Vaccine Hesitancy in Parents: Role of Social Networks, Social Media, and Parental Autonomy

Introduction. Vaccine hesitancy in parents is a composite of multiple dimensions such as confidence, complacency, and convenience. A large proportion of parents can be deemed vaccine hesitant, meaning that their vaccine behaviors can range from delaying vaccines, skipping select vaccines, to refusal of all vaccinations. Furthermore, parental vaccine uptake rates and patterns can reflect their decisions based on the balance of parental autonomy versus protecting population health. The current manuscript uses Social Network Theory to explain some of the external influences on parental autonomy. Social networks, both private and public, play a role in vaccine decision making through providing information and support for parents in their choices. This influence, in turn, is mediated by parents’ health literacy and local vaccination policy. Discussion. Social media is an important type of public network that has an outsized influence on vaccine hesitancy. The rhetoric used on anti-vaccine websites often denigrates scientific evidence while at the same time endorsing poor-quality evidence that supports the anti-vaccine point of view. The websites continually propose new hypotheses of how vaccines can cause harm when studies refute their previous assertions, censor critics, and attack people with opposing viewpoints. The contentious nature of vaccine hesitancy based on beliefs, opinions, and attitudes needs a solution much deeper than simply providing factual knowledge or pointing people to reliable websites. Recommendations. Public health practitioners and researchers should try segmenting audiences, targeting private and public social networks, and then testing which persuasive strategies towards vaccinations appeal to different community groups.

Commentary: Who is Remembering Local Public Health? The Forgotten Pandemic Worker

As the COVID-19 pandemic rages, there is no end in sight to the stress induced on the public health workforce. It is clear over the last 18+ months that the woeful underfunding of public health efforts across the US impacted the speed and agility with which public health experts have tackled the pandemic. This has led to the emotional decimation of public health workers who have plowed forward, even as they have worked long and stressful hours while also being politically and physically vilified. If this continues, what does the future of our public health workforce look like?

Predictors of Health Insurance Literacy Among University Employees

Background: Health insurance literacy (HIL) is “the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about plans, select the best plan for their own or their families’ financial and health circumstances and use the plan once enrolled”. Many Americans have low health insurance literacy, but this concept has not been studied to the same extent as general health literacy. Objective: The purpose of this study was to explore predictors of health insurance literacy among employees of a large public institution of higher education in the South-Atlantic. Design: This single-setting cross-sectional study employed an online, anonymous survey administered to approximately 3,000 employees at a large university in the USA after open enrollment in state health insurance. The survey measured demographics and included a validated measure of health insurance literacy. Results: Using several multivariate regression models, results (N=480) indicated high overall HIL. Subscale means were highest for likelihood of using insurance plans proactively and confidence comparing insurance plans but were lower for confidence choosing and using insurance plans, indicating lack of understanding that may lead to poor insurance coverage choice and use. Employment category, income, race, and age also predicted HIL. Discussion: Based on the results, there is an opportunity for employers to provide information about health insurance policies. Health promotion programs should also seek to increase HIL through educational programs and policies to ensure both adequate coverage and ability to use health insurance in such a way that it promotes and protects one’s health.

Characterization of Physical Activity and Sedentary Time Across College Years

The purpose of this study was to characterize physical activity (PA), sedentary time (ST), and body composition across collegiate years. 143 participants (Age: 19.7±1.2yrs) were measured using a modified four compartment model and the Long International Physical Activity Questionnaire. Two-way ANOVAs and Pearson Correlations were utilized. For males, PA and ST were significant across class year. Vigorous PA and ST were significantly correlated to %body fat (p=0.001 and p=0.036, respectively) and fat mass (p=0.002 and p=0.023, respectively) suggesting vigorous PA and reduced ST may be associated with improved body composition. Males expressed differences in PA and ST across class year while females were stable.

