Antibiotic Knowledge, Beliefs, and Behaviors: Testing Competing Hypotheses Using an Urban Community Sample.

Antibiotic use and misuse continue to be a worldwide concern with the increasing rate of antimicrobial resistance, lack of new antibiotics in the pipeline, and rising health care costs. Despite studies that attempt to distinguish between factors associated with antibiotic use and misuse (e.g., knowledge and beliefs and provider-patient communication), few studies have tested comparative hypotheses related to antibiotic use behavior. This study 1) compares two theoretical models (health belief and patient-centered communication) to learn which best represents the pathways associated with antibiotic use; and 2) describes urban consumers' knowledge, beliefs, and behaviors regarding antibiotic use. Interviewers completed 505 intercept surveys across six clinic- and community-based sites in Southeast Michigan. Structural equation modeling was utilized to compare two competing theoretical models predicting antibiotic behavior. Findings support the assertion that a patient-provider communication model fits the data better than the null model. Descriptive statistical analysis explicated participant knowledge was mixed. While many participants knew correct general facts about antibiotics, 35% of the sample put forth that they believed that antibiotics cure colds and flu and over half (57%) endorsed the belief that antibiotics are good for treating infections caused by viruses. The implications for theory and practice are discussed including the need for clinicians to target communication strategies for the populations that they serve.

Stress, Coping, Resilience and Trust during the Flint Water Crisis.

In 2014, government officials in the City of Flint, Michigan switched the municipal water source from the Detroit Water System (water source: Lake Huron) to the Flint River. During this time, an estimated 102,000 Flint residents were potentially exposed to multiple chemical (e.g., lead) and biological threats (e.g., Legionella). After the switch to water sourced from the Flint River, Flint residents consistently reported concerns over water quality while also experiencing rashes, hair loss, and other health problems, including anxiety and depression. This study 1) reports on the Flint Water Crisis and its subsequent impact on residents' stress, coping, resilience and trust and 2) describes a process methodology that trained, hired and deployed Flint residents as members of a multidisciplinary research team. A random sample of 320 Flint residents underwent household-based interviews to assess their health and mental health needs. Concomitantly, household water samples were obtained and residents were connected to known resources based on interview responses relative to need. This study found that declines in health and mental health status were correlated with increased stressors (i.e., fatigue, financial concern, anxiety), coping and less resilience or the capacity to recover. Perceived trust in government officials was significantly lower after the water crisis. While the water crisis generated numerous stressors, the event also galvanized community competence to engage in solution-focused coping and other adaptive capacities. By assessing and building upon Flint residents' resilience, community resource specialists, identified and subsequently strengthened city residents' ability to survive devastating challenges.

A Descriptive Study Using an Intercept Survey: Knowledge, Attitudes, Beliefs, and Behaviors About Systemic Antibiotic Use in Adults Who Reported a Wound Within the Previous Year.

PURPOSE: This project examined knowledge, attitudes, beliefs, and behaviors about systemic antibiotic use for persons who reported a wound within the previous year. DESIGN: Secondary data analyses of 505 adults from a cross-sectional, prospective, intercept survey where every fifth adult was randomly approached to participate. SUBJECTS AND SETTING: Twenty-six participants (5.15% of the parent sample) stated having a wound within the previous year. METHODS: Participants were "interviewed" using the Facilitators and Barriers to Consumer Use of Antibiotics questionnaire that included demographics, health, information sources, antibiotic knowledge, attitudes, beliefs, and behavior questions. Hierarchical agglomerative cluster analysis was used to find clusters of items on the attitude, beliefs, and behavior questions. RESULTS: Sample demographics included 15 women and 11 African Americans, and 17 had some college education. Knowledge about antibiotics had a mean correct score of 10 out of 15 (67%) questions. Higher antibiotic knowledge was significantly related to higher education (rs = 0.69, P < .001). There were 2 attitude and beliefs clusters: most participants (>85%) recognized the need for medical supervision of antibiotic use (cluster 1), and beliefs about the need for antibiotics to prevent illness or treat wounds varied in 27% to 62% of participants (cluster 2). There were 4 behavior clusters: almost all participants 96% (cluster 1) filled and took the antibiotic if prescribed; greater than 71% (cluster 2) disagreed with unapproved methods of obtaining antibiotics; greater than 87% (cluster 3) used prescribed antibiotics correctly; and 36% of participants heard about antibiotic resistance through television or radio or Internet (40%) (cluster 4). CONCLUSIONS: Knowledge about antibiotics was low, while attitudes were positive. These findings support the need for research and evidence-based information on the role of antibiotics in wound care.

Prevalence of Infection-Competent Serogroup 6 Legionella pneumophila within Premise Plumbing in Southeast Michigan.

