Boot Camp Translation using Community-Engaged messaging for adolescent Vaccination: A Cluster-Randomized trial.

BACKGROUND: Routine vaccination coverage for adolescents living in the rural US is lower than adolescents living in urban areas. We sought to measure the effect of Boot Camp Translation (BCT), a community-based participatory intervention, on rural adolescent vaccination coverage. METHODS: A cluster randomized controlled trial was performed September 2018-November 2021 involving 16 rural Colorado counties. Intervention county community members engaged in BCT to develop interventions to improve adolescent vaccination locally. Adolescent vaccination coverage was measured using the Colorado Immunization Information System. RESULTS: For 11-12-year-olds, HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage was lower post- versus pre-intervention in the control and intervention groups. For 11-12-year-olds in the intervention group, there was no significant difference post- versus pre-intervention in the odds of HPV vaccine initiation (adjusted ratio of odds ratios [aROR] = 0.93, 95 %: 0.85-1.02, p = 0.10) or up-to-date HPV vaccination (aROR: 1.10, 95 % CI: 0.98-1.23, p = 0.11) compared with the control group. Among 11-12-year-olds, the decrease in the proportion vaccinated with MenACWY and Tdap in the intervention group was significantly greater than the control group. Among 13-17-year-olds, there were significant increases in HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage from pre- to post-intervention for both groups, with no significant differences between groups. CONCLUSION: 11-12-year-old vaccination coverage decreased slightly from pre- to post-intervention while 13-17-year-old vaccination coverage increased. We saw no effect from the BCT intervention. Our findings about the effectiveness of BCT for improving vaccine uptake may not be generalizable because the study coincided with the COVID-19 pandemic. CLINICAL TRIAL REGISTRY: This study was registered with ClinicalTrials.gov, NCT03955757.

Comparing the Effects of Victimization, School Connectedness, and Social Support on Heterosexual and Sexual Minority Adolescent Suicidality in the United States: A Partial Test of Minority Stress Theory.

In the United States, sexual minority adolescents are among the subpopulations at the highest risk for suicide; yet, predictors of suicidality among this unique group remain significantly understudied. Drawing from Meyer's minority stress theory (MST), this study examines whether general stressors act as predictors of adolescent suicidality and whether differences exist in the variation of these effects between heterosexual and sexual minority adolescents. Specifically, multivariate logistic regression models were developed to examine the impact that victimization, school connectedness, and social support have on heterosexual and sexual minority adolescent suicidality using a sample of 166,176 U.S. adolescents drawn from the 2019 Minnesota Student Survey. Participants ranged from 10 to 18 years of age and identified as heterosexual, bisexual, gay or lesbian, questioning, pansexual, queer, or as none of these. Findings highlight that sexual minorities (Exp(B) = 1.870, p < .001) were roughly twice as likely to report suicidality compared to their heterosexual peers. All victimization measures were highly predictive of suicidality among heterosexual and sexual minority adolescents. Overall, adolescents who were less connected to their school setting and more socially isolated were also more likely to experience suicidality; however, such effects were not reflected uniformly in every item measuring school connectedness and social support. Findings highlight important avenues for policies implementation aimed at mitigating the effects of multiple sources of stressors on adolescents' mental health and reducing adolescents' suicide rates. Interventions tailored to the unique needs of sexual minority adolescents are needed to address their disproportionate representation among those at risk for suicide.

SARS-CoV-2 Seroprevalence Compared with Confirmed COVID-19 Cases among Children, Colorado, USA, May-July 2021.

To compare SARS-CoV-2 antibody seroprevalence among children with seropositive confirmed COVID-19 case counts (case ascertainment by molecular amplification) in Colorado, USA, we conducted a cross-sectional serosurvey during May-July 2021. For a convenience sample of 829 Colorado children, SARS-CoV-2 seroprevalence was 36.7%, compared with prevalence of 6.5% according to individually matched COVID-19 test results reported to public health. Compared with non-Hispanic White children, seroprevalence was higher among Hispanic, non-Hispanic Black, and non-Hispanic other race children, and case ascertainment was significantly lower among Hispanic and non-Hispanic Black children. This serosurvey accurately estimated SARS-CoV-2 prevalence among children compared with confirmed COVID-19 case counts and revealed substantial racial/ethnic disparities in infections and case ascertainment. Continued efforts to address racial and ethnic differences in disease burden and to overcome potential barriers to case ascertainment, including access to testing, may help mitigate these ongoing disparities.

