Preventive behaviors, beliefs, and anxieties in relation to the swine flu outbreak among college students aged 18-24 years

Modeling the effects of Prophylactic behaviors on the spread of SARS-CoV-2 in West Africa

Various general and individual measures have been implemented to limit the spread of SARS-CoV-2 since its emergence in China. Several phenomenological and mechanistic models have been developed to inform and guide health policy. Many of these models ignore opinions about certain control measures, although various opinions and attitudes can influence individual actions. To account for the effects of prophylactic opinions on disease dynamics and to avoid identifiability problems, we expand the SIR-Opinion model of Tyson et al. (2020) to take into account the partial detection of infected individuals in order to provide robust modeling of COVID-19 as well as degrees of adherence to prophylactic treatments, taking into account a hybrid modeling technique using Richard's model and the logistic model. Applying the approach to COVID-19 data from West Africa demonstrates that the more people with a strong prophylactic opinion, the smaller the final COVID-19 pandemic size. The influence of individuals on each other and from the media significantly influences the susceptible population and, thus, the dynamics of the disease. Thus, when considering the opinion of susceptible individuals to the disease, the view of the population at baseline influences its dynamics. The results are expected to inform public policy in the context of emerging and re-emerging infectious diseases.

COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic

OBJECTIVE

This study examined the impact of COVID-19 in the early stages of the pandemic on university students in the U.S. by: (1) characterizing COVID-19-related disruptions; (2) evaluating health anxiety, obsessive-compulsive (OC), depression, and stress symptoms; and (3) analyzing the unique role of COVID-19 anxiety on mental health outcomes, after accounting for relevant variables.

PARTICIPANTS

Participants included 263 students (63.9% female).

METHODS

Data were collected online between March 19, 2020 and May 1, 2020.

RESULTS

Participants screened positive for health anxiety (6.5%), OC symptoms (48.7%), or depression (29.7%). COVID-19 anxiety was positively associated with mental health symptoms. After controlling for demographics and COVID-19 impact, COVID-19 anxiety accounted for significant variance in health anxiety, OC symptoms, and stress.

CONCLUSIONS

Findings demonstrate the vast impact of COVID-19 on mental health among university students and provide guidance for identifying mental health priorities in the context of public health crises.

The Effects of COVID-19 Pandemic on Adults Living in Turkey and Ways of Coping

This study investigated the experiences and views of adult people living in Turkey about the changes in their usual life during the pandemic, the effects of these changes, difficulties they had, and ways of coping with these difficulties. The study adopted a qualitative design within the scope of the phenomenological approach. The study sample consisted of 449 adults. The findings showed that the changes due to the pandemic were divided into eight categories that included social life, work-life, daily routines, emotions, school life, economy, and cognitive and physiological changes. The participants reported both positive and negative effects of these changes in terms of emotions, cognition, work and school life, physiology, and social life. In the pandemic process, the participants were found to have difficulties in emotions, social life, work-life and economy, physiology, and daily routines. To cope with these difficulties, the participants were found to demonstrate various emotion-focused, problem-focused, and appraisal-focused behaviors.

Affective Attitudes in the Face of the COVID-19 Pandemic: The Dynamics of Negative Emotions and a Sense of Threat in Poles in the First Wave of the Pandemic

For millions of people, the COVID-19 pandemic situation and its accompanying restrictions have been a source of threat and confrontation with negative emotions. The pandemic's universal and long-term character, as well as the ensuing drastic limitation of control over one's life, have made it necessary to work out adaptive strategies that would reduce negative experiences and eventually lead to the restoration of well-being. The aim of this research was to identify strategies that people use in response to a long-term threat that restore affective balance and a subjective sense of security. We registered selected manifestations of affective reactions to the pandemic situation. The researchers focused on the dynamics of changes in the areas of (1) experienced negative emotions (asked in an indirect way) and (2) a subjective feeling of threat regarding the pandemic (in three different contexts: Poland, Europe, and worldwide) during the first phase of the pandemic in Poland. It was expected that both the negative emotions and the sense of threat would decrease with time. In addition, it was anticipated that the physical distance would modify the assessment of the situation as threatening depending on the geographical proximity: in Poland, Europe, and worldwide. We used the mixed quasi-experimental design in the series of four studies conducted by Internet in March, May, June, and July 2020. The intensity of negative emotions and the sense of threat caused by the pandemic situation in Poland, Europe, and worldwide were measured. Despite the objective number of confirmed COVID-19 cases during each of the stages of the study, both the intensity of emotions attributed by participants as well as the feeling of threat were found to have decreased. In addition, surprisingly, a reversed effect of the distance was revealed: namely, a sense of threat experienced towards distant locations (Europe and the world) was found to be more acute when compared with the threat experienced in Poland. The obtained results are interpreted as a manifestation of adaptive perception of the threat that lies beyond one's control, which takes the form of unconscious, biased distortions: unrealistic optimism. The decrease in the intensity of negative emotions explains unrealistic absolute optimism, while the perception of the situation in Poland as less threatening than in Europe and around the world is predicted by unrealistic comparative optimism.

