Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches.

"Vaccine hesitancy" is a concept used frequently in vaccination discourse and is challenging previously held perspective that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. Given the importance of achieving high vaccine coverage in Canada to avoid vaccine preventable diseases and their consequences, vaccine hesitancy is an important issue that needs to be addressed. This article describes the scope and causes of vaccine hesitancy in Canada and proposes potential approaches to address it.

Reasons for ART non-adherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi.

HIV prevalence in the American Deep South has reached crisis proportions and greater numbers of patients are enrolling in clinical care and beginning antiretroviral therapy (ART). In order to gain maximum benefit from ART, patients must sustain high levels of adherence to demanding regimens over extended periods of time. Many patients are unable to maintain high rates of adherence and may need assistance to do so, which may be based upon an understanding of barriers to adherence for a given population. The current study sought to gain understanding of barriers to adherence for a mixed urban/rural HIV-positive patient population in Mississippi and to determine whether barriers to adherence may be specific to gender, employment, depressive symptoms or educational attainment status. Seventy-two patients who missed a dose of ART medication over the last three days endorsed the top five reasons for missing a dose as: (1) not having the medication with them, (2) sleeping through the dose time, (3) running out of the medication, (4) being busy with other things and (5) other. Reported barriers were fairly consistent across different groups, although women and those classified as having moderate to severe depressive symptoms reported different patterns of adherence barriers. Results suggest that adherence interventions implemented in the Deep South must take into account specific barriers faced by individuals within this region, where stigma, gender disparities and limited resources are prevalent.

Canadian menopause study-I: Understanding women's intentions to utilise hormone replacement therapy.

OBJECTIVES: This research examines women's intentions to use or to continue to use HRT, as a function of perceived advantages and disadvantages of HRT and perceived social support for utilising HRT. METHODS: A cross-national sample of 205 pre-, peri-, and postmenopausal women convened in 33 'Women's Health Discussion Groups' in small, mid-sized, and large cities across the regions of Canada. Participants completed close-ended questionnaires assessing perceptions of advantages, disadvantages, and social support for HRT, and intentions to utilise or to continue to utilise HRT in the future. RESULTS: Women who intended to utilise or to continue to utilise HRT, compared with women who did not, perceived significantly more advantages of HRT and significantly more social support for utilising HRT, and did not, in general, differ in their perceptions of the negative side effects of HRT. Regression analysis indicated that perceived advantages of HRT and perceived social support for using HRT, but not perceived negative side effects of HRT, were significantly associated with intentions to utilise or to continue to utilise therapy and explained 46% of the variance in these intentions. CONCLUSIONS: Findings suggest that the importance of perceived health benefits of HRT and perceived social support for HRT may be substantially underestimated, and that the importance of perceived negative side effects of HRT may be substantially overestimated, in understanding women's HRT decision making and in counselling women about initiation or maintenance of therapy.

Understanding condom use among heroin addicts in methadone maintenance using the information-motivation-behavioral skills model.

The current study represents the application of a health behavior model to account for unsafe sexual behavior (as opposed to unsafe needle use) among heroin addicts in methadone treatment. The Information-Motivation-Behavioral Skills (IMB) model of HIV preventive behavior asserts that HIV prevention information, motivation, and behavioral skills are fundamental determinants of HIV preventive behavior. Participants (N = 156 heroin-addicted individuals in methadone treatment) completed assessments of their levels of HIV prevention information, motivation, behavioral skills, and safer sexual behavior. Overall measures of fit generated via structural equation modeling indicate that the IMB model adequately fits the data obtained. The constructs of the model accounted for a substantial proportion of the variance in safer sexual behavior, and tests of parameter estimates indicate that while information and motivation had direct and reliable associations with safer sexual behavior in this population, behavioral skills did not. Discussion focuses on the primary roles of HIV prevention information and motivation as determinants of safer sexual behavior in this population, on the lack of a significant contribution of HIV prevention behavioral skills, and on the implications for intervention of this pattern of findings.

