RESUMO
Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Papillomavirus , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Criança , República Dominicana , Humanos , Infecções por Papillomavirus/prevenção & controle , Pesquisa Qualitativa , VacinaçãoAssuntos
Publicidade/legislação & jurisprudência , Rotulagem de Produtos/legislação & jurisprudência , Saúde Pública , Indústria do Tabaco/legislação & jurisprudência , Analgésicos Opioides , Bebidas , Armas de Fogo/legislação & jurisprudência , Rotulagem de Alimentos/legislação & jurisprudência , Educação em Saúde/legislação & jurisprudência , Manobras Políticas , Governo Estadual , Estados UnidosAssuntos
Indústria Farmacêutica/legislação & jurisprudência , Responsabilidade Legal , Epidemia de Opioides , Indústria do Tabaco/legislação & jurisprudência , Analgésicos Opioides/uso terapêutico , Indústria Farmacêutica/economia , Humanos , Legislação de Medicamentos , Marketing , Prevenção do Hábito de Fumar/economia , Prevenção do Hábito de Fumar/legislação & jurisprudência , Governo Estadual , Estados Unidos/epidemiologiaRESUMO
The Doctor of Public Health (DrPH) Core Competency Model aspires to rigorously train future leaders of public health practice to direct and advance societal efforts that address socially rooted causes of health and illness. Although there is no proven formula for success, 3 principles derived from practice may guide the way forward: (1) institutionalize mutual learning and reciprocity between schools of public health and public health agencies and organizations, (2) capitalize on the full resources of the larger university to enrich the educational experiences of DrPH candidates and public health leaders, and (3) globalize the search for model DrPH programs that may be adapted for US schools. Schools of public health must ensure that DrPH programs gain the status and resources needed to fulfill their societal mandate.
Assuntos
Saúde Pública/educação , Humanos , Competência Profissional , Administração em Saúde Pública/educação , Administração em Saúde Pública/normas , Faculdades de Saúde Pública/organização & administração , Faculdades de Saúde Pública/normas , Estados UnidosRESUMO
Knowledge of current public opinion is important as the Food and Drug Administration (FDA) applies the best scientific evidence available to tobacco product regulation. Based on a nationally representative survey of the US adult population, we report 43% support for banning of cigarettes, 65% for reducing nicotine, and 77% for reducing nicotine if such an action could cause fewer children to become addicted to cigarettes. The FDA should consider protecting children by removing all but non-addictive cigarettes from the marketplace.
Assuntos
Atitude Frente a Saúde , Regulamentação Governamental , Legislação de Medicamentos , Nicotina , Fumar/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Inquéritos Epidemiológicos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Opinião Pública , Prevenção do Hábito de Fumar , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women's knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups (N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.
Assuntos
Programas de Rastreamento/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias do Colo do Útero/diagnóstico , República Dominicana , Detecção Precoce de Câncer/métodos , Feminino , Grupos Focais/métodos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Neoplasias do Colo do Útero/epidemiologiaRESUMO
OBJECTIVE: This study is a follow-up to an examination of the racial/ethnic composition of public health students (1996) and faculty (1997) at schools of public health that was conducted 20 years ago. We examined data on the race/ethnicity of students, graduates, and faculty among Association of Schools and Programs of Public Health (ASPPH)-member institutions during 2016-2017 and how these data have changed in the past 20 years. METHODS: We obtained data on the race/ethnicity of students (in 1996 and 2016), graduates (in 1996 and 2016), and faculty (in 1997 and 2017) at ASPPH-member institutions from the ASPPH Data Center. We tabulated frequencies, percentages, and 20-year percentage-point changes by race/ethnicity. We examined data for all current ASPPH-member institutions and for comparable subcohorts of 1996 and 1997 member institutions that are current ASPPH members. RESULTS: In graduate student enrollment, the 20-year increase in each nonwhite racial/ethnic subgroup was ≤5 percentage points. Among tenured faculty, the 20-year increase was greatest among Asians (8 percentage points) but was <3 percentage points for black, Hispanic, and Native American faculty. CONCLUSIONS: The increasing racial/ethnic diversity among students, graduates, and faculty in schools and programs of public health contributes to parallel increases in racial/ethnic diversity in the public health workforce. Schools and programs of public health should recruit clusters of racial/ethnic minority students using holistic application review processes, provide enrolled students with racially/ethnically diverse role models and mentors, and dedicate staffing to ensure a student-centered approach. In addition, those who mentor racially/ethnically diverse students and junior faculty should be rewarded.
