One Health Approach for Reporting Veterinary Carbapenem-Resistant Enterobacterales and Other Bacteria of Public Health Concern.

A carbapenem-resistant Enterobacterales outbreak at a veterinary teaching hospital in the United States increased urgency for improved communication among diagnostic laboratories, public health authorities, veterinarians, and pet owners. Kansas State University, University of Missouri, Kansas Department of Health and Environment, and Veterinary Laboratory Investigation and Response Network created a surveillance, storage, and reporting protocol for veterinary antimicrobial-resistant bacteria; determined frequency of those bacteria in companion animals during 2018-2021; and created educational flyers for veterinarians and pet owners. We recommend a One Health strategy to create efficient surveillance programs to identify and report antimicrobial-resistant bacteria and educate veterinarians and pet owners about transmission risks.

Examining weight stigmatization toward obese individuals among nutrition and dietetic students using the attribution theory.

Background: Despite the increasing prevalence of obesity in the United States, negative attitudes toward obese individuals are widespread. Health-care providers, including dietetics and nutritionists, are not exempt from showing bias toward obese individuals, which may lead to subsequent psychological and health problems. Objectives: The purpose of this study was to measure the extent of weight bias among dietetics and nutrition students and investigate its determinants. Materials and Methods: A cross-sectional survey (316) was conducted among undergraduate dietetics and nutrition students at a large Midwestern University to assess weight bias using the Fat Phobia Scale. Eating competence was measured using the ecSI 2.0 and body dissatisfaction using the Stunkard Figure Rating Scale. Other variables included experience with obesity, media exposure to health and nutrition information, and demographic characteristics. Results: About 36% of the participants had weight bias, 64% were unsatisfied with their body image and none of the participants had eating competence. Media exposure to health information, body dissatisfaction, and eating competence was related to fat phobia (P < 0.05). Conclusion: These findings highlight that weight bias is an apparent issue among students enrolling in health-related programs. Considering their future role in clinical and community settings, this issue should be addressed properly.

The Influence of Information Source on COVID-19 Vaccine Efficacy and Motivation for Self-Protective Behavior.

This study examined the influence of health information sources on the efficacy of the COVID-19 vaccine and other motivations for self-protective behavior. Based on the protection motivation theory, the study focused on threat appraisal factors (risk perception and perceived severity), response efficacy, and health information sources (media and interpersonal channels) as predictors for vaccine efficacy and self-protective behavior. Data were gathered in Kenya through a self-administered survey (n = 715) that was conducted at the pick of the COVID-19 pandemic. Results show that media sources (newspapers, radio, television, internet, and telephone) were viewed as more useful compared to interpersonal sources (health professionals, family, friends, and other personal influencers) for COVID-19-related information. Additionally, media sources influenced risk perception, perceived severity, response efficacy, vaccine efficacy, and self-protective behavior. Interpersonal sources were also correlated with perceived severity and response efficacy, and self-protective behavior but did not influence vaccine efficacy. The study suggests exploring the use of media and other digital sources including mobile phones to enhance threat appraisal and promote vaccine efficacy among other motivations for self-protection behavior in future pandemics or disease outbreaks, especially in resource-poor settings.

HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system.

BACKGROUND: Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS: Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS: The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS: Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.

Examining the role of youth empowerment in preventing adolescence obesity in low-income communities.

INTRODUCTION: Youth empowerment programs have increasingly gained attention in public health as emphasis shifts on children and adolescents as decision makers in their health and well-being. Adolescence obesity is among the public health concerns that require more active engagement at individual and community level while empowering adolescents to take charge of their own health. This study examines the influence of youth empowerment on nutritional and physical activity factors associated with adolescence obesity. METHODS: Data were gathered through a self-administered survey among adolescents (N = 410) ages 11-15 years in three U.S. States - Kansas, Ohio and South Dakota. RESULTS: Findings show that youth empowerment significantly influences adolescents' self-efficacy, perceptions for healthy food choice, healthy eating, attitudes towards physical activity and the overall motivation for health. Gender differences exist in adolescents' self-efficacy for physical activity whereas ethnicity played a role in perceived youth empowerment and perceived barriers to healthy eating. Age was also a significant contributor in efficacy for healthy food choice and perception of healthy food availability. CONCLUSIONS: This study suggests more focus on youth empowerment in interventions that seek to reduce obesity and improve adolescents' overall health by creating environments where they can play a more active decision-making role. With empowerment, adolescents are more likely to be motivated to adopt healthier dietary habits and engage more in physical activity. Further research would establish the impact of youth empowerment on obesity reduction and other public health problems that impact children across ages.