Coinciding with major changes to its municipal water system, Flint, MI, endured Legionnaires' disease outbreaks in 2014 and 2015. By sampling premise plumbing in Flint in the fall of 2016, we found that 12% of homes harbored legionellae, a frequency similar to that in residences in neighboring areas. To evaluate the genetic diversity of Legionella pneumophila in Southeast Michigan, we determined the sequence type (ST) and serogroup (SG) of the 18 residential isolates from Flint and Detroit, MI, and the 33 clinical isolates submitted by hospitals in three area counties in 2013 to 2016. Common to one environmental and four clinical samples were strains of L. pneumophila SG1 and ST1, the most prevalent ST worldwide. Among the Flint premise plumbing isolates, 14 of 16 strains were of ST367 and ST461, two closely related SG6 strain types isolated previously from patients and corresponding environmental samples. Each of the representative SG1 clinical strains and SG6 environmental isolates from Southeast Michigan infected and survived within macrophage cultures at least as well as a virulent laboratory strain, as judged by microscopy and by enumerating CFU. Likewise, 72 h after infection, the yield of viable-cell counts increased >100-fold for each of the representative SG1 clinical isolates, Flint premise plumbing SG6 ST367 and -461 isolates, and two Detroit residential isolates. We verified by immunostaining that SG1-specific antibody does not cross-react with the SG6 L. pneumophila environmental strains. Because the widely used urinary antigen diagnostic test does not readily detect non-SG1 L. pneumophila, Legionnaires' disease caused by SG6 L. pneumophila is likely underreported worldwide.IMPORTANCEL. pneumophila is the leading cause of disease outbreaks associated with drinking water in the United States. Compared to what is known of the established risks of colonization within hospitals and hotels, relatively little is known about residential exposure to L. pneumophila One year after two outbreaks of Legionnaires' disease in Genesee County, MI, that coincided with damage to the Flint municipal water system, our multidisciplinary team launched an environmental surveillance and laboratory research campaign aimed at informing risk management strategies to provide safe public water supplies. The most prevalent L. pneumophila strains isolated from residential plumbing were closely related strains of SG6. In laboratory tests of virulence, the SG6 environmental isolates resembled SG1 clinical strains, yet they are not readily detected by the common diagnostic urinary antigen test, which is specific for SG1. Therefore, our study complements the existing epidemiological literature indicating that Legionnaires' disease due to non-SG1 strains is underreported around the globe.

Enhancing aging services through evidence-based health promotion: a training for service providers.

During the next several decades, increasing numbers of older Americans will suffer chronic illnesses and many will face challenges due to growing racial and economic health disparities. Agencies serving older adults need to respond by creating and promoting evidence-based health promotion (EBHP) practices to address the growing diversity among older adults in urban areas. One such agency, the Detroit Area Agency on Aging recently partnered with the Wayne State University School of Social Work to conduct an EBHP educational program for service providers. The educational program used information from the National Council on Aging Center for Healthy Aging, the reach, effectiveness/efficacy, adoption, implementation, and maintenance (RE-AIM) model, and the National Wellness Institute. Survey respondents found that the interaction with other participants was beneficial and helped them to conceptualize EBHP as a new way of thinking about service delivery. Participants learned practical lessons about implementing a training program on evidence-based practice and additional steps are offered to increase the uptake of EBHP practices by older adult service providers.

Organizational capacity building: addressing a research and practice gap.

The purpose of this article is to address the gap between evaluation research, and the practice of capacity building with nonprofits. This study describes a 5-year capacity building initiative with grassroots organizations including a longitudinal evaluation of the implementation and outcomes achieved. Formative processes yielded many lessons that were used to improve the capacity building model of services. The results show that the majority of groups met a priori expectations for participation success. Organizational staff valued technology, consultants, and program funding the most. Increases were found in board membership and perceptions of visibility of the organization were enhanced. Executive directors reported greater awareness of needs and improved management knowledge. These small organizations fill many unmet needs and more capacity building evaluation studies are needed to understand the mechanisms that support their efforts and the impact on their sustainability.

The role of psychosocial factors in the transition to substance use: are they protective among urban minority adolescents?

Changes in psychosocial risk and protective factors associated with the onset of substance use were examined in a sample of 556 urban public school sixth graders. General linear modeling analyses indicated that students who did not use substances by the end of sixth grade consistently had higher scores on protective factors than did students who were already using substances at the beginning of sixth grade. Students who began to use during the school year were in flux with scores similar to nonusers at Time 1 and scores closer to early users by Time 2. These findings suggest that interventions which focus on skill enhancement during the transition to middle school may be effective at delaying the onset of substance use. Editors' Strategic Implications: The authors find the same protective factors in this urban, primarily African American sample that are typical in suburban, White samples. Developmentalists and school officials will find interesting the changing effects of protective factors against early substance use during the transitional sixth grade year.

Long-term care preferences and attitudes among Great Lakes American Indian families: cultural context matters.

This research examines the role of family and culture in planning for future long-term care needs and preferences among 252 elders age 55 and older and 74 middle generation children of Great Lakes American Indians living in three residential areas: urban, reservation, and off-reservation rural. Findings show that both generations prefer a non-institutional home-based choice for care if needed, and that acculturation levels influence those choices. Level of acculturation differed by area of residence.