Risk Factors Associated With Increased Anxiety Sensitivity in Children and Adolescents in Northwest China During COVID-19 Pandemic Lockdown

Purpose

A large body of evidence has revealed that the sudden outbreak of public health emergencies induces dramatic effects on the mental health of the general public. We aimed to investigate the level of anxiety sensitivity and its risk factors in children and adolescents from northwest China during the COVID-19 pandemic lockdown in early 2020.

Methods

A cross-sectional survey was conducted through the Wenjuanxing platform using a convenience sampling method between 18 and 26 February 2020. The self-designed questionnaire contained sociodemographic characteristics, factors associated with the COVID-19 pandemic, and the Childhood Anxiety Sensitivity Index (CASI) scale. The data from 1,091 valid questionnaires from students aged 9–17 years were analyzed using ANOVA, multiple linear regression, and binary logistic regression.

Results

The average CASI scores were 11.47 ± 6.631, and 642 students (58.9%) had prominent anxiety sensitivity. Gender, education level, family members participating in anti-COVID-19 work, getting ill and needing medical help during the lockdown, feeling afraid or having heart palpitations on hearing things associated with COVID-19, believing that COVID-19 would have adverse impacts on themselves or their family in the future, and fear of infection were identified as significant factors for elevated levels of anxiety sensitivity (p < 0.05). We established a multiple linear regression model for the anxiety sensitivity score. Risk factors found for anxiety sensitivity in children and adolescents during the COVID-19 lockdown included studying in secondary or high school, becoming ill during the pandemic, feeling afraid or experiencing rapid heartbeat or palpitations on hearing about the COVID-19 pandemic, thinking that COVID-19 would have an adverse impact on themselves or their family in the future, and fear of infection.

Conclusions

During the COVID-19 pandemic and home quarantine, scores measuring the prevalence of anxiety sensitivity in children and adolescents from northwest China were elevated. We should develop measures that especially target possible risk factors to intervene against and prevent anxiety sensitivity in children and adolescents in both the current and future pandemics.

Associations between COVID-19 risk perceptions, behavior intentions and worry

BACKGROUND

Risk perceptions are central to health behavior, but some types of risk perceptions may be more strongly connected to behavior than others. This research examined different risk perceptions of COVID-19 and their respective associations with behavior intentions and worry.

PARTICIPANTS AND PROCEDURE

U.S. college students (N = 248) and general adults (N = 300) reported their risk perceptions of COVID-19 - including absolute numerical, verbal, comparative, and feelings of risk - as well as their worry and intentions to do things such as get vaccinated.

RESULTS

Although most risk perceptions related to intentions and worry, feelings of risk were the most strongly and consistently related. The associations showed that the higher people's feelings of risk were, the greater were their intentions and worry.

CONCLUSIONS

Assessing feelings of risk of COVID-19 may provide the best insight into people's perceived threat of this virus.

Vaccination anxiety when vaccinations are available: The role of existential concerns

This study examined how existential fears are related to COVID-19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness-to-death (SNtD) and death anxiety, to COVID-19 vaccination anxiety during the first month of COVID-19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID-19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID-19 vaccination anxiety while controlling for demographics and for receiving COVID-19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID-19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID-19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID-19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID-19 vaccination anxiety more effectively.

