COVID-19 Vaccine-Related Beliefs and Behaviors Among Patients With and Survivors of Hematologic Malignancies.

PURPOSE: Patients with and survivors of hematologic malignancies are particularly vulnerable to COVID-19 disease and complications. This study examined patients' vaccination attitudes and behaviors and their correlates. METHODS: A two-wave survey was fielded in December 2020 and June 2021 among hematologic malignancy patients and survivors (N = 2,272). Demographic characteristics, intent to get vaccinated, vaccination status, attitudes toward vaccination, and level of trust in specific sources of information about COVID-19 vaccines were assessed. Descriptive statistics were calculated, and linear probability models were estimated to examine binary outcomes and their correlates. RESULTS: In December 2020, before COVID-19 vaccines were available, 73% stated they were likely or very likely to get vaccinated if an FDA-approved vaccine became available; however, in June 2021 over 90% reported being vaccinated. Being younger, unmarried, trusting local faith leaders, and not having a bachelor's degree or more were negatively associated with getting vaccinated. Among those hesitant in December 2020, those who expressed a distrust of vaccines in general were least likely to get vaccinated. Being vaccinated in June 2021 was positively associated with the degree to which respondents trust their oncologist, federal agencies, and pharmaceutical companies. Oncologists and primary care physicians were reported as the most trusted sources for information about vaccines. DISCUSSION: COVID-19 vaccine hesitancy remains a public policy concern even now, as additional boosters are recommended among vulnerable populations. Our findings suggest that patient trust in their treating physicians can play a critical role in promoting individual patient and public health goals.

Program to improve colorectal cancer screening in a low-income, racially diverse population: a randomized controlled trial.

PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening, particularly among the poor, racial and ethnic minorities, and individuals with limited English proficiency. We examined whether the direct mailing of fecal occult blood testing (FOBT) kits to patients overdue for such screening is an effective way to improve screening in this population. METHODS All adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31, 2009, and who had had at least 2 visits to the community health center in the prior 18 months were randomized to the outreach intervention or usual care. Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group could be referred for screening during usual clinician visits. The primary outcome was completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol. Outcome measures were compared using the Fisher exact test. RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care. In all, 30% of patients in the outreach group completed colorectal cancer screening during the study period, compared with 5% of patients in the usual care group (P <.001). Nearly all of the screenings were by FOBT. The groups did not differ significantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test. CONCLUSIONS The mailing of FOBT kits directly to patients was efficacious for promoting colorectal cancer screening among a population with high levels of poverty, limited English proficiency, and racial and ethnic diversity. Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened.

Association of 340B contract pharmacy growth with county-level characteristics.

OBJECTIVES: To estimate the association of 340B contract pharmacy growth between 2009 and 2019 with county-level characteristics, including availability of health care providers, health care spending, population, and socioeconomic characteristics. STUDY DESIGN: Observational study. METHODS: We constructed county-level maps of 340B contract pharmacy penetration for the years 2009 and 2019 by 340B participant type (hospital or safety-net clinic). We then used a multivariable linear probability regression model to estimate the association of county-level characteristics in 2009 with the probability of gaining at least one 340B contract pharmacy within the county by 2019. We estimated separate regressions for safety-net clinics and hospitals. RESULTS: We find that growth of contracts with 340B hospitals was uncorrelated with uninsured rates, poverty rates, or areas of medical underservice. By contrast, we find that growth of contracts with 340B safety-net clinics was positively correlated with poverty rates and metropolitan statistical status. These findings suggest different patterns of access for patients. CONCLUSIONS: Our results add systematic evidence of a difference in how the 2 main types of 340B participants-hospitals and safety-net clinics-use the 340B program. Policy proposals to reform 340B should consider reforms for safety-net clinics and hospitals separately.

A day in the life: Using contextual interviews to understand the health of home-based Mapuche weavers.