Association of Cancer Worry and Physical Activity Behaviors in Adults without Cancer

Background: Cancer worry has been conceptualized as a potential motivator to engage in cancer preventative behaviors like cancer screening, genetic testing, or smoking cessation. It is currently unknown if these findings extend to the domain of physical activity, as physical activity has been associated with decreased cancer risk. Objective: To examine if the association between cancer worry and other health behaviors will extend to physical activity in a sample of adults not diagnosed with cancer. Methods: Data are drawn from the NCI's 2017 Health Information National Trends Survey (HINTS) Iteration 5 Cycle 1 (N = 2,706) dataset, a nationally representative survey of adults in the United States. A KruskalWallis-H test was conducted to determine whether physical activity duration (i.e., daily minutes) differed between cancer worry levels with a post hoc Dunn's multiple comparison test to compare the differences between mean ranks. Results: A Kruskal-Wallis-H test showed statistically significant differences in PA duration (i.e., daily minutes) between groups that differed in their level of cancer worry. PA in minutes on a typical day was significantly lower in those who reported not at all, moderate, and extreme worry about developing cancer compared to those who reported slightly and somewhat worried. Conclusion: Contrary to our expectations, our results suggest that higher cancer worry levels are paradoxically associated with less PA. This study's results are significant in that they add to the breadth of literature linking cancer worry to health behaviors and may be used to inform future health promotion interventions.

Health Education Specialists’ Attitudes toward End-of-Life Education And Planning

This study explored attitudinal differences of Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES) toward providing end-of-life education. From a national CHES/MCHES list, we stratified health education specialists by geographic location then randomly selected participants. In our sample (N = 373), older individuals, those who cared for terminally ill persons/families, and those who had death and dying education had more positive attitudes toward providing end-of-life education. We offer three approaches to address the advance care-planning crisis: 1) providing additional end-of-life education to medical professionals, 2) assisting medical schools with incorporating experiential learning, and 3) community outreach.

Brief Motivational Interviewing Training for Outreach in School Health Programming

This study assessed a brief 6-week motivational interviewing (MI) training program for extension field specialists (EFS) involved in supporting a statewide school wellness initiative called SWITCH. A total of 16EFS were instructed in MI principles to support the programming and half (n = 8) volunteered to participate in the hybrid (online and in-person) MI training program. Phone calls between EFS and school staff involved in SWITCH were recorded and coded using the Motivational Interviewing Treatment Integrity (MITI) system to capture data on utilization of MI principles. Differences in MI utilization between the trained (n=8) and untrained (n=8) EFS were evaluated using Cohen’s d effect sizes. Results revealed large differences for technical global scores (d=1.5) and moderate effect sizes for relational global components (d=0.76) between the two groups. This naturalistic, quasi-experimental study indicates a brief MI training protocol is effective for teaching the spirit and relational components of MI to EFS.

Provision of Advanced Care Planning Information by Public Institutions of Higher Education in the U.S.

This study explored how many, and in what form, U.S. public institutions of higher education (IHE; n=1,642) provide information regarding advance care planning (ACP), advance care directives (ACDs), and end-of-life (EOL) care on their official websites. Chi-square analysis was used to examine relationships between the availability of information and three institutional characteristics (size, type, and medical degree offering). Results show that most public IHE (92.1%, n=1,513) do not provide any information regarding ACDs or ACP on their websites. Overall, large, four-year institutions that offer medical degrees were significantly more likely to provide ACP and ACD information on their official websites.

Addressing the Opioid Epidemic with a K-12 Drug Prevention Curriculum, Website and Toolkit

Opioid overdose has become a large public health crisis with devastating consequences, particularly for young people. Programs have started to address the impact of prevention and education in approaching the issue, but many lack focus on helping students prevent drug misuse by practicing the skills students need to avoid or reduce risky health behaviors. The purpose of this manuscript is to introduce readers to the process of developing skills-based K - 12 Opioid/Rx Use educational lessons. Procedures: The educational lessons were developed using data-driven practice for the following age level clusters; K-2, 3-5, 6-8, and 9-12. All lessons contain active learning strategies and include a resource bank such that any teacher, administrator, or school personnel can select and deliver a lesson using the online interface.

Advanced Care Planning Information and Public Institutions of Higher Education

This review was designed to identify behavior change techniques used to enhance pelvic floor muscle exercise (PFME) interventions to prevent and treat urinary incontinence among women. A systematic search of peer-reviewed literature was conducted to identify interventions for adult women to address UI with PFME. A taxonomy of BCTs was used to code intervention content. Ten articles were retrieved. Across the ten interventions, 111 BCTs were described, and 34 unique BCTs were identified. The most frequently coded BCTs included Instruction on how to perform the behavior (BCT 4.1; n=10 studies), Demonstration of the behavior (BCT 6.1; n=9 studies), Behavioral practice/rehearsal (BCT 8.1; n=9), and Credible source (BCT 9.1; n=9 studies). Specific findings indicate that a core intervention of four techniques is commonly used, and supported by complementary techniques from the categories feedback and monitoring as well as goals and planning.