in the next calendar year. MAIN OUTCOME MEASURE: Self-reported influenza vaccination. RESULTS: Two interview questions that asked about feeling at risk and feeling vulnerable predicted subsequent behavior better (r = .44, p = .001) than 2 questions that asked for agreement or disagreement with statements about risk probability (r = .25, p = .001) or 4 questions that asked respondents to estimate the magnitude of the risk probability (r = .30, p = .001). Of the 4 perceived risk magnitude scales, a 7-point verbal scale was the best predictor of behavior. Anticipated regret was the strongest predictor of vaccination (r = .45, p = .001) of all constructs studied, including risk perceptions, worry, and perceived vaccine effectiveness. CONCLUSION: Risk perceptions predicted subsequent vaccination. However, perceived risk phrased in terms of feelings rather than as a purely cognitive probability judgment predicted better. Because neither feeling at risk nor anticipated regret is represented in the most commonly used theories of health behavior, the data suggest that these theories are missing important constructs.