Anxiety, resilience and local conditions: A cross-cultural investigation in the time of Covid-19

The spread of Covid‐19 is a worldwide phenomenon, unprecedented in modern times. Differences among countries in such matters are of interest as they provide a unique window to understand human behaviour and culture. The aim of this study is to examine cross‐cultural differences in state anxiety, and any moderating role of resilience and social contact. Participants from three countries were recruited: Ireland (n = 449), Italy (n = 324) and Spain (n = 471). While these countries share many characteristics, it was anticipated that their experiences might differ because of pronounced differences in governmental measures and the local severity and history of the pandemic at the time of data collection. Results indicated that: (a) Resilience was negatively related to state anxiety both bivariately and multivariately; (b) number of hours outside per week did not predict state anxiety but was negatively correlated with fear of contagious diseases in the essential workers from the Irish sample; (c) national measures had a moderating role in the relationship between resilience and state anxiety; and (d) social contact, in terms of numbers of written, audio or visual interactions, was not a statistically significant predictor of state anxiety. These results may help to understand the adverse impact on mental health.

Seroprevalence of anti-SARS-CoV-2 antibodies after the first wave of the COVID-19 pandemic in a vulnerable population in France: a cross-sectional study

OBJECTIVES

We aimed to assess the level of prior SARS-CoV-2 infection in socially deprived neighbourhoods after the first wave of the pandemic, and to identify factors associated with seropositivity.

DESIGN

A cross-sectional study.

SETTING

Three socially deprived neighbourhoods of the city of Perpignan, in the south of France, where large settled Roma communities live.

PARTICIPANTS

People aged 6 years old or over, living in the study area. 700 people were included in the study using two-stage stratified sampling design.

INTERVENTIONS

The study included a questionnaire and SARS-CoV-2 antibody testing by the Roche Elecsys immunoassay between 29 June and 17 July 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

SARS-CoV-2 antibody seroprevalence was estimated from weighted data. Associated factors and reported symptoms were investigated using univariable and multivariable logistic regressions.

RESULTS

The seroprevalence of anti-SARS-CoV-2 antibodies was 35.4% (95% CI 30.2% to 41.0%). People aged 15-64 years old had increased odds of being seropositive than those aged 65 years or over. Obese people had higher odds of being seropositive (adjusted OR (aOR)=2.0, 95% CI 1.1 to 3.8). The odds of being seropositive were higher in households with clinical COVID-19 cases (one case: aOR=2.5, 95% CI 1.3 to 5.0; several cases: aOR=6.9, 95% CI 3.1 to 15.2). In the neighbourhood with the highest measured seroprevalence, people living in a dwelling with one to two rooms had higher odds of being seropositive than those living in a four-room house (aOR=2.8, 95% CI 1.2 to 6.3). Working during the lockdown was associated with lower odds of being seropositive (aOR=0.2, 95% CI 0.03 to 1.0).

CONCLUSION

Transmission of SARS-COV-2 in this vulnerable population was very high during the COVID-19 pandemic's first wave. Our results highlight the need to strengthen and adapt preventive measures taking into account all social determinants of health, especially housing conditions.

Emotional and Behavioral Responses to COVID-19

Abstract. This review appraises evidence for the role of personality in COVID-19 related emotions and behaviors. Three key models of personality are considered: the Five-factor Model, HEXACO model, and Reinforcement Sensitivity Theory (RST). In line with personality research, more generally, most studies focus on the Five-Factor model. Key findings are that neuroticism is most associated with poor mental health, and extraversion is associated with a reluctance to socially isolate. Conscientiousness predicts compliance with safety guidelines but also with fewer prosocial behaviors, particularly stockpiling. Research within the HEXACO framework largely confirms these findings, especially for emotionality and mental health. The additional HEXACO Honesty-Humility factor is found to be associated with prosocial views and abstention from panic buying. Studies based on the Reinforcement Sensitivity Theory of personality indicate emotional conflict as people wish to stay safe while maintaining a sense of normality. Behavioral compliance is driven by activation in the Fight-Flight-Freeze System (FFFS; fear-related) and the Behavioral Inhibition System (BIS; anxiety-related). The Behavioral Approach System (BAS) is implicated in approach-driven behaviors such as avoiding infection. These findings have implications for health communications and post-pandemic support.

