Investigation of risk factors for introduction of highly pathogenic avian influenza H5N1 virus onto table egg farms in the United States, 2022: a case-control study.

Introduction: The 2022-2023 highly pathogenic avian influenza (HPAI) H5N1 outbreak in the United States (U.S.) is the most geographically extensive and costly animal health event in U.S. history. In 2022 alone, over 57 million commercial and backyard poultry in 47 U.S. states were affected. Over 75% of affected poultry were part of the commercial table egg production sector. Methods: We conducted a case-control study to identify potential risk factors for introduction of HPAI virus onto commercial table egg operations. Univariate and multivariable analyses were conducted to compare farm characteristics, management, and biosecurity factors on case and control farms. Results: Factors associated with increased risk of infection included being in an existing control zone, sightings of wild waterfowl, mowing or bush hogging vegetation less than 4 times a month, having an off-site method of daily mortality disposal (off-site composting or burial, rendering, or landfill), and wild bird access to feed/feed ingredients at least some of the time. Protective factors included a high level of vehicle washing for trucks and trailers entering the farm (a composite variable that included having a permanent wash station), having designated personnel assigned to specific barns, having a farm entrance gate, and requiring a change of clothing for workers entering poultry barns. Discussion: Study results improve our understanding of risk factors for HPAI infection and control measures for preventing HPAI on commercial U.S. table egg farms.

Healthcare providers' perceived learning needs and barriers to providing care for chronic multisymptom illness and environmental exposure concerns.

OBJECTIVE: Patient provider encounters for chronic multisympom illness (CMI) and/or environmental exposures are difficult often resulting in Veterans and providers having high levels of dissatisfaction. Patients attribute these difficulties to providers lacking knowledge about these health concerns. It is not known whether providers perceive themselves as lacking expertise in CMI and environmental exposure concerns. METHODS: This needs assessment used a descriptive online survey design. A total of 3632 VA healthcare providers across disciplines were surveyed. RESULTS: Healthcare providers reported speaking with Veterans about CMI and environmental exposures despite feeling they have minimal to no knowledge of these topics. At the same time, only half of the providers had taken an available training on CMI or environmental exposure within the last year. CONCLUSION: Healthcare providers recognize a knowledge gap regarding CMI and environmental exposures, despite this, there is low uptake of provider education on these topics. PRACTICE IMPLICATIONS: A better understanding of barriers to uptake of training on CMI and environmental exposures is needed to increase engagement with these important trainings.

HPV Vaccine recommendations: does a health care provider's gender and ethnicity matter to Unvaccinated Latina college women?

Objectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences. Design: Unvaccinated Latina college students (n = 187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP. Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider. Conclusions: Latinas' preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.

Factorial Invariance and Convergent Validity of the Group-Based Medical Mistrust Scale across Gender and Ethnoracial Identity.

The objective of this study was to assess the factorial invariance and convergent validity of the Group-Based Medical Mistrust Scale (GBMMS) across gender (male and female) and ethnoracial identity (Latino and Black). Minority students (N = 686) attending a southeastern university were surveyed in the fall of 2011. Psychometric analysis of the GBMMS was performed. A three-factor solution fit the data after the omission of two problematic items. This revised version of the GBMMS exhibited sufficient configural, metric, and scalar invariance. Convergence of the GBMMS with conceptually related measures provided further evidence of validity; however, there was variation across ethnoracial identity. The GBMMS has viable psychometric properties across gender and ethnoracial identity in Black and Latino populations.

Racial/ethnic differences in electronic cigarette knowledge, social norms, and risk perceptions among current and former smokers.

Psychosocial factors that may affect electronic cigarette (e-cigarette) initiation or maintenance among racial/ethnic minorities are not well-understood. This study examined racial/ethnic differences in e-cigarette knowledge, risk perceptions, and social norms among current and former smokers. Individuals with a tobacco smoking history and an awareness of e-cigarettes (N=285) were recruited from the community from June to August 2014. Telephone-administered surveys assessed demographics, smoking status, and e-cigarette knowledge, risk perceptions, and normative beliefs. Analyses of covariance and multinomial logistic regression tested associations by race/ethnicity. Controlling for sociodemographics and smoking status, White participants scored significantly higher on e-cigarette knowledge, compared to both Hispanics and African Americans/Blacks. Knowledge was lower among African Americans/Blacks compared to Hispanics. Compared to both Whites and Hispanics, African American/Black participants held lower perceptions regarding e-cigarette health risks and were less likely to view e-cigarettes as addictive. Normative beliefs did not differ by race/ethnicity. In conclusion, e-cigarette knowledge, health risk perceptions, and perceived addictiveness differed by race/ethnicity. The variation in e-cigarette knowledge and beliefs among smokers and former smokers has implications for use, and potentially, dual use. Understanding these relationships in unrepresented populations can inform future research and practice.