Principles underlying a model policy on relationships between staff and service recipients in a mental health system.

OBJECTIVE: The authors participated in a work group to produce a model policy addressing the boundaries of relationships between staff and recipients of service in a public mental health system that provides and regulates services in a variety of treatment settings. METHODS: The chief medical officer of the New York State Office of Mental Health assembled a work group of administrators, clinicians, state officials, and a representative of service recipients. The group reviewed the professional literature and existing ethics guidelines and policies addressing relationships between staff members and service recipients and made recommendations for a new policy. RESULTS AND CONCLUSIONS: The work group formulated five guiding principles: prevention of the exploitation of recipients of services by staff; the right of recipients to be treated as competent autonomous human beings; recognition that certain developmental stages, treatment settings, and pre-existing relationships increase a service recipient's vulnerability to exploitation and call for more stringent regulation of staff actions; acceptance of a spectrum of permissible relationships for staff and recipients outside of the relationship dictated by the staff member's job description; and recognition of the difference between a relationship focused on treatment or service provision and other professional relationships between providers and current or former recipients. The principles were used to develop a model policy on relationships between staff and recipients that addresses both the organizational complexity and the recipient-centered rehabilitation model of a large state-operated mental health system.

Psychological distress and infertility: forty years of research.

A critical review is provided of the literature of psychosomatic infertility, including research on the relation of psychological distress and infertility, interventional studies in which efforts to treat underlying psychopathology are related to success or failure in conceiving, and proposed neurophysiological mechanisms that relate psychological status and fertility. Directions for future research to address the issue of psychological distress and infertility are also outlined.

Interpersonal perception of the AIDS risk potential of persons of the opposite sex.

Individuals engage in high rates of AIDS risk behavior, despite awareness that infection is preventable, and use biased decision rules for determining the AIDS risk potential of their own and others' behavior. In this laboratory study, 32 male and 32 female university students made judgments of the AIDS risk potential of persons of the opposite sex following exposure to explicit information regarding AIDS-related attitudes and behavior in a discussion group. A social relations analysis showed that judgments of AIDS risk potential were determined by perceiver-based assimilation that was stronger than target-based consensus for both men and women. Further, perceptions of others were related to self-perception. However, the consensus that was observed showed moderate accuracy. Implications for AIDS prevention are discussed.

Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population.

This research used the Information-Motivation-Behavioral Skills (IMB) model of AIDS risk behavior change (J. D. Fisher & Fisher, 1992a) to reduce AIDS risk behavior in a college student population. College students received an IMB model-based intervention that addressed AIDS risk reduction information, motivation, and behavioral skills deficits that had been empirically identified in this population, or were assigned to a no-treatment control condition. At a 1-month follow-up, results confirmed that the intervention resulted in increases in AIDS risk reduction information, motivation, and behavioral skills, as well as significant increases in condom accessibility, safer sex negotiations, and condom use during sexual intercourse. At a long-term follow-up, the intervention again resulted in significant increases in AIDS preventive behaviors.

PIP: In 1992 at the University of Connecticut, researchers conducted a case control study to evaluate the effect of an AIDS risk reduction intervention on AIDS risk behavior in a college student population. They used the Information-Motivation-Behavioral Skills (IMB) model to design, implement, and evaluate the intervention. A health educator and five peer educators implemented the intervention, which consisted of three 2-hour sessions held 1 week apart. The first session, the information component, consisted of mainly an AIDS 101 humorous, heavily illustrated slide show that targeted information gaps. The second session, the motivation component, included small group discussions guided by peer educators followed by large group discussions guided by the health educator and a screening of a video entitled People Like Us. These discussions aimed to change attitudes and norms regarding preventive behavior and to influence students' perceptions of their social networks' support and expectations for safer sexual behavior. The third session, the behavioral skills component, focused on teaching the students how to effectively initiate and maintain safer sexual behavior in their own social environment and on influencing perceptions of self-efficacy and response efficacy. After 1 month, it appeared that the intervention significantly increased AIDS risk reduction information at the individual and group levels (p .0001). At the individual and group levels, it improved attitudes toward the performance of AIDS preventive acts (p .0001) and increased behavioral interventions to adopt preventive behaviors (p .0001 at individual level and p .059 at group level). The intervention significantly increased participants' perceptions of the effectiveness and ease with which they could enact critical AIDS preventive behaviors at both the individual and group levels. It also resulted in significant increases in condom accessibility, safer sex negotiations, and condom use during sexual intercourse at the individual and group levels. It had a significant effect on follow-up HIV testing at the individual level (p .05).