Frequency of Anxiety, Depression, and Irritability Symptoms in Children During the COVID-19 Outbreak and Potential Risk Factors Associated With These Symptoms

ABSTRACT

The aim of this study was to determine the frequency of anxiety, depression, and irritability symptoms in children during the COVID-19 outbreak and to investigate the associated factors of these symptoms. This study was conducted with 1071 children aged 6 to 17. Results showed that 49.9% of the participants had anxiety symptoms, 29.5% had depression symptoms, and 51.4% had irritability symptoms. Low age was a potential risk factor for anxiety symptoms. Female sex was a potential risk factor for anxiety and depression symptoms. A COVID-19 death in the family or environment was a potential risk factor for depression and irritability symptoms. Exposure to COVID-19 information on television and on the internet was a potential risk factor for anxiety, depression, and irritability symptoms. In conclusion, this study revealed that the COVID-19 outbreak may have serious effects on the mental health of children, and the study highlighted potential risk factors.

Depression, Anxiety, and Suicidal Ideation in Chinese University Students During the COVID-19 Pandemic

Coronavirus disease-2019 (COVID-19) pandemic has seriously threatened the global public health security and caused a series of mental health problem. Current research focuses mainly on mental health status and related factors in the COVID-19 pandemic among Chinese university students. Data from 11133 participants was obtained through an online survey. The Patient Health Question-9 (PHQ-9) was used to assess depressive symptoms, the Social Support Rate Scale (SSRS) was used to assess social support. We also used 7-item Generalized Anxiety Disorder Scale (GAD-7) to assess anxiety symptoms. Totally, 37.0% of the subjects were experiencing depressive symptoms, 24.9% anxiety symptoms, 20.9% comorbid depressive and anxiety symptoms, and 7.3% suicidal ideation. Multivariable logistic regression analysis revealed an increased presence of mental health problems in female students, graduate students, and those with personal COVID-19 exposure. Awareness of COVID-19, living with family were protective factors that reduced anxiety and depression symptoms. In addition, male, personal COVID-19 exposure, depressive and anxiety symptoms were risk factors for suicidal ideation. Social support, COVID-19 preventive and control measures, prediction of COVID-19 trends, living with family and graduate students are protective factors for reducing suicidal ideation.

Impact of a Banning Indoor Dining Policy on Restaurant Avoidance Behavior during the COVID-19 Outbreak

The coronavirus disease 2019 (COVID-19) is spreading around the world, and Taiwan is no exception. Faced with the outbreak of the epidemic, the Taiwan government immediately ordered a policy banning indoor dining. The main purpose of the present research is to extend a Theory of Planned Behavior (TPB) theoretical framework to explore the public perception toward banning indoor dining policy on restaurant avoidance behavior during the COVID-19 outbreak. An online survey was administered in Taiwan during the COVID-19 pandemic from 25 May to 8 June 2021; a total of 326 responses were collected by a convenience sampling method, and partial least square (PLS) analysis was deployed to examine the hypothesized relationships. The results showed that perception toward banning indoor dining policy had independent significant associations with attitude, perceived behavioral control, and restaurant avoidance behavior. Moreover, attitude, perceived behavioral control, and subjective norm had independent significant associations with restaurant avoidance behavior. This study provides theoretical and practical insights into the psychological and behavioral processes involved in policy by the general public during the COVID-19 pandemic, thus helping policymakers to better understand public opinion and responses to policy issues.

Understanding misinformation infodemic during public health emergencies due to large-scale disease outbreaks: a rapid review

AIM

The coronavirus disease 2019 (COVID-19) has caused hundreds of thousands of deaths, impacted the flow of life and resulted in an immeasurable amount of socio-economic damage. However, not all of this damage is attributable to the disease itself; much of it has occurred due to the prevailing misinformation around COVID-19. This rapid integrative review will draw on knowledge from the literature about misinformation during previous abrupt large-scale infectious disease outbreaks to enable policymakers, governments and health institutions to proactively mitigate the spread and effect of misinformation.

SUBJECT AND METHODS

For this rapid integrative review, we systematically searched MEDLINE and Google Scholar and extracted the literature on misinformation during abrupt large-scale infectious disease outbreaks since 2000. We screened articles using predetermined inclusion criteria. We followed an updated methodology for integrated reviews and adjusted it for our rapid review approach.

