Elizabeth W. Mitchell

Public Response to Community Mitigation Measures for Pandemic Influenza

Results from a national survey indicated that most persons would follow public health officials’ guidelines.

Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project.

OBJECTIVES We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials. METHODS At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness. RESULTS We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved. CONCLUSIONS The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies.

Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers

We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women <35 years were less likely to get the vaccine and had differing views and experiences. Despite H1N1 vaccination rates that are higher than past seasonal influenza rates, barriers like safety concerns may persist in a pandemic. Messaging from providers that encourages women to believe the vaccine is very safe and benefits their baby may be compelling. Messaging and outreach during future pandemics may require customization to increase vaccination among high-risk groups.

Pregnant and Recently Pregnant Women’s Perceptions about Influenza A Pandemic (H1N1) 2009: Implications for Public Health and Provider Communication

The objective of this study was to explore pregnant and recently pregnant women’s perceptions of influenza vaccine and antivirals during the 2009 H1N1 pandemic. We conducted 18 focus groups with pregnant and recently pregnant women in three US cities in September 2009. Participants were segmented into groups by insurance status (no or public insurance vs. private insurance), vaccine attitudes (higher vs. lower likelihood of acceptance of any vaccines, not only influenza vaccines), and parity (first child vs. other children in the home) based on information they provided on the screening questionnaire at the time of recruitment. We found that women are not well informed about influenza vaccinations and antiviral medicine and have significant concerns about taking them during pregnancy. An interest in their infant’s well-being, however, can be strong motivation to adopt preventive recommendations, including vaccination. A woman’s health care provider is a highly trusted source of information about the 2009 H1N1. Pregnant women have unique communication needs for influenza. Messages directing pregnant women to adopt public health recommendations, particularly for vaccination or prophylactic medication should include a detailed description of the benefits or lack of risk to the fetus and the safety of breastfeeding. Additionally, messages should recognize that pregnant women are taught to be selective about taking medication and provide a clear rationale for why the medicine or vaccine is necessary.

Prenatal Care Providers and Influenza Prevention and Treatment: Lessons from the Field

To better understand the knowledge, attitudes, and behaviors of providers regarding influenza infection and vaccination in pregnancy, fourteen focus groups were conducted among 92 providers in Atlanta, GA; Dallas, TX; and Portland, OR in late 2009. NVivo 8.0 was used for analysis. Most providers had no experience with pregnant women severely affected by influenza. Many perceived the 2009 H1N1 pandemic to be limited and mild. Providers knew that pregnant women should receive the 2009 H1N1 vaccine and reported plans to vaccinate more patients than the previous season. Most knew CDC guidelines for antiviral treatment and prophylaxis, but some reported hesitancy with presumptive treatment. Although awareness of influenza’s potential to cause severe illness in pregnant women was observed, providers’ experience and comfort with influenza prevention and treatment was suboptimal. Sustained efforts to educate prenatal care providers about influenza in pregnancy through trusted channels are critical.

Effective Strategies for Promoting Preconception Health— From Research to Practice

The development and publication of this supplement of the American Journal of Health Promotion have provided an opportunity to connect with new partners in the field of preconception health education, assess the current state of the science on this topic, and note gaps in research that we hope readers will consider filling. As guest editors, we appreciate our colleagues who submitted articles for consideration, the guest reviewers for their time and willingness to serve, and the journal staff for their flexibility and support throughout the process. This supplement serves as a platform to elevate contributions made in the context of preconception health promotion since 2006 as well as to issue a call to action to expand the work being done in this important arena. Six years ago, in partnership with over 35 national organizations and hundreds of partners, a select panel of experts on preconception health issued a series of 4 goals, 10 recommendations, and over 40 action steps focused on improving the health and well-being of women and men of childbearing age. The recommendations addressed a number of domains, including consumer education, clinical care, advocacy and policy, research, and public health and community interventions. A complete list of the recommendations and action steps is included in the online version of this article (http://www.cdc.gov/mmwR/preview/ mmwrhtml/rr5506a1.htm). Four national workgroups were created to move this agenda forward based on these different domains. To catalyze action in the context of consumer education and health promotion, the National Preconception Health Consumer Workgroup was formed. A main charge of the consumer workgroup continues to be to improve the knowledge, attitudes, and behaviors of men and women related to preconception health by using information that is relevant across various age groups, literacy levels, and cultural and ethnic groups. This journal issue on preconception health focuses mainly on women’s preconception health and is one example of the consumer workgroup’s efforts. In the context of women, preconception health refers to the health of a woman of childbearing age prior to or between pregnancies. The purpose of preconception care is to identify and modify biomedical, behavioral, and social risks to a woman’s health in order to maximize her health as well as that of any babies she may have in the future. Increasing awareness, knowledge, and engagement in preconception health practices among women and their partners are important objectives. Data suggest that pregnancy intentions can improve birth outcomes. Given the high infant mortality rates in the United States, particularly as compared to 28 other countries with better birth outcomes, this work is essential. Preconception health is unique as it is comprised of numerous components, including lifestyle (i.e., healthy weight, physical activity, smoking, drinking, substance use), screenings and vaccination (i.e., sexually transmitted infections, human immunodeficiency virus, rubella), and chronic disease management (i.e., diabetes, hypertension), along with family planning and exposure to teratogens, to name a few. Mass communication and clinician intervention about preconception health are challenging because of the volume of health topics within this issue and in light of the fact that half of all pregnancies are unplanned. Ultimately, a key task of the preconception health movement is to change social norms about the importance of the health of women and men and the impact it can have on their future reproductive goals. Formative research, education campaigns, and interventions on single health topics among women of childbearing age are well documented in the literature. However, less is known about how to effectively bundle and deliver a preconception health ‘‘package’’ to consumers in a way that resonates with them and motivates them to take action. One goal of this supplement is to inform this dialogue. In soliciting the content for this issue, we were particularly interested in preconception health audience research, advances in message development and dissemination strategies, and innovations in public and private partnerships, as well as insight into improving the preconception health of at-risk populations. A critical step in the process of developing and disseminating health promotion messages is to conduct audience Elizabeth W. Mitchell, PhD, is with the National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities, Prevention Research Branch, National, Atlanta, Georgia. Sarah Verbiest, DrPH, MSW, MPH, is with the Center for Maternal and Infant Health, University of North Carolina at Chapel Hill.

Understanding Women’s Preconception Health Goals: Audience Segmentation Strategies for a Preconception Health Campaign

This article discusses the social marketing planning process and strategies used to design a preconception health campaign, Show Your Love, launched in February 2013. Developing a social marketing strategy for preconception health is a challenging endeavor, in part because preconception health represents a set of diverse behaviors and the audience for the campaign is quite large, encompassing all women of childbearing age whether they intend to become pregnant or not. The network of organizations implementing the campaign, the National Preconception Health Consumer Workgroup, required a broad audience segmentation strategy; therefore, two large audiences were selected. This commentary describes the two primary audiences selected for the campaign based on the Transtheoretical Model—intenders (those in contemplation, preparation, and action) and nonintenders (precontemplators)—and explores how levels of knowledge, motivations, the campaign product, and the campaign goals are distinct for each audience. Additionally, the authors describe potential extensions to the segmentation strategy that could offer finer grained approaches for social marketers who may be building on the Show Your Love campaign or designing other programs in this area.