Understanding and promoting AIDS-preventive behavior: insights from the theory of reasoned action.

Psychological determinants of AIDS-preventive behaviors were examined from the perspective of the theory of reasoned action in prospective studies of gay men, heterosexual university students, and heterosexual high school students. Across samples, preventive behaviors, and prospective intervals of 1 and 2 months' duration. AIDS-preventive behaviors were predicted by behavioral intentions; behavioral intentions were a function of attitudes and norms; and attitudes and norms were a function of their theorized basic underpinnings. Discussion focuses on the development of AIDS-prevention interventions that modify intentions, attitudes, and norms concerning performance of AIDS-preventive behaviors by targeting the empirically identified underpinnings of attitudes and norms related to specific preventive behaviors in specific populations of interest.

The state psychiatric center as an academically affiliated tertiary care hospital.

Conventional wisdom views state psychiatric hospitals as a problem as much as a solution in the fight against mental illness. The legacy of the historic shortcomings of these hospitals--overcrowding, dreary environment, ineffective treatments, understaffing--frames the discussions of their future. The authors argue that a positive, constructive mission and vision for state hospitals is emerging in New York. This vision calls for fewer, smaller, specialized centers redefined as academically affiliated, community based, consumer oriented, tertiary care centers. To transform these centers, a major reengineering is proposed, including centralized treatment, patient and family participation, continuing education for all staff, outcome research, specialization, multi-service campuses, and technology transfer programs. With this transformation, State Psychiatric Centers become partners in efforts to improve the quality of life for people with mental illness throughout society.

Restraint and seclusion: a review of the literature.

OBJECTIVE: The author reviewed the literature published since 1972 concerning restraint and seclusion. METHOD: The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. RESULTS: The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. CONCLUSIONS: The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.

Canadian street youth: correlates of sexual risk-taking activity.

The purpose of this study was to develop a national perspective on the sexual activity of street youth in Canada and to determine the correlates of risky sexual behavior according to street youth's link to the street. Five categories of street youth (sex industry workers, heavy drug and/or alcohol users, young offenders, homeless and unemployed) ages 15 to 20 years were recruited in 1988 from 10 Canadian urban centers to participate in a 45-minute structured interview focusing on knowledge and attitudes regarding sexually transmitted diseases (STD)/human immunodeficiency virus, current sexual practices, sexual and STD history, demographic background, alcohol/drug use and relationship with parents and peers. Data from the survey were also compared with findings from more than 15,000 non-street youth adolescents surveyed in the same year with the use of parallel questionnaires. Of 712 street youth surveyed (391 males, mean age 17.3 years; 321 females, mean age 16.8 years), the majority were sexually active (95% males, 93% females) and 22% reported at least one previous STD (16% males, 30% females). The lowest STD rates were in unemployed males (5%) and the highest (68%) in female sex industry workers. STD/human immunodeficiency virus high risk behaviors were frequent with 47% of males and 41% of females having had at least 10 different partners, 73% of males and 75% of females inconsistently using condoms and 22% of males and 24% of females participating in anal intercourse. Even among sex industry workers more than 40% used condoms inconsistently.(ABSTRACT TRUNCATED AT 250 WORDS)

Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students.

This article contains empirical tests of the information-motivation-behavioral skills (IMB) model of AIDS-preventive behavior (J.D. Fisher & Fisher, 1992; W.A. Fisher & Fisher, 1993a), which has been designed to understand and predict the practice of AIDS-preventive acts. The IMB model holds that AIDS-preventive behavior is a function of individuals' information about AIDS prevention, motivation to engage in AIDS prevention, and behavioral skills for performing the specific acts involved in prevention. The model further assumes that AIDS-prevention information and motivation generally work through AIDS-prevention behavioral skills to influence the initiation and maintenance of AIDS-preventive behavior. Supportive tests of the model, using structural equation modeling techniques, are reported with populations of gay male affinity group members (n = 91) and heterosexual university students (n = 174).

Unwanted teenage pregnancies: incidence, interpretation, and intervention.

PIP: North American and western European cultures are more permissive than they were before World War II about the increased incidence of teen sexual activity. Societies may be more open and teens are having more premarital sex than they used to, but they surely are not using contraception as often as they should. As such, there is a great deal of unintended and unwanted teenage pregnancies, especially in the US. Even the threat of contracting and/or transmitting HIV has not caused heterosexual youths to change their sexual or contraceptive behaviors. The authors conceptualize explanations for this lack of adolescent behavioral change, including procedures designed to identify deficiencies and to bring about necessary changes in contraception-relevant information, motivation, behavioral skills, and situational constraints. Examples of successful intervention programs are outlined. Sections consider the incidence of premarital intercourse, contraceptive use, and unwanted pregnancies; contraceptive neglect; unintended and unwanted pregnancies; and why teenagers have unprotected sexual intercourse. The conceptual framework of intervening to prevent unwanted teenage pregnancies is presented in sections on providing improved contraceptive information, increasing precontraceptive motivation, improving contraceptive skills, altering situational factors which inhibit contraception, and evaluation research.^ieng

Changing AIDS-risk behavior.

This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.

A programmable analog neural network processor.

An analog neural network breadboard consisting of 256 neurons and 2048 programmable synaptic weights of 5 bits each is constructed and tested. The heart of the processor is an array of custom-programmable synapse (resistor) chips on a reconfigurable neuron board. The analog bandwidth of the system is 90 kHz. The breadboard is used to demonstrate the application of neural network learning to the problem of real-time adaptive mirror control. The processor control is 21 actuators of an adaptive mirror with a step-response setting time of 5 ms. The demonstration verified that it is possible to modify the control law of the high-speed analog loop using neural network training without stopping the control loop.

High-risk STD/HIV behavior among college students.

The current sexually transmitted disease (STD) epidemic in adolescents has led to concern about the potential for spread of the human immunodeficiency virus (HIV). In 1988, a total of 5514 students in first-year community college and university classrooms across Canada were surveyed to assess STD/HIV-related knowledge, attitudes, and risk behavior. The students' mean age was 19.7 years; the male-to-female ratio was 1:1.4. Students knew more about HIV/acquired immunodeficiency syndrome than other STDs. Of the 74.3% of the men and 68.9% of the women who were coitally active, 14.3% of the men and 18.6% of the women had participated in anal intercourse and 5.5% reported a previous STD. Only 24.8% of the men and 15.6% of the women always used a condom during sexual intercourse. Among the 21.3% of the men and 8.6% of the women with 10 or more partners, regular condom use was reported in only 21% and 7.5%, respectively. In this subgroup, anal intercourse was practiced by 26.9% of the men and 34.8% of the women, and previous STD was reported by 10.6% and 24.2%, respectively. Factors associated with not using a condom included number of sexual partners, embarrassment about condom purchase, difficulty discussing condom use with a partner, use of oral contraceptives, insufficient knowledge of HIV/STDs, and the belief that condoms interfere with sexual pleasure. These factors are potentially amenable to change. Effective, behaviorally focused educational programs are needed to improve condom use and reduce STD/HIV risk.