RESULTS

We found widespread misinformation in all aspects of large-scale infectious disease outbreaks since 2000, including prevention, treatment, risk factor, transmission mode, complications and vaccines. Conspiracy theories also prevailed, particularly involving vaccines. Misinformation most frequently has been reported regarding Ebola, and women and youth are particularly vulnerable to misinformation. A lack of scientific knowledge by individuals and a lack of trust in the government increased the consumption of misinformation, which is disseminated quickly by the unregulated media, particularly social media.

CONCLUSION

This review identified the nature and pattern of misinformation during large-scale infectious disease outbreaks, which could potentially be used to address misinformation during the ongoing COVID-19 or any future pandemic.

Restaurant preventive behaviors and the role of media during a pandemic

This study explores how the preventive behaviors of restaurant customers towards COVID-19 are shaped by exposure and attention to media coverage, thereby connecting the issues of community anxieties and business resilience during crises. Ways in which media exposure and attention predict COVID-19 preventive behaviors were examined, as these relate to emotional fear responses and cognitive risk perceptions. An online survey was administered in Taiwan during the COVID-19 pandemic to test the proposed research framework. A total of 366 responses were collected using convenience sampling, and structural equation modeling was deployed to examine the hypothesized relationships. Results indicate that consumer fears and risk perceptions were positively influenced by media coverage of COVID-19. Moreover, fear positively affected individual risk perceptions, and risk perception positively influenced restaurant preventive behaviors. Risk perception was also identified as a mediator between a) media exposure and restaurant preventive behaviors and b) media attention and restaurant preventive behaviors.

Online-Based Survey on College Students' Anxiety During COVID-19 Outbreak

Purpose

Studies have suggested that public health emergencies can have many psychological effects on college students, therefore, the aim of this study is to investigate current situation of college students’ anxiety and its determinants in the time of an unexpected pandemic.

Patients and Methods

We conducted convenience sampling to collect the data through network-based online questionnaires in February 2020, a total of 17,876 college students were included in the analysis. Chi-square test and multivariate logistic were used to identify the associations between the outbreak experiences and anxiety detection.

Results

This study found that detection rate of anxiety among college students was 18.2%. The differences in male students, students whose self-perceived risk of infection were high, who were greatly affected by the outbreak, eager to go back to school, reluctant to leave home and stay at home enough were of statistical significance among different anxiety level (OR>1, P<0.05). And the severe anxiety rate of students who living in cities was significantly higher (2.337[1.468, 3.721]).

Conclusion

Although our results show that anxiety among college students was at a low level, various universities should focus on the online activities and develop appropriate epidemic management plans to prevent their feelings of worry, tension and panic.

The Impact of COVID-19 Pandemic and Lockdown Measures on Quality of Life among Italian General Population

The COVID-19 pandemic that has hit the world in the year 2020 has put a strain on our ability to cope with events and revolutionized our daily habits. On 9 March, Italy was forced to lockdown to prevent the spread of the infection, with measures including the mandatory closure of schools and nonessential activities, travel restrictions, and the obligation to spend entire weeks in the same physical space. The aim of this study was to assess the impact of the COVID-19 pandemic and lockdown measures on quality of life (QoL) in a large Italian sample, in order to investigate possible differences in QoL levels related to both demographic and pandemic-specific variables. A total of 2251 Italian adults (1665 women, mainly young and middle adults) were recruited via a snowball sampling strategy. Participants were requested to answer to an online survey, which included demographic and COVID-related information items, and the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF). The results showed statistically significant differences in QoL depending on a number of variables, including sex, area of residence in Italy, and being diagnosed with a medical/psychiatric condition. To our knowledge, this is the first study to assess QoL during COVID-19 pandemic in Italy, therefore the present findings can offer guidelines regarding which social groups are more vulnerable of a decline in QoL and would benefit of psychological interventions.

Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort

INTRODUCTION

This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations.

METHODS

This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives.

RESULTS

Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings.

CONCLUSIONS

A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.