The craft sector employs 305 million people worldwide, primarily women, rural and home-based workers. Home-based weavers, an understudied workforce, are subject to a range of hazards and adverse health effects related to their weaving work and domestic responsibilities (e.g., housework, farm work, childcare, eldercare). The Mapuche represent Chile's largest Indigenous group with about 20 percent residing in the Araucanía region, where agriculture and tourism, including craftwork, are important sources of income. Using a purposive sampling approach, we conducted Spanish-language contextual interviews (N = 10) with Mapuche weavers across four communities, allowing us to observe participants in their home settings, watching them weave and discussing tasks, decision-making, and behaviors during the work process. Participants ranged in age from 29-55 years. A combination of semi-structured, audio-recorded interviews, videos, photographs and written observations yielded a time-wheel of a typical day for each weaver; the types of weaving and non-weaving work (including hours per day); workspace visuals; self-reported health problems, causes and treatments; exposure hazards; and potential ergonomic interventions. In addition to weaving, housework (n = 10), farm work (n = 7), wool production (n = 7), natural and chemical dyeing (n = 7) and child-rearing (n = 4) were identified as work activities. The most commonly cited weaving-related health problems were eyestrain (n = 7) and pain in the back (n = 6), shoulder (n = 5), arm (n = 4), hand (n = 4), neck (n = 3), wrist (n = 3) and fingers (n = 3). When asked to identify potential improvements to their weaving workspace, participants identified the need to having a dedicated workspace for weaving (n = 7), improving their existing workspace with better seating (n = 4), lighting (n = 3), insulation (n = 2) and increasing the size of their workspace (n = 2). This methodology, blending traditional occupational health tools with qualitative methods, was instrumental in understanding the range of hazards associated with home-based work and identifying potential ergonomic interventions for this global workforce.

Design, implementation and evaluation of a participatory ergonomics program among home-based Mapuche weavers.

The Mapuche comprise 80% of the indigenous population of Chile. The Araucanía has the highest concentration of Mapuche peoples and is also the poorest region of the country. The region's proximity to a large tourist sector provides opportunities for weavers to work from home and sell their products as a primary or secondary income source. The adverse health effects related to craft production and home-based work are significant and not well described in the literature. Participatory ergonomics (PE), an approach that emphasizes the input and participation of individuals directly impacted by the work being studied, is a strong fit for this population. This article describes a PE project among 33 Mapuche weavers that characterizes the hazards, risks and perceived adverse health effects associated with home-based weaving and the identification, implementation and evaluation of three ergonomic interventions. This project can inform the development of sustainable ergonomics health programs for home-based artisans.

Out-of-Pocket Costs of Treatment Among Employer-Insured Women With Invasive Breast Cancer.

This cross-sectional study examines out-of-pocket costs for the treatment of invasive breast cancer in employer-insured women younger than 65 years.

Newspaper stories as measures of structural stigma.

OBJECTIVES: Structural stigma and discrimination occur when an institution like a newspaper, rather than an individual, promulgates stigmatizing messages about mental illness. This study examined current trends in the news media on reporting topics of mental illness. METHODS: All relevant stories (N=3,353) in large U.S. newspapers were identified and coded during six weeklong periods in 2002. Stories were coded by themes that fit into four categories: dangerousness, blame, treatment and recovery, and advocacy action (that is, calls for public policy and action that increase the quality of care or opportunities for those with mental illness). RESULTS: Thirty-nine percent of all stories focused on dangerousness and violence; these stories most often ended up in the front section. Few stories promulgated the idea that either the person or the family was responsible for mental illness (2 percent). Instead, stories about genetic or biological or environmental causation (for example, stress and trauma) were more common (15 percent). There were equal numbers of stories about biological and psychosocial treatments (13 and 14 percent, respectively). Four percent of all treatment-related stories addressed recovery. Twenty percent of stories contained themes that fell into the broad category of advocacy action. These stories addressed the shortage of resources in the public mental health arena, the need for better care, the absence of good-quality housing, and the goal of insurance parity. CONCLUSIONS: Data on how mental illness is represented in newspapers yield a useful perspective on structural stigma and the policies and standards that are applied by the news media. These findings have implications for influencing the press.

Structural stigma in state legislation.

OBJECTIVE: This article discusses examples of structural stigma that results from state governments' enactment of laws that diminish the opportunities of people with mental illness. METHODS: To examine current trends in structural stigma, the authors identified and coded all relevant bills introduced in 2002 in the 50 states. Bills were categorized in terms of their effect on liberties, protection from discrimination, and privacy. The terms used to describe the targets of bills were examined: persons with "mental illness" or persons who are "incompetent" or "disabled" because of mental illness. RESULTS: About one-quarter of the state bills reviewed for this survey related to protection from discrimination. Within that category, half the bills reduced protections for the targeted individuals, such as restriction of firearms for people with current or past mental illness and reduced parental rights among persons with a history of mental illness. Half the bills seemed to expand protections, such as those that required mental health funding at the same levels provided for other medical conditions and those that disallowed use of mental health status in child custody cases. Legislation frequently confuses "incompetence" with "mental illness." CONCLUSIONS: Examples of structural stigma uncovered by surveys such as this one can inform advocates for persons with mental illness as to where an individual state stands in relation to the number of bills that affect persons with mental illness and whether these bills expand or contract the liberties of this stigmatized group.