Racial/Ethnic Differences in Electronic Cigarette Use and Reasons for Use among Current and Former Smokers: Findings from a Community-Based Sample.

The prevalence of e-cigarette use is increasing, yet few studies have focused on its use in racial/ethnic minority populations. We examined associations between race/ethnicity and e-cigarette use, plans to continue using e-cigarettes, and reasons for use among current/former smokers. Participants (285 in total; 29% non-Hispanic White, 42% African American/Black, and 29% Hispanic) were recruited between June and November 2014. Telephone-administered surveys assessed demographics, cigarette smoking, e-cigarette use, plans to continue using, and reasons for use. Analyses of covariance (ANCOVAs) and multivariable logistic regressions were conducted. African Americans/Blacks were significantly less likely to report ever-use compared to Whites and Hispanics (50% vs. 71% and 71%, respectively; p < 0.001). However, African American/Black ever users were more likely to report plans to continue using e-cigarettes compared to Whites and Hispanics (72% vs. 53% and 47%, respectively, p = 0.01). African American/Black participants were more likely to use e-cigarettes as a cessation aid compared to both Whites (p = 0.03) and Hispanics (p = 0.48). White participants were more likely to use e-cigarettes to save money compared to Hispanics (p = 0.02). In conclusion, racial/ethnic differences in e-cigarette use, intentions, and reasons for use emerged in our study. African American ever users may be particularly vulnerable to maintaining their use, particularly to try to quit smoking. These findings have implications for cigarette smoking and e-cigarette dual use, continued e-cigarette use, and potentially for smoking-related disparities.

Distress, race/ethnicity and smoking cessation in treatment-seekers: implications for disparity elimination.

BACKGROUND AND AIMS: Distress is a modifiable risk factor for smoking maintenance. This study aimed to assess racial/ethnic differences in distress pre- and post-cognitive-behavioral therapy (CBT) for smoking cessation, and relations with abstinence. DESIGN: Analyses of variance and logistic regressions were conducted. SETTING: University-based smoking cessation laboratory in South Florida, USA. PARTICIPANTS: The sample comprised 234 treatment-seekers recruited from the community (18% white, 60% African American and 22% Hispanic). INTERVENTION: All participants received eight sessions of group CBT plus 8 weeks of transdermal nicotine patches (TNP). MEASUREMENTS: Demographics and smoking history [baseline], perceived stress and depressive symptoms [baseline and end of therapy (EOT)], carbon monoxide-verified 7-day point prevalence abstinence (p.p.a.) at EOT, 3 months post-CBT (primary outcome) and 6 months (self-report). FINDINGS: Compared with whites, African Americans reported greater baseline perceived stress (P = 0.03) and depressive symptoms (P = 0.06); no EOT differences were found. African Americans (P < 0.001) and Hispanics (P < 0.01) reported greater perceived stress reduction, and African Americans reported greater reductions in depressive symptoms (P < 0.01). EOT-perceived stress (adjusted odds ratio (AOR) = 0.93 (0.89-0.98)) and depressive symptoms [AOR = 0.96 (0.93-0.99)] were associated inversely with 7-day p.p.a. at 3 months. Reductions in perceived stress [AOR = 0.93 (0.89-0.98)] and depressive symptoms at the EOT [AOR = 0.96 (0.93-0.99)] were associated with cessation, such that reduced distress increased the odds of abstinence. The interactions between race/ethnicity and distress on 7-day p.p.a. were not significant at any assessment point. CONCLUSIONS: Among smokers in Florida, USA, racial/ethnic differences in distress before starting cognitive-behavioral therapy for smoking cessation were eliminated at the end of treatment, driven by improvements among African Americans and Hispanics. High levels of distress were associated with reduced odds of abstinence through 6 months across racial/ethnic groups.

Human Papillomavirus Vaccine Knowledge and Attitudes, Preventative Health Behaviors, and Medical Mistrust Among a Racially and Ethnically Diverse Sample of College Women.