Assuntos
Educação de Pós-Graduação/estatística & dados numéricos , Educação Profissional em Saúde Pública/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Docentes/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Diversidade Cultural , Humanos , Estados UnidosRESUMO
OBJECTIVES: We examined the effectiveness of a program to increase exposure to national "truth" tobacco countermarketing messages among youths in rural and low-population-density communities. METHODS: A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of "truth" messages. RESULTS: Confirmed awareness of "truth" increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign's messages. CONCLUSIONS: Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence-based tobacco prevention campaigns.
Assuntos
Promoção da Saúde , Meios de Comunicação de Massa , Prevenção do Hábito de Fumar , Adolescente , Criança , Custos e Análise de Custo , Feminino , Promoção da Saúde/economia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Meios de Comunicação de Massa/economia , População Rural , Estados UnidosAssuntos
Política de Saúde , Neoplasias Pulmonares/prevenção & controle , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/prevenção & controle , Dispositivos para o Abandono do Uso de Tabaco , United States Dept. of Health and Human Services , Previsões , Política de Saúde/história , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , História do Século XX , História do Século XXI , Humanos , Neoplasias Pulmonares/epidemiologia , Fatores de Risco , Fumar/efeitos adversos , Fumar/história , Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/história , Abandono do Hábito de Fumar/legislação & jurisprudência , Fatores de Tempo , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/história , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Dispositivos para o Abandono do Uso de Tabaco/história , Dispositivos para o Abandono do Uso de Tabaco/tendências , Estados Unidos , United States Dept. of Health and Human Services/história , United States Dept. of Health and Human Services/legislação & jurisprudência , United States Dept. of Health and Human Services/tendênciasRESUMO
Our society bears a tremendous public health burden from tobacco-related disability and death, particularly in the realm of cancer. Yet research in lung cancer and other tobacco-related diseases research is dramatically underfunded when compared to the number of people affected. Persuading policy makers to increase funding for tobacco-related research, treatment, and policy initiatives will require considerable cooperation among the researchers, clinicians, and advocates who focus on tobacco control and those who concentrate on tobacco-related disease. Traditionally, these groups have battled over resources, expending precious energy competing for scarce funding. We propose a new way forward: these forces should come together in support of a common agenda that includes both increased tobacco control efforts and additional funding for disease-related research and treatment. Speaking with a unified voice in support of a full continuum of tobacco-related policy initiatives would significantly increase the size and influence of the coalition working to address this public health epidemic. Working together offers our nation the best chance of significantly reducing the scourge of disease and death caused by tobacco use.
Assuntos
Neoplasias Pulmonares/etiologia , Política Pública , Pesquisa/economia , Alocação de Recursos , Prevenção do Hábito de Fumar , Financiamento de Capital , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/prevenção & controle , Fumar/psicologia , Nicotiana/efeitos adversos , Estados UnidosRESUMO
OBJECTIVES: We sought to fill gaps in knowledge of smoking behaviors among college-educated and non-college-educated young adults. METHODS: We used data from the 2003 Tobacco Use Supplement of the Current Population Survey to analyze smoking behaviors among young adults aged 18-24 years and older young adults aged 25-34 years by college status (enrolled, or with a degree, but not enrolled) and other measures of socioeconomic position. RESULTS: Current smoking prevalence among US young adults aged 18-24 years who are not enrolled in college or who do not have a college degree was 30%. This was more than twice the current smoking prevalence among college-educated young adults (14%). Non-college-educated young adults were more likely than were college-educated young adults to start smoking at a younger age and were less likely to have made a quit attempt, although no differences were found in their intentions to quit. Higher rates of smoking in the non-college-educated population were also evident in the slightly older age group. CONCLUSIONS: Non-college-educated young adults smoke at more than twice the rate of their college-educated counterparts. Targeted prevention and cessation efforts are needed for non-college-educated young adults to prevent excess morbidity and mortality in later years.
