Association of influenza vaccine uptake with health,access to health care,and medical mistreatment among adults from low-income neighborhoods in New Haven,CT: A classification tree analysis

ObjectiveThe aim of this study is to identify population subgroups under-vaccinated for influenza through classification tree analysis to inform interventions aimed at improving future vaccine uptake.MethodA cross-sectional community health needs assessment was conducted from 09/2012 through 11/2012 among randomly selected households in six low-income neighborhoods in New Haven, CT (N = 1300 adults, aged 18–65). Known correlates of influenza vaccine uptake plus experience of medical mistreatment were used to develop a classification tree to identify under-vaccinated population subgroupsResultsForty-five percent of respondents reported receiving the influenza vaccine. The classification tree identified healthy adults and uninsured adults at increased risk of influenza complications as subgroups with low vaccine uptake (40% and 30%, respectively). The subgroup representing insured, high-risk adults who reported experience of medical mistreatment had moderate vaccine uptake (45%). Sensitivity of the classification tree was high (83%, 95% CI = 80% to 86%), indicating a strong true positive rate using these subgroups.ConclusionResults highlight the need for renewed attention to promoting the influenza vaccination recommendation for all adults, particularly among healthy adults, uninsured, high-risk adults and insured, high-risk adults who have experienced medical mistreatment. Further research is needed to better understand how to reach these population subgroups.     

Reaching the unreached with polio vaccine and other child survival interventions through partnership with military in Angola

BackgroundGrowing conflict and insecurity played a major role in precipitating polio outbreaks in the Horn of Africa and the Middle East. In Angola, the early post-conflict situation was characterized by the presence of many inaccessible zones and districts due to insecurity and poor infrastructure. Partnership with the Angolan Army health service (AAHS) was one of the innovative strategies that the Polio Eradication Initiative (PEI) introduced into the country to support the polio vaccination campaigns in insecure and hard to reach zones.MethodsBefore embarking on creating a partnership with Angolan military it was essential to make high-level advocacy with top military decision makers to engage the leadership in the process for better and sustainable support to the strategy. The principal supports provided by the AAHS were the administration of oral polio vaccine, vitamin A, deworming agents, social mobilization, monitoring campaign quality, and surveillance. Distribution of logistics using military vehicles and helicopters to hard to reach and insecure zones was also part of the support.ResultsUsing this partnership it was possible to reach a significant number of children in insecure and hard to reach areas with polio vaccine and other child survival interventions. The military partnership also contributed in increasing the demand and addressing rejection for the polio vaccine.ConclusionMilitary is a potentially productive force that can be used for any development activities in any country. The Angolan experience has demonstrated that it is possible to form a partnership with the military for basic health intervention activities with little training and investment.     

Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age

BackgroundWomen using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. We undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age.MethodsWe searched bibliographic databases for probability surveys of women aged 16–44 years in the European Union, USA, Canada, Australia, UK or New Zealand undertaken January 1994–January 2014.ResultsEleven papers were included. Unplanned pregnancy was associated with smoking, depression, being single and sexual debut < 16 years. Abortion was associated with lack of closeness to parents, leaving home at an early age, and relationship break-up. Multiple partnerships were associated with intensity of marijuana and alcohol use, and smoking. STI diagnosis was associated with relationship break-up and younger partners. Non-use of contraception was associated with smoking, obesity, relationship status, sedentary lifestyles, fatalistic pregnancy attitudes and lower alcohol use. Condom non-use was higher (at first sex) with partners 5 + years older and lower (at last sex) in less stable partnerships.ConclusionPsychosocial variables, particularly relationship status and smoking, may help identify women in primary care for STI testing and contraception advice and supply.