Community Perspectives on Communication Strategies for Alcohol Abuse Prevention in Rural Central Kenya.

The current study explores community perspectives on alcohol abuse prevention strategies in rural Kenya. Data from focus group discussions with members of community organizations and in-depth interviews with a snowball sample of key informants revealed that rural communities view national alcohol abuse prevention interventions as ineffective and messages as unpersuasive in changing this high-risk behavior. The use of ethnic languages, stronger fear appeals, and visual aids were recommended for alcohol prevention messages aimed at communities with low literacy. Community members favored narratives and entertainment-education strategies, which are more engaging, and print media for their educational value. Health activism, although common, was viewed as less effective in motivating individuals to change drinking behavior but more effective in advocacy campaigns to pressure the government to enforce alcohol regulations. This study suggests further empirical research to inform evidence-based prevention campaigns and to understand how to communicate about alcohol-related health risks within communities that embrace alcohol consumption as a cultural norm.

Gender and HIV infection in the context of alcoholism in Kenya.

Women in sub-Saharan Africa account for more than half (58%) of people living with the HIV and it is the only continent where HIV prevalence is higher for women than for men. Studies have attributed alcoholism with the high rates of HIV infection due to its impact on sexual behaviour and arousal. African countries with high rates of alcoholism also reportedly have higher rates of HIV infection. This study explores rural communities' perspectives on the risk factors for HIV infection among women who are in alcohol discordant relationships where the man drinks alcohol excessively. Data were gathered through focus group discussions in rural central Kenya where alcoholism has reached epidemic levels. Key findings indicate the perceived severity of alcoholism, the perceived impact of alcoholism on men's reproductive health and the unmet sexual and reproductive needs of women in alcohol discordant relationships. Women engage in risky sexual behaviours in an attempt to meet these needs. Such risky behaviour in addition to alcohol-related sexual violence and low response-efficacy for safer sexual practices make them vulnerable to HIV infection and enhances the spread of HIV within communities. The study concludes that in preventing HIV infection among women in alcohol communities affected by alcohol, it is important to focus on their response efficacy. Intervention programmes that focus on HIV prevention among older married women and that integrate alcohol and HIV prevention are long overdue.

Subjective health literacy and older adults' assessment of direct-to-consumer prescription drug ads.

Older adults are increasingly the intended target of direct-to-consumer (DTC) prescription drug ads, but limited evidence exists as to how they assess the educational value of DTC ads and, more importantly, whether their assessment depends on their level of health literacy. In-person interviews of 170 older adults revealed that those with low subjective health literacy evaluated the educational value of DTC ads significantly lower than did those with high subjective health literacy. The results prompt us to pay more scholarly attention to determining how effectively DTC ads convey useful medical information, particularly to those with limited health literacy.

Older adults' perspectives on HIV/AIDS prevention strategies for rural Kenya.

HIV/AIDS is devastating sub-Saharan Africa with great impact in the rural communities. Though prevention is the mainstay of various responses to the epidemic, communication strategies used to influence risk perception and motivate behavior change are culturally inappropriate, hence the lack of success. The bulk of prevention efforts target the 15-49 age group, resulting in limited knowledge and understanding of HIV/AIDS in adults over age 50 who are considered at a lower or no risk of infection. This paper addresses older adults as a key segment of the population in HIV/AIDS prevention given the increasing number that is living with the disease or newly infected. Many older adults are also caregivers of those infected and affected by the disease. As cultural, social, political, and opinion leaders in rural Kenya, older adults are in a position to influence attitudes and behaviors of their community members, but they have not been involved in the current intervention strategies. Through application of a participatory and culture-centered approach, the study sought views of older adults on the factors contributing to the epidemic in rural Kenya and their opinions on effective prevention strategies that are culturally appropriate. Several recommendations are made for a culture-specific HIV/AIDS prevention intervention for rural Kenya.