Injury and Illness Data for Illinois Mining Industry Employees, 1990 to 2012.

OBJECTIVE: This study identifies and evaluates injury types associated with distribution of cause of injuries and compensation among Illinois miners. METHODS: Cases were selected from the Illinois Workers' Compensation database from 1990 to 2012 to determine injury distributions and compensation among miners and non-miners. Logistic models were used to analyze total monetary compensation, temporary total disability (TTD), and permanent partial disability as primary outcomes. RESULTS: The major predictors of total monetary compensation in both miners and non-miners were TTD, permanent partial disability, average weekly wage, and age at the time of filing. Systemic injuries were an additional driver of final monetary compensation among miners. Miners were compensated $618 less (total monetary compensation; confidence interval 95%: -971, -266; P < 0.001), had 2.1 more weeks away from work (TTD; confidence interval 95%: 1.58, 2.63; P < 0.001), and had higher numbers of systemic injuries than non-miners. CONCLUSIONS: Systemic injuries are important drivers for TWC in miners in terms of median compensation and TTD.

Implications of educating the public on mental illness, violence, and stigma.

This study examined how two types of public education programs influenced how the public perceived persons with mental illness, their potential for violence, and the stigma of mental illness. A total of 161 participants were randomly assigned to one of three programs: one that aimed to combat stigma, one that highlighted the association between violence and psychiatric disorders, and a control group. Participants who completed the education-about-violence program were significantly more likely to report attitudes related to fear and dangerousness, to endorse services that coerced persons into treatment and treated them in segregated areas, to avoid persons with mental illness in social situations, and to be reluctant to help persons with mental illness.

Análisis de la promoción cultural como herramienta para fortalecer la identidad afro esmeraldeña / Analysis of cultural promotion as a tool to strengthen the identity of afro-emeraldeña / Análise da promoção cultural como instrumento de fortalecimento da identidade da afro-emeraldeña

Resumen Introducción: La identidad cultural representa los valores, orgullos, costumbres, creencias y comportamientos que forman parte de un grupo social y que actúan con la misión de engendrar un sentimiento de pertenencia. Esta cultura se puede convertir en el pilar primordial de cada localidad; por lo cual es necesario resguardar la, defenderla y ampararse, para que dicha fortaleza pueda convertirse en una ventaja competitiva. Objetivo: Analizar la promoción cultural como herramienta para fortalecer la identidad afro esmeraldeña. Materiales y métodos: Constan entrevistas efectuadas a personas expertas en el área de arte, cultura y promoción, así como a personajes destacados en las distintas disciplinas que enmarcan la cultura de Esmeraldas como lo son la poesía, el canto, la pintura, la escultura, la música, la marimba y el deporte. Además del aporte de la ciudadanía a través de encuestas y entrevistas. Resultados: Los personajes destacados dentro de la cultura esmeraldeña indican que se sienten satisfechos por la labor que han realizado. Se identificó que los ciudadanos se sienten muy identificados (35%) o identificados (47%) con la cultura afroesmeraldeña; y el mayor rasgo identitario es la marimba, con un 45%. Sin embargo el 23% no asiste a ningún evento cultural en la ciudad por falta de difusión. Conclusiones: La investigación permitió determinar que fortalecer la identidad afro esmeraldeña es una tarea compleja que debe de fomentarse en el hogar y las instituciones educativas. Finalmente las investigadoras recomiendan ejecutar estrategias de creación y difusión de productos culturales para conservar y proteger la identidad cultural afro esmeraldeña.

Abstract Introduction: The cultural identity represents the values, pride, customs, beliefs and behaviors that are part of a social group and that act with the mission of engendering a feeling of belonging. This culture can become the main pillar of each locality; Therefore, it is necessary to protect, defend and protect it, so that this strength can become a competitive advantage. Objective: Analyze cultural promotion as a tool to strengthen the Afro-Emerald identity. Materials and methods: They include interviews conducted with experts in the area of art, culture and promotion, as well as prominent figures in the different disciplines that frame the culture of Esmeraldas such as poetry, song, painting, sculpture, music, Marimba and sports. In addition to the contribution of citizenship through surveys and pentrevistas. Results: The prominent figures in the Esmeralda culture indicate that they are satisfied with the work they have done. It was identified that citizens feel very identified (35%) or identified (47%) with the Afro-Emerald culture; and the biggest identity feature is the marimba, with 45%. However, 23% do not attend any cultural event in the city due to lack of dissemination. Conclusions The investigation made it possible to determine that strengthening the Afro-Emerald identity is a complex task that should be fostered in the home and educational institutions. Finally, the researchers recommend implementing strategies for the creation and dissemination of cultural products to conserve and protect the Afro-Emerald identity.