Estimating Vaccine Hesitancy in Colorado by Using Immunization Information System Data.

OBJECTIVES: Vaccine hesitancy is a complex issue that threatens global health. We used data from the Colorado Immunization Information System (CIIS) to quantify vaccine hesitancy. METHODS: We examined immunization records from CIIS for patients age 2 up to 9 months to estimate vaccine hesitancy by tabulating the number of doses received per visit and comparing it with the number of expected doses based on recommendations of the Advisory Committee on Immunization Practices. We calculated the percentage of patients in each vaccine hesitancy group who were up to date on the 7-antigen series by age 35 months. We examined the distribution of vaccine-hesitant populations among vaccination providers who report to CIIS to estimate the difference in vaccine-hesitant patient populations among vaccination providers in Colorado. RESULTS: Of 201 450 patients, 5147 (2.6%) consistently limited the number of shots received at each visit as compared with recommendations from the Advisory Committee on Immunization Practices; 166 927 (82.9%) patients did not limit the number of shots received; 5693 (2.8%) limited the number of shots received at >1 visit but not all visits; and 23 683 (11.8%) limited the number of shots received at only 1 visit. We found differences in vaccine hesitancy distributions among certain Colorado vaccination providers. CONCLUSIONS: Immunization information system data, although sometimes incomplete, offer an opportunity to investigate state-level vaccine hesitancy. Areas of future research include performing similar analyses over time and determining geographic and socioeconomic factors that contribute to vaccine hesitancy.

Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status - 13 U.S. Jurisdictions, April 4-July 17, 2021.

COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8-15.8) to 4.6 (95% CI = 2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI = 11.3-15.6) to 10.4 (95% CI = 8.1-13.3) and from 16.6 (95% CI = 13.5-20.4) to 11.3 (95% CI = 9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.

Rapid Increase in Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant - Mesa County, Colorado, April-June 2021.

On May 5, 2021, the Colorado Department of Public Health and Environment (CDPHE) identified the first five COVID-19 cases caused by the SARS-CoV-2 B.1.617.2 (Delta) variant in Mesa County in western Colorado (population 154,933, <3% of the state population). All five initial cases were associated with school settings. Through early June, Mesa County experienced a marked increase in the proportion of Delta variant cases identified through sequencing: the 7-day proportion of sequenced specimens identified as B.1.617.2 in Mesa County more than doubled, from 43% for the week ending May 1 to 88% for the week ending June 5. As of June 6, more than one half (51%) of sequenced B.1.617.2 specimens in Colorado were from Mesa County. CDPHE assessed data from surveillance, vaccination, laboratory, and hospital sources to describe the preliminary epidemiology of the Delta variant and calculate crude vaccine effectiveness (VE). Vaccination coverage in early May in Mesa County was lower (36% of eligible residents fully vaccinated) than that in the rest of the state (44%). Compared with that in all other Colorado counties, incidence, intensive care unit (ICU) admissions, and COVID-19 case fatality ratios were significantly higher in Mesa County during the analysis period, April 27-June 6, 2021. In addition, during the same time period, the proportion of COVID-19 cases in persons who were fully vaccinated (vaccine breakthrough cases) was significantly higher in Mesa County compared with that in all other Colorado counties. Estimated crude VE against reported symptomatic infection for a 2-week period ending June 5 was 78% (95% confidence interval [CI] = 71%-84%) for Mesa County and 89% (95% CI = 88%-91%) for other Colorado counties. Vaccination is a critical strategy for preventing infection, serious illness, and death from COVID-19. Enhanced mitigation strategies, including masking in indoor settings irrespective of vaccination status, should be considered in areas with substantial or high case rates.

Model choice for estimating the association between exposure to chemical mixtures and health outcomes: A simulation study.

Challenges arise in researching health effects associated with chemical mixtures. Several methods have recently been proposed for estimating the association between health outcomes and exposure to chemical mixtures, but a formal simulation study comparing broad-ranging methods is lacking. We select five recently developed methods and evaluate their performance in estimating the exposure-response function, identifying active mixture components, and identifying interactions in a simulation study. Bayesian kernel machine regression (BKMR) and nonparametric Bayes shrinkage (NPB) were top-performing methods in our simulation study. BKMR and NPB outperformed other contemporary methods and traditional linear models in estimating the exposure-response function and identifying active mixture components. BKMR and NPB produced similar results in a data analysis of the effects of multipollutant exposure on lung function in children with asthma.