Tools for Assessing Cardiovascular Disease Risk Factors in Underserved Young Adult Populations: A Systematic Review.

Cardiovascular disease (CVD, i.e., disease of the heart and blood vessels) is a major cause of death globally. Current assessment tools use either clinical or non-clinical factors alone or in combination to assess CVD risk. The aim of this review was to critically appraise, compare, and summarize existing non-clinically based tools for assessing CVD risk factors in underserved young adult (18-34-year-old) populations. Two online electronic databases-PubMed and Scopus-were searched to identify existing risk assessment tools, using a combination of CVD-related keywords. The search was limited to articles available in English only and published between January 2008 and January 2019. Of the 10,383 studies initially identified, 67 were eligible. In total, 5 out of the 67 articles assessed CVD risk in underserved young adult populations. A total of 21 distinct CVD risk assessment tools were identified; six of these did not require clinical or laboratory data in their estimation (i.e., non-clinical). The main non-clinically based tools identified were the Heart Disease Fact Questionnaire, the Health Beliefs Related to CVD-Perception measure, the Healthy Eating Opinion Survey, the Perception of Risk of Heart Disease Scale, and the WHO STEPwise approach to chronic disease factor surveillance (i.e., the STEPS instrument).

HIV/AIDS stigma and religiosity among African American women.

African American women are disproportionately affected by HIV/AIDS compared with other ethnicities, accounting for two-thirds (67%) of all women diagnosed with HIV. Despite their increased risk of HIV infection, few studies have been conducted to understand culture-specific factors leading to their vulnerability. Given the central role of religious organizations in African American communities, this study explored whether and to what extent religiosity plays a role in stigma toward HIV/AIDS. Results of hierarchical regression showed that after controlling for key factors, religiosity was a significant factor predicting the level of religious stigma. Those with high religiosity displayed significantly higher stigma, associating HIV/AIDS with a curse or punishment from God. Verbatim responses to an open-ended question also revealed seemingly ingrained prejudice against HIV/AIDS from a religious perspective. The findings point to the important role of faith-based organizations (FBOs) in addressing HIV/AIDS issues within African American communities.

The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students.

Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.

Assessing Physical Activity, Fruit, Vegetable, and Sugar-Sweetened Beverage Intake Patterns of College Students in Kansas.

OBJECTIVE: To test the effectiveness of a 15-month intervention for reducing sugar-sweetened beverage (SSB) intake among college students and assess fruit and vegetable (F/V) intake and physical activity (PA) habits and their relationship to SSB intake. DESIGN: Randomized, controlled study. PARTICIPANTS: A total of 156 college students (aged 18-24 years) from a Kansas university, mostly female (72%), white (89%), and freshmen (51%). INTERVENTION: Two-staged intervention included participants receiving: (1) 3 weekly stage-tailored messages on healthful behaviors for 10 weeks; and (2) 3 monthly stage-tailored messages and 1 monthly e-mail encouraging a visit to the portal page, after the 3-month physical assessment. MAIN OUTCOME MEASURE(S): Stages of change for PA and F/V intake, self-reported PA scores, self-reported F/V intake, and SSB intake habits. ANALYSIS: Generalized linear mixed models and linear regression models were used to test changes and associations among outcome measures. RESULTS: No significant decrease occurred in SSB consumption (P > .05) among intervention participants. Both control and intervention groups recorded low F/V intake and moderate PA scores. CONCLUSIONS AND IMPLICATIONS: Low F/V intake and high SSB intake evident among study participants may pose risk for unwanted weight gain and obesity-related conditions. Furthermore, college campuses can continue to support an environment conducive for being physically active, while promoting healthy eating behaviors.

Assessing the Environment for Support of Youth Physical Activity in Rural Communities.