INTRODUCTION: Medical mistrust is associated with disparities in a variety of health outcomes. The human papillomavirus (HPV) vaccine has the potential to decrease disparities in cervical cancer by preventing infection with the virus that causes these malignancies. No study has examined associations between medical mistrust and preventative health behaviors including the HPV vaccine among young minority women. METHODS: Self-reported racial/ethnic minority students completed a web-based survey in fall of 2011. Wilcoxon and Kruskal-Wallis were used to test differences in medical mistrust scores by demographics and health behaviors. RESULTS: Medical mistrust varied significantly by race with Black women reporting the highest scores. Women with no regular health-care provider (HCP) or who had difficulty talking to their provider had higher mistrust. Higher medical mistrust was associated with a preference to receive HPV vaccine recommendation from a HCP of the same race or ethnicity among unvaccinated women. Black and Asian women who had not received the HPV vaccine had higher mistrust scores than vaccinated women. Perceived difficulty in talking to a HCP was associated with ever having a Pap smear. DISCUSSION: Awareness of medical mistrust and the influence on health behaviors may aid in increasing delivery of quality health services for racial and ethnic minority populations. Further research among different populations is needed to elucidate impacts of medical mistrust and provider communication on preventative health behaviors.

Negative emotions and stigma associated with a human papillomavirus test result: A comparison between human papillomavirus-positive men and women.

Human papillomavirus has largely been framed as a women's health issue, and the psychosocial impact of human papillomavirus among men remains unclear. In this study, we found that women infected with human papillomavirus (n = 154) experienced a greater degree of negative emotions and stigma than human papillomavirus-infected men (n = 190). Among women, younger age and less education were associated with greater expression of negative emotions and stigma. Conversely, being single was significantly associated with a greater degree of negative emotions and stigma beliefs among men. These findings suggest the need to re-frame messages that both men and women receive regarding human papillomavirus.

Support for indoor bans on electronic cigarettes among current and former smokers.

OBJECTIVES: Electronic cigarette (e-cigarette) use is increasing in the U.S. Although marketed as a safer alternative for cigarettes, initial evidence suggests that e-cigarettes may pose a secondhand exposure risk. The current study explored the prevalence and correlates of support for e-cigarette bans. METHODS: A sample of 265 current/former smokers completed a cross-sectional telephone survey from June-September 2014; 45% Black, 31% White, 21% Hispanic. Items assessed support for home and workplace bans for cigarettes and e-cigarettes and associated risk perceptions. RESULTS: Most participants were aware of e-cigarettes (99%). RESULTS demonstrated less support for complete e-cigarette bans in homes and workplaces compared to cigarettes. Support for complete e-cigarette bans was strongest among older, higher income, married respondents, and former smokers. Complete e-cigarette bans were most strongly endorsed when perceptions of addictiveness and health risks were high. While both e-cigarette lifetime and never-users strongly supported cigarette smoking bans, endorsement for e-cigarette bans varied by lifetime use and intentions to use e-cigarettes. CONCLUSIONS: Support for indoor e-cigarette bans is relatively low among individuals with a smoking history. Support for e-cigarette bans may change as evidence regarding their use emerges. These findings have implications for public health policy.

Influences on human papillomavirus vaccination status among female college students.

OBJECTIVE: In 2006, the Food and Drug Administration (FDA) approved the human papillomavirus (HPV) vaccine Gardasil® (Merck) for girls and women aged 9-26 years. Although the vaccine is ideally administered to 11 and 12 year olds, college-aged women may be uniquely at risk for HPV due to high rates of sexual activity and, thus, serve as an important catch-up population for the HPV vaccine. The purpose of this study is to examine factors associated with HPV vaccination status among college women. METHODS: In fall 2008, a convenience sample of 256 undergraduate women enrolled in an introductory social science course at a large, public, urban university in the southeastern United States was surveyed. The 30-item paper-and-pencil questionnaire asked for demographic information, HPV knowledge, HPV vaccine beliefs, and HPV vaccination status. The overall survey response rate was 89.6%. RESULTS: Most women were unmarried/single (91.7%), with a mean age of 18.9 years (range 17-42). Race/ethnicity status included 73.0% white, 17.5% Hispanic, and 7.7% black/African American. One hundred eleven (40.5%) women reported receiving the vaccine. Nonvaccinated women were less likely to have heard of the vaccine through a healthcare provider (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.35) or from a family member (OR 0.33, 95% CI 0.16-0.68) and more likely to consider a healthcare provider recommendation as being only somewhat important (OR 2.91, 95% CI 1.32-6.41) or not important at all (OR 5.61, 95% CI 0.44-71.87) vs. very important. CONCLUSIONS: Findings suggest that healthcare providers have an important role in encouraging HPV vaccination. Continuing education for providers who see preadolescent girls in conjunction with a parent or who treat women of college age may be a worthwhile endeavor.