University Students' Knowledge, Attitudes, and Sources of Information About Zika Virus

Colleges and universities are valuable partners for community health education outreach targeted to young adults. After the outbreak of Zika virus infection in the Americas was declared to be a Public Health Emergency of International Concern on February 1, 2016, postsecondary institutions played an important role in educating at-risk communities about health promotion and disease prevention strategies. In April 2016, we recruited 613 undergraduate students from a large public university to complete a survey about their Zika-related knowledge, attitudes, and information seeking behaviors. We standardized the results so that the participants' reports would be representative of the age, sex, major (course of study), and other characteristics of the university's student population. Most students knew that Zika virus is spread by mosquitoes (88.1%), but only about half knew that the virus could be transmitted through sexual intercourse (56.8%). Students perceived Zika to be a health risk for pregnant women in Zika-affected countries (83.0%), but did not personally feel at risk (12.1%). Many students (43.8%) reported not knowing where to get accurate information about Zika. Identifying gaps in scientific knowledge, misperceptions about personal susceptibility, and opportunities for behavioral risk reduction is an important foundation for designing community-based health interventions when future emerging infectious disease events occur.

Health Beliefs of Wearing Facemasks for Influenza A/H1N1 Prevention: A Qualitative Investigation of Hong Kong Older Adults

Although vaccination is the first-line strategy controlling and preventing influenza A/H1N1 for older adults, personal protective measures, such as wearing facemasks, are also important preventive behaviors to reduce the risk of becoming infected with influenza A/H1N1 during a pandemic. In the current study, we aimed to explore the belief-related psychological factors of wearing facemasks for influenza A/H1N1 prevention in a sample of Hong Kong older adults. Community-dwelling Chinese adults (N = 137) aged between 65 and 80 years (M_age = 75.10; SD_age = 6.49) participated in semistructured interviews. Data were analyzed using theoretical thematic analysis and identified themes were matched deductively within the belief-based processes of the health belief model. Results revealed beliefs that underpinned 4 general dimensions of facemask wearing: (1) perceived susceptibility and seriousness of influenza A/H1N1 pandemic (e.g., influenza A/H1N1 as contagious and lethal), (2) modifying factors (e.g., social responsibility to prevent influenza), (3) cues to action (e.g., seeing others doing it), and (4) perceived benefits and barriers (e.g., protects oneself and others, difficult to breathe). Future interventions can target these beliefs to improve facemask wearing of older adults and, thus, curb preventable infection rates during an influenza A/H1N1 pandemic.

Maintaining pre-school children's health and wellbeing in the UK: a qualitative study of the views of migrant parents

Background

There is evidence that key health behaviours of people who migrate deteriorate over time, which has a consequent impact upon the health of dependent children. As health in the early years sets the course for lifelong health, it is important to explore parents' views on maintaining children's health following migration.

Methods

Five focus groups were held with parents of preschool children who had migrated to the UK within the last 10 years (n = 28). Parents originated from Romania, Poland, Somalia and Pakistan, with one group of Roma Gypsy parents. Data collection took place in January to March 2015.

Results

All groups, apart from the Roma, perceived barriers to maintaining optimal health and well-being for their preschool children following migration to the UK. Eastern European parents experienced difficulties in ensuring family financial security, while parents from more established communities focused on barriers to children's exercise, play and nutrition.

Conclusions

This study highlights aspects of public health where migrants and their children can experience adverse effects in the UK. These findings have implications for policymakers, commissioners and providers of health services who aim to promote good health among preschool children.

Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA

Background

Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks.

Methods

In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between people's awareness to prior pandemics and their awareness of and knowledge about MERS.

Results

Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified.

Conclusions

Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling

Background

Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group.

Methods

We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7-10 children aged 24-77 months were selected from each settlement using systematic sampling. Information on children's vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process.

Results

A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35-39% of children 'minimum vaccination' (DTP3 and IPV2 and MMR1) was administered, while 34-38% had received HepB3 and 31-35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices.

Conclusions

Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies.

Community engagement to enhance trust between Gypsy/Travellers, and maternity, early years' and child dental health services: protocol for a multi-method exploratory study

Background

Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services.

Methods

This multi-method 30-month study, commenced in June 2015, and comprises four stages.