OBJECTIVE: Assess environmental support of physical activity (PA) in rural areas and determine whether there is a correlation between the measured environment for PA and participant perceptions of the environment for PA. DESIGN: The PA environment was assessed using the Active Neighborhood Checklist (ANC) and the Physical Activity Resource Assessment (PARA). Youth behavior and perceptions related to PA and the local environment were assessed using 5 questions from previously validated tools. SETTING: Four rural low-income communities in South Dakota and Kansas. PARTICIPANTS: Sixth- through eighth-grade youth. VARIABLES MEASURED: Physical Activity Resource Assessment, ANC, behavior, and perception. ANALYSIS: The authors used ANOVA to determine whether there were differences in ANC, PARA, and Perception of the Environment scores among communities. Pearson correlations were used to assess associations between ANC and student perception of the environment and PARA and student perception of the environment. RESULTS: There were no differences in total ANC or total PARA among communities. Perception was weakly correlated with total ANC (multivariate coefficient, 0.016; P = .026; n = 308) but not total PARA. CONCLUSIONS AND IMPLICATIONS: Perception of PA in rural communities may not match objective measures. Future research should work toward refining and improving existing environmental audit tools and developing new, comprehensive, location-specific tools.

Alcohol consumption and reproductive health risks in rural Central Kenya.

OBJECTIVE: The goal of the current study is to explore the perceived reproductive health risks associated with alcoholism from the perspective of rural communities in Kenya where abuse of illicit liquor especially among men has become an epidemic. METHODS: Data for the study were gathered qualitatively through focus groups among community members and in-depth interviews with opinion leaders and key informants who were selected through a snowball method. All recorded data were analyzed through constructivist and interpretive techniques, which started with a line-by-line examination of transcripts for identification of emerging themes. RESULTS: Rural communities are aware of the lethal nature of the illicit liquor and the severe reproductive health problems associated with it among male consumers. Alcoholism also affects women's sexual and reproductive needs and is attributed to risky sexual behaviors in alcohol-discordant relationships, which puts them at a higher risk of HIV infection. CONCLUSIONS: Results indicate a need to address alcoholism in rural Kenya as a public health problem focusing on education and understanding of the long-term health consequences. Addressing the impact on male reproductive health is crucial because it impacts the wider community. Given the complex relationship between alcohol abuse and HIV/AIDS, it is also important for prevention interventions to target married women and non-alcohol consumers. Furthermore, engaging communities will ensure development of culture- and gender-specific interventions. Such engagement requires facilitation of health practitioners for development of meaningful community-based initiatives.

Communication for HIV/AIDS prevention in Kenya: social-cultural considerations.

The acquired immune deficiency syndrome (AIDS) epidemic is spreading fast in Africa in spite of the various efforts and resources put in place to prevent it. In Kenya, reproductive health programs have used the mass media and other communication interventions to inform and educate the public about the disease and to promote behavior change and healthy sexual practices. This effort has led to a discrepancy between awareness and behavioral change among people of reproductive age. In this article I examine the discrepancy in Kenya from a communications perspective addressing social cultural and related factors contributing to the lack of change in behavior and sexual practices. I draw on the theoretical framework of Grunig's model of excellence in communication, the importance of understanding and relationship building between programs and their stakeholders. Data were gathered qualitatively using focus groups and in-depth interviews among men and women in rural Kenya. Key findings indicate that although awareness of sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV)/AIDS is high in Kenya, a majority of the population, particularly those in the rural communities, lack understanding of the communicated messages. They also lack the knowledge of other ways of transmitting HIV particularly among those not sexually involved. Cultural beliefs, values, norms, and myths have played a role in the rapidly increasing epidemic in the rural communities and yet HIV/AIDS communication programs have not addressed these factors adequately. I conclude that successful behavior change communication must include strategies that focus on increasing understanding of the communicated messages and understanding of the audience through application of appropriate methodologies. Building a relationship with the audience or stakeholders through dialogues and two-way symmetrical communication contributes toward this understanding and the maintenance of the newly adopted behaviors and practices.