The Health Belief Model in predicting healthcare workers' intention for influenza vaccine uptake in Jordan

BackgroundTheories of health behavior change are being inadequately adopted to understand the reasons behind low influenza vaccination rates among healthcare workers (HCWs). The Theory of Planned Behavior (TPB) is being used to predict intention-behavior relationship while the Health Belief Model (HBM) is being employed to predict actual behavior. The purpose of this study was to test a conceptual model based on the HBM’s constructs to predict Jordanian HCWs’ intentions for influenza vaccine uptake as an alternative to the TPB.MethodA cross-sectional questionnaire-based study was conducted in 2016 in a tertiary teaching hospital in Amman-Jordan including a convenience sample of 477 HCWs with direct patient contact. The study instrument was tested for validity and reliability. A conceptual regression model was proposed incorporating the constructs of the primary HBM with some modifications in the threat construct as well as an additional variable about explicit past vaccination behavior (in the past year and/or any previous history of influenza vaccine uptake).ResultsAlmost all the constructs of the HBM demonstrated significant differences between participants intending and those who did not intend to vaccinate against influenza. After adjusting for the confounding variables in the final conceptual regression model, past vaccination behavior (OR= 4.50, 95%Confidence Interval 3.38–6.00, P< 0.0005) and the perceived benefit scale (OR= 1.19, 95% Confidence Interval 1.11–1.28, P< 0.0005) were the only significant predictors of intentions to vaccinate against influenza in the next season.ConclusionTaking into consideration the altruistic beliefs of HCWs and their explicit past vaccination history augments the utility of the original HBM tool in predicting HCWs’ intentions to vaccinate against influenza in a way that is consistent with the predictive ability of the Theory of Planned Behavior.     

Enhanced surveillance of tetanus toxoid,reduced diphtheria toxoid,and acellular pertussis (Tdap) vaccines in pregnancy in the Vaccine Adverse Event Reporting System (VAERS), 2011–2015

BackgroundIn October 2011, the Advisory Committee on Immunization Practices (ACIP) issued updated recommendations that all pregnant women routinely receive a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine.ObjectivesWe characterized reports to the Vaccine Adverse Event Reporting System (VAERS) in pregnant women who received Tdap after this updated recommendation (2011–2015) and compared the pattern of adverse events (AEs) with the period before the updated recommendation (2005–2010).MethodsWe searched the VAERS database for reports of AEs in pregnant women who received Tdap vaccine after the routine recommendation (11/01/2011–6/30/2015) and compared it to published data before the routine Tdap recommendation (01/01/2005–06/30/2010). We conducted clinical review of reports and available medical records. The clinical pattern of reports in the post-recommendation period was compared with the pattern before the routine Tdap recommendation.ResultsWe found 392 reports of Tdap vaccination after the routine recommendation. One neonatal death but no maternal deaths were reported. No maternal or neonatal deaths were reported before the recommendation. We observed an increase in proportion of reports for stillbirths (1.5–2.8%) and injection site reactions/arm pain (4.5–11.9%) after the recommendation compared to the period before the routine recommendation for Tdap during pregnancy. We noted a decrease in reports of spontaneous abortion (16.7–1%). After the 2011 Tdap recommendation, in most reports, vaccination (79%) occurred during the third trimester compared to 4% before the 2011 Tdap recommendation. Twenty-six reports of repeat Tdap were received in VAERS; 13 did not report an AE. One medical facility accounted for 27% of all submitted reports.ConclusionsNo new or unexpected vaccine AEs were noted among pregnant women who received Tdap after routine recommendations for maternal Tdap vaccination. Changes in reporting patterns would be expected, given the broader use of Tdap in pregnant women in the third trimester.     

Higher smoking prevalence among United States adults with co-occurring affective and drug use diagnoses

IntroductionIndividuals with drug use disorders or affective disorders have higher cigarette smoking prevalence and smoking intensity and are less likely to quit than the general population. We sought to estimate the prevalence of cigarette