Assuntos
Escolaridade , Promoção da Saúde/métodos , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Prevalência , Fatores de Risco , Fumar/epidemiologia , Fumar/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
This study assesses whether a national anti-tobacco campaign for youth could create a social context that would elevate social desirability response bias on surveys, as measured by an increase in under-reporting of smoking. This could give rise to data that falsely suggest a campaign-induced decline in youth smoking, or it could exaggerate campaign effects. Data were obtained from a national sample of 5511 students from 48 high schools that were matched to schools sampled for the 2002 National Youth Tobacco Survey (NYTS). Self-reported smoking was compared with biochemical indicators of smoking, measured using saliva cotinine. The rate of under-reporting detected was 1.3%. Level of truth exposure was not related to under-reporting. This study suggests that for high school students, anti-tobacco campaigns are not an important cause of social desirability responses on surveys, and that in general under-reporting smoking is not a major source of error in school-based surveys.
Assuntos
Promoção da Saúde , Marketing , Tabagismo/prevenção & controle , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Projetos de Pesquisa/estatística & dados numéricos , Desejabilidade Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To develop, implement, and assess the efficacy of a comprehensive, evidence-based smoking cessation program for entertainment industry workers and their families. METHODS: Study participants were recruited from 5 outpatient medical clinics and a worksite setting. Tobacco use data were collected during the initial counseling visit and at 6-month follow-up. Univariate and multivariate regressions were used in analysis. RESULTS: More than 50% of participants (n=470) self-reported 7-day abstinence at follow-up. The majority of participants used combination cessation medications, with more than 50% still using at least 1 medication at 6 months. CONCLUSIONS: This evidence-based smoking cessation program using behavioral counseling and combination pharmacotherapy was successful with entertainment industry workers.
Assuntos
Comportamentos Relacionados com a Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Humanos , Comunicação não VerbalRESUMO
Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.
Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Modelos Educacionais , Saúde Pública/educação , Pesquisa/organização & administração , Humanos , Disseminação de InformaçãoRESUMO
OBJECTIVE: To determine the proportion of televised movie trailers that included images of tobacco use during 1 year and the extent of youth exposure to those trailers. DESIGN: Content analysis combined with Nielsen data measuring media exposure. All movie trailers (N = 216) shown on television from August 1, 2001, through July 31, 2002. MAIN OUTCOME MEASURES: Exposure among youth aged 12 to 17 years to televised movie trailers that included smoking imagery. RESULTS: Of the movie trailers televised during the study period, 14.4% (31 trailers) included images of tobacco use. Tobacco use was shown in 24.0% of the 23 trailers for R-rated (restricted) movies and 7.5% of the 8 trailers for PG-13- and PG-rated (parental guidance) movies. Ninety-five percent of all youth aged 12 to 17 years in the United States saw at least 1 movie trailer depicting tobacco use on television during this 1 year, and 88.8% saw at least 1 of these trailers 3 or more times. CONCLUSIONS: Nearly all US youth aged 12 to 17 years were exposed to images of tobacco use on television in the context of a movie trailer during the study period. Given the relationship between youth exposure to tobacco use in movies and smoking initiation, the public health community should work to enact policy to reduce or eliminate the influence of tobacco use in televised movie trailers.