Geoffrey R. Swain

Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients.

An experimental components analysis of brief HIV risk-reduction counseling based on the information-motivation-behavioral skills (IMB) model was conducted with 432 men and 193 women receiving sexually transmitted infection (STI) clinic services. Following baseline assessments, participants were randomly assigned to 1 of 4 90-min risk-reduction counseling sessions that deconstructed the IMB model within a full factorial design. Participants were followed for 9 months, with STI diagnoses monitored over 12 months. Men who received the full IMB session evidenced relatively greater use of risk-reduction behavioral skills and relatively lower rates of unprotected intercourse over 6-months follow-up and had fewer new STIs. For women, however, the motivational counseling demonstrated the most positive outcomes. Results suggest that brief single-exposure HIV prevention counseling can reduce HIV transmission risks.

County Health Rankings Relationships Between Determinant Factors and Health Outcomes

INTRODUCTION The County Health Rankings (CHR) provides data for nearly every county in the U.S. on four modifiable groups of health factors, including healthy behaviors, clinical care, physical environment, and socioeconomic conditions, and on health outcomes such as length and quality of life. The purpose of this study was to empirically estimate the strength of association between these health factors and health outcomes and to describe the performance of the CHR model factor weightings by state. METHODS Data for the current study were from the 2015 CHR. Thirty-five measures for 45 states were compiled into four health factors composite scores and one health outcomes composite score. The relative contributions of health factors to health outcomes were estimated using hierarchical linear regression modeling in March 2015. County population size; rural/urban status; and gender, race, and age distributions were included as control variables. RESULTS Overall, the relative contributions of socioeconomic factors, health behaviors, clinical care, and the physical environment to the health outcomes composite score were 47%, 34%, 16%, and 3%, respectively. Although the CHR model performed better in some states than others, these results provide broad empirical support for the CHR model and weightings. CONCLUSIONS This paper further provides a framework by which to prioritize health-related investments, and a call to action for healthcare providers and the schools that educate them. Realizing the greatest improvements in population health will require addressing the social and economic determinants of health.

Impact of Framing on Intentions to Vaccinate Daughters against HPV: A Cross-Cultural Perspective

BackgroundEffective promotion of the human papilloma virus (HPV) vaccine across ethnic/racial groups may help curtail disparities in cervical cancer rates.PurposeThis study aims to investigate mothers’ intentions to vaccinate daughters against HPV as a function of message framing (gain versus loss) across three cultural groups: Hispanic, non-Hispanic white, and non-Hispanic African-American.MethodsOne hundred fifty mothers were recruited from city department of health clinics and asked to respond to information about the HPV vaccine for their daughters. In a repeated-measures experiment, two different frames (gain and loss) were used to present the information.ResultsThe results indicated that both frames are equally effective in promoting vaccination intentions in non-Hispanic white mothers. Conversely, a loss frame message was more effective in non-Hispanic African-American and Hispanic mothers.ConclusionsInformation sharing campaigns, aimed at promoting the HPV vaccine among ethnic minority groups should be modified to not focus exclusively on the benefits of vaccination.

A comparison of HIV/AIDS knowledge and attitudes of STD clinic clients in St. Petersburg, Russia and Milwaukee, Wi, USA.

Over the last decade, Russia has experienced alarming increases in rates of HIV and other sexually transmitted diseases (STDs). Most empirically validated HIV-prevention studies have been conducted in the United States or other developed nations and it is unclear the extent to which these techniques may be useful in the different conditions found in Eastern Europe. The present study compared HIV/AIDS knowledge, attitudes toward condoms, perceived vulnerability to HIV, and attitudes towards HIV testing in samples of 400 Russian and 401 American STD clinic patients. Participants in both samples exhibited knowledge deficits. Overall, Russians had less accurate HIV transmission knowledge, fewer sources of HIV-relevant information, and lower perceived vulnerability to HIV/AIDS. In both countries, a desire to be tested for HIV was related to perceived vulnerability to the disease. American participants were more likely to indicate that they planned to be tested (or re-tested) for HIV in the future (88) relative to Russian participants (40). Americans also were more likely to have been tested in the past. Results suggest that interventions designed to work with STD clinic patients are urgently needed but that appropriate intervention strategies may differ from one country to the other, reflecting the more advanced state of the HIV epidemic in the United States vs. the emerging epidemic in Russia.