Resumo Introdução: A identidade cultural representa os valores, orgulho, costumes, crenças e comportamentos que fazem parte de um grupo social e que atuam com a missão de gerar um sentimento de pertencimento. Essa cultura pode se tornar o principal pilar de cada localidade; Portanto, é necessário protegê-lo, defendê-lo e protegê-lo, para que essa força possa se tornar uma vantagem competitiva. Objetivo: Analisar a promoção cultural como ferramenta para fortalecer a identidade afro-esmeralda. Materiais e métodos: entrevistas constan com especialistas na área de arte, cultura e promoção, bem como figuras proeminentes nas várias disciplinas que emolduram a cultura de Esmeraldas tais como poesia, canto, pintura, escultura, música, Marimba e esportes. Além da contribuição da cidadania através de pesquisas e pentrevistas. Resultados: As figuras proeminentes da cultura Esmeralda indicam que estão satisfeitas com o trabalho que fizeram. Foi identificado que os cidadãos se sentem muito identificados (35%) ou identificados (47%) com a cultura afro-esmeralda; e a maior característica de identidade é a marimba, com 45%. No entanto, 23% não participam de nenhum evento cultural na cidade devido à falta de divulgação. Conclusões: A investigação permitiu determinar que o fortalecimento da identidade afro-esmeralda é uma tarefa complexa que deve ser promovida nas instituições de origem e de ensino. Finalmente, os pesquisadores recomendam implementar estratégias para a criação e disseminação de produtos culturais para conservar e proteger a identidade afro-esmeralda.

Age analysis of newspaper coverage of mental illness.

In this study, we examine newspaper coverage of mental illness in children and adults taken from 6 weeks during a 1-year period. Articles were coded for (1) type of article; (2) types of disorders named or described; (3) themes related to crime, attributions of the disorder, treatments, and critiques of the mental health system; and (4) "elements of responsible journalism," including inclusion of perspectives from mental health experts, statistics related to mental illness, referrals to additional sources of information, and avoidance of slang terminology. We examine how these variables differ by the age of the group discussed in the article: children/adolescents and adults/older adults. One thousand two hundred fifty-two articles were coded for these four clusters as well as age of group discussed in the article. Inter-rater correlations of two independent judges were satisfactory for 10% of the stories. Age group comparisons revealed that the child articles contained a significantly higher proportion of feature articles; were significantly more likely to discuss behavior and conduct disorders, and alcohol and drug abuse, attention deficit hyperactivity disorder (ADHD), anxiety disorders, and eating disorders, and to contain themes of causation, treatment, and critiques of the mental health system. The adult articles contained a significantly higher proportion of episodic news stories and were significantly more likely to present themes of dangerousness and crime. Our analysis found that child articles were significantly more likely to incorporate elements of responsible journalism, while adult articles were significantly more likely to use stigmatizing terminology. Our report encourages journalists to develop contextually comprehensive and informative presentations of mental illness and issues surrounding the mental health system for all population groups in order to provide readers with accurate information within the context of general social trends and relevant expert opinion.

Some recovery processes in mutual-help groups for persons with mental illness; II: qualitative analysis of participant interviews.

Previous research suggests that consumer operated services facilitate recovery from serious mental illness. In part I of this series, we analyzed the content of the GROW program, one example of a consumer operated service, and identified several processes that Growers believe assists in recovery. In this paper, we review the qualitative interviews of 57 Growers to determine what actual participants in GROW acknowledge are important processes for recovery. We also used the interviews to identify the elements of recovery according to these Growers. Growers identified self-reliance, industriousness, and self-esteem as key ingredients of recovery. Recovery was distinguished into a process-an ongoing life experience-versus an outcome, a feeling of being cured or having overcome the disorder. The most prominent element of GROW that facilitated recovery was the support of peers. Gaining a sense of personal value was also fostered by GROW and believed to be important for recovery. The paper ends with a discussion of the implications of these findings for the ongoing development of consumer operated services and their impact on recovery.

Stigmatizing attitudes about mental illness and allocation of resources to mental health services.

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.