Three related reviews: a) systematic review of Gypsy/Travellers’ access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers’ participation in health services. The reviews will consider any economic literature;

Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice;

Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32–48 mothers of pre-school children, 32–40 healthcare providers and 8–12 informants from third sector organisations.

Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable.

Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one.

The main outputs will be: a) an evaluative framework of Gypsy/Travellers’ engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs.

Discussion

Our novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy/Travellers. The findings may have wider resonance for other marginalised populations. Strengths and limitations of the study are discussed.

Trial registration

Prospero registration for literature reviews: CRD42015021955 and CRD42015021950

UKCRN reference: 20036

An examination of unmet health needs as perceived by Roma in Central and Eastern Europe

BACKGROUND

Roma comprise the largest ethnic minority in Europe, with an estimated population of 10-12 million. Roughly 50-60% of European Roma live in the countries of Central and Eastern Europe. In this study, we set out to quantify and explain disparities in unmet health needs for Roma populations relative to non-Roma populations, using self-reported access to health care.

METHODS

The United Nations Development Programme/World Bank/European Commission 2011 regional Roma survey was used for this study (12 countries, 8735 Roma and 4572 non-Roma living in same communities), with self-reported unmet health need (did not consult a doctor or health professional when they felt it was necessary in past year) as the primary outcome. Multivariable logistic regressions were performed to study the determinants of unmet health need for Roma populations relative to non-Roma populations. Covariates controlled for included sociodemographic characteristics, economic ability, health status and healthcare access.

RESULTS

We found in unadjusted models that Roma throughout Central and Eastern Europe, with the exception of Montenegro, are two to three times more likely to report having an unmet health need in the past 12 months than non-Roma living nearby. These disparities largely remain significant, even after adjusting for gender, age, marital status, employment status, education, number of chronic conditions, health insurance status and geographical proximity to medical providers.

CONCLUSIONS

Controlling for conventional measures of access to medical care (i.e. geographic access to providers and health insurance) does not eliminate observed disparities in unmet need. Although improving funding and routine access to healthcare services for Roma is important in its own right as a means of increasing inclusion, there is a need for detailed assessments of the barriers that exist in each country, within and outside the health system, coupled with measures to implement existing commitments on Roma rights.

The financial crisis and the expected effects on vaccinations in Europe: a literature review

Starting in 2008 several European countries experienced a financial crisis. Historically, diseases whose prevention and treatment depend highly on the continuity of healthcare re-emerge during political and financial crises. Evidence suggests that the current financial crisis has had an impact on the health and welfare of Europeans and that population health status and morbidity as well as mortality patterns may change in the coming years. At the same time decisions about expenditure for health services may impact the ability of public health providers to respond. It is expected that the current crisis will further exacerbate socioeconomic and health inequalities and novel vulnerable groups will emerge in addition to existing ones. We review the available evidence and discuss how the current crisis may have an impact on vaccine-preventable diseases and influence vaccination coverage rates in Europe.

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003-2012

OBJECTIVES

To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.

METHODS

Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.

RESULTS

We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed.

CONCLUSIONS

Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

Reasons for Low Pandemic H1N1 2009 Vaccine Acceptance within a College Sample

This study examined health beliefs associated with novel influenza A (H1N1) immunization among US college undergraduates during the 2009-2010 pandemic. Undergraduates (ages 18-24 years) from a large Midwestern University were invited to complete an online survey during March, 2010, five months after H1N1 vaccines became available. Survey items measured H1N1 vaccine history and H1N1-related attitudes based on the health belief literature. Logistic regression was used to identify attitudes associated with having received an H1N1 vaccine, and thematic analysis of student comments was conducted to further understand influences on vaccine decisions. Among the 296 students who participated in the survey, 15.2% reported having received an H1N1 vaccine. In regression analysis, H1N1 immunization was associated with seasonal flu vaccine history, perceived vaccine effectiveness, perceived obstacles to vaccination, and vaccine safety concerns. Qualitative results illustrate the relationship of beliefs to vaccine decisions, particularly in demonstrating that students often held concerns that vaccine could cause H1N1 or side effects. Vaccine safety, efficacy, and obstacles to immunization were major considerations in deciding whether to accept the H1N1 pandemic vaccine. Therefore, focusing on those aspects might be especially useful in future vaccine efforts within the college population.