Local health department and academic partnerships: education beyond the ivy walls.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Preparedness: medical ethics versus public health ethics.

Medical ethics generally applies to individual interactions between physicians and patients. Conversely, public health ethics typically applies to interactions between an agency or institution and a community or population. Four main principles underlie medical ethics: autonomy, nonmaleficence, beneficence, and justice. By contrast, public health ethical principles address issues such as interdependence, community trust, fundamentality, and justice. In large part because of the significant community-level effects of public health issues, medical ethics are suboptimal for assessing community-level public health interventions or plans-especially in the area of emergency preparedness. To be effective, as well as ethical, public health preparedness efforts must address all of the core principles of public health ethics.

Perceived Need of a Parental Decision Aid for the HPV Vaccine: Content and Format Preferences

The human papillomavirus (HPV) is a precursor of cervical cancer. In 2006, the Federal Drug Administration licensed a vaccine to protect against four types of HPV. Three years postlicensure of the vaccine, HPV vaccination is still fraught with controversy. To date, research suggests that contrary to popular notions, parents are less concerned with controversies on moral issues and more with uncertainty regarding because long-term safety of a drug is resolved after licensure. This study was designed to understand whether mothers from diverse ethnicities perceive a need for a decision support tool. Results suggest that the design of a culturally tailored decision support tool may help guide parents through the decision-making process.

Research ArticleCounty Health Rankings: Relationships Between Determinant Factors and Health Outcomes

INTRODUCTION The County Health Rankings (CHR) provides data for nearly every county in the U.S. on four modifiable groups of health factors, including healthy behaviors, clinical care, physical environment, and socioeconomic conditions, and on health outcomes such as length and quality of life. The purpose of this study was to empirically estimate the strength of association between these health factors and health outcomes and to describe the performance of the CHR model factor weightings by state. METHODS Data for the current study were from the 2015 CHR. Thirty-five measures for 45 states were compiled into four health factors composite scores and one health outcomes composite score. The relative contributions of health factors to health outcomes were estimated using hierarchical linear regression modeling in March 2015. County population size; rural/urban status; and gender, race, and age distributions were included as control variables. RESULTS Overall, the relative contributions of socioeconomic factors, health behaviors, clinical care, and the physical environment to the health outcomes composite score were 47%, 34%, 16%, and 3%, respectively. Although the CHR model performed better in some states than others, these results provide broad empirical support for the CHR model and weightings. CONCLUSIONS This paper further provides a framework by which to prioritize health-related investments, and a call to action for healthcare providers and the schools that educate them. Realizing the greatest improvements in population health will require addressing the social and economic determinants of health.

Universal influenza vaccination recommendations: Local health department perspectives.

Modern vaccines-including influenza vaccine-provide a uniquely powerful and cost-effective way to prevent deadly communicable diseases from spreading. Unfortunately, since the last decade of the 20th century, influenza vaccine supply and distribution problems have steadily grown worse in the United States. Supply disruptions such as delayed deliveries or shortages have occurred in 5 of the last 6 years, hindering efforts to combat a disease that every year kills about 36,000 people and sends more than 200,000 to hospital. Universal influenza recommendations may be one means of resolving our nations recurring influenza vaccine supply and distribution crises.

Screening and Prevention of Sexually Transmitted Infections

Sexually transmitted infections (STIs) are common and costly, in part because they are asymptomatic and result in serious complications. Primary care clinicians can easily diagnose and effectively treat most STIs. Clinicians should screen patients for STIs based on high-risk behaviors, and consult with local public health officials to adapt national screening guidelines to local epidemiology. Clinical encounters involving STI screening are opportunities to counsel patients on risk behaviors, and vaccinate against human papillomavirus and hepatitis B. Electronic health records and mobile phone apps show promise for improving the clinical care of STIs.