The joint effect of ambient air pollution and agricultural pesticide exposures on lung function among children with asthma.

BACKGROUND: Ambient environmental pollutants have been shown to adversely affect respiratory health in susceptible populations. However, the role of simultaneous exposure to multiple diverse environmental pollutants is poorly understood. OBJECTIVE: We applied a multidomain, multipollutant approach to assess the association between pediatric lung function measures and selected ambient air pollutants and pesticides. METHODS: Using data from the US EPA and California Pesticide Use Registry, we reconstructed three months prior exposure to ambient air pollutants ((ozone (O3), nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter < 2.5 µm (PM2.5) and <10 µm (PM10)) and pesticides (organophosphates (OP), carbamates (C) and methyl bromide (MeBr)) for 153 children with mild intermittent or mild persistent asthma from the San Joaquin Valley of California, USA. We implemented Bayesian kernel machine regression (BKMR) to estimate the association between simultaneous exposures to air pollutants and pesticides and lung function measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75)). RESULTS: In BKMR analysis, the overall effect of mixtures (pollutants and pesticides) was associated with reduced FEV1 and FVC, particularly when all the environmental exposures were above their 60th percentile. For example, the effect of the overall mixture at the 70th percentile (compared to the median) was a -0.12SD (-50 mL, 95% CI: -180 mL, 90 mL) change in the FEV1 and a -0.18SD (-90 mL, 95% CI: -240 mL, 60 mL) change in the FVC. However, 95% credible intervals around all of the joint effect estimates contained the null value. CONCLUSION: At this agricultural-urban interface, we observed results from multipollutant analyses, suggestive of adverse effects on some pediatric lung function measures following a cumulative increase in ambient air pollutants and agricultural pesticides. Given the uncertainty in effect estimates, this approach should be explored in larger studies.

Children's understanding of when a person's confidence and hesitancy is a cue to their credibility.

The most readily-observable and influential cue to one's credibility is their confidence. Although one's confidence correlates with knowledge, one should not always trust confident sources or disregard hesitant ones. Three experiments (N = 662; 3- to 12-year-olds) examined the developmental trajectory of children's understanding of 'calibration': whether a person's confidence or hesitancy correlates with their knowledge. Experiments 1 and 2 provide evidence that children use a person's history of calibration to guide their learning. Experiments 2 and 3 revealed a developmental progression in calibration understanding: Children preferred a well-calibrated over a miscalibrated confident person by around 4 years, whereas even 7- to 8-year-olds were insensitive to calibration in hesitant people. The widespread implications for social learning, impression formation, and social cognition are discussed.

Imagining Others' Minds: The Positive Relation Between Children's Role Play and Anthropomorphism.

Children's role playing, whether personifying toys or imagining invisible friends, involves imagining others' minds and internal states. Similarly, anthropomorphism - the attribution of internal states to non-human others (e.g., animals, inanimate nature, or technologies) - also involves imagining others' minds and internal states. We propose that the imaginative process of simulating and projecting internal states is common to both role play and anthropomorphism. The current study investigated the relation between children's role play and anthropomorphism. Ninety children (5, 7, and 9 years) were administered Individual Differences in Anthropomorphism Questionnaire - Child Form (IDAQ-CF), comprised of the technology-inanimate nature and animal subscales, and the Role Play Scale, which assessed (a) impersonation of animals, people, and/or machines and (b) imaginary companions (ICs), including invisible friends and personified toys. Results indicated that the imaginative act of impersonating an animal, person, and/or machine was positively related to anthropomorphism, and specifically anthropomorphism of inanimate nature and technology. Second, anthropomorphism of animals was highest amongst children with invisible ICs, followed by those with toy ICs and those who impersonated. Finally, children who frequently engaged with an invisible ICs more readily anthropomorphized in general and technology and inanimate nature in particular relative to all other children. Results are discussed in terms of the differing degrees of imagination involved in anthropomorphism of animals versus technology and inanimate nature.

Occupational physical activity in brewery and office workers.

Active lifestyles are beneficial to health and well-being but our workplaces may not be inherently supportive of physical activity at work. With the increasing use of technology in the workplace, many jobs are becoming more sedentary. The purpose of this study was to characterize levels of occupational physical activity (OPA) among active and sedentary workers. Two types of activity trackers (Fitbit Charge HR and Hexoskin) were used to assess activity measures (steps, heart rate, and energy expenditure) among workers during one full work shift. The first objective of the study was to assess the agreement between two types of accelerometer-based activity trackers as measures of occupational physical activity. The second objective of this study was to assess differences in measures of OPA among workers in generally physically active (brewery) and sedentary (office) work environments. Occupational physical activity data were collected from 50 workers in beer-brewing tasks and 51 workers in office work tasks. The 101 subjects were from the brewing service sector, a call center, and an engineering office within a manufacturing facility. A two-factor repeated measures analysis of variance (ANOVA) was used to assess the two activity tracking devices while two-sample t-tests were used to compare the two worker groups. There were statistically significant differences in total steps and mean heart rate between the two devices. When comparing the two groups of workers there were statistically significant differences in measures of steps, mean heart rate, and energy expenditure. The results of the present study provide quantitative evidence that levels of OPA should be identified for different work groups.

Enhancing "theory of mind" through behavioral synchrony.

Theory of mind refers to the abilities underlying the capacity to reason about one's own and others' mental states. This ability is critical for predicting and making sense of the actions of others, is essential for efficient communication, fosters social learning, and provides the foundation for empathic concern. Clearly, there is incredible value in fostering theory of mind. Unfortunately, despite being the focus of a wealth of research over the last 40 years relatively little is known about specific strategies for fostering social perspective taking abilities. We provide a discussion of the rationale for applying one specific strategy for fostering efficient theory of mind-that of engaging in "behavioral synchrony" (i.e., the act of keeping together in time with others). Culturally evolved collective rituals involving synchronous actions have long been held to act as social glue. Specifically, here we present how behavioral synchrony tunes our minds for reasoning about other minds in the process of fostering social coordination and cooperation, and propose that we can apply behavioral synchrony as a tool for enhancing theory of mind.

"Robovie, you'll have to go into the closet now": children's social and moral relationships with a humanoid robot.

Children will increasingly come of age with personified robots and potentially form social and even moral relationships with them. What will such relationships look like? To address this question, 90 children (9-, 12-, and 15-year-olds) initially interacted with a humanoid robot, Robovie, in 15-min sessions. Each session ended when an experimenter interrupted Robovie's turn at a game and, against Robovie's stated objections, put Robovie into a closet. Each child was then engaged in a 50-min structural-developmental interview. Results showed that during the interaction sessions, all of the children engaged in physical and verbal social behaviors with Robovie. The interview data showed that the majority of children believed that Robovie had mental states (e.g., was intelligent and had feelings) and was a social being (e.g., could be a friend, offer comfort, and be trusted with secrets). In terms of Robovie's moral standing, children believed that Robovie deserved fair treatment and should not be harmed psychologically but did not believe that Robovie was entitled to its own liberty (Robovie could be bought and sold) or civil rights (in terms of voting rights and deserving compensation for work performed). Developmentally, while more than half the 15-year-olds conceptualized Robovie as a mental, social, and partly moral other, they did so to a lesser degree than the 9- and 12-year-olds. Discussion focuses on how (a) children's social and moral relationships with future personified robots may well be substantial and meaningful and (b) personified robots of the future may emerge as a unique ontological category.

Behaving as or behaving as if? Children's conceptions of personified robots and the emergence of a new ontological category.

Imagining another's perspective is an achievement in social cognition and underlies empathic concern and moral regard. Imagination is also within the realm of fantasy, and may take the form of imaginary play in children and imaginative production in adults. Yet, an interesting and provocative question emerges in the case of personified robots: How do people conceive of life-like robots? Do people imagine about robots' experiences? If so, do these imaginings reflect their actual or pretend beliefs about robots? The answers to these questions bear on the possibility that personified robots represent the emergence of a new ontological category. We draw on simulation theory as a framework for imagining others' internal states as well as a means for imaginative play. We then turn to the literature on people's and, in particular, children's conceptions of personified technologies and raise the question of the veracity of children's beliefs about personified robots (i.e., are they behaving as or behaving as if?). Finally, we consider the suggestion that such personified technologies represent the emergence of a new ontological category and offer some suggestions for future research in this important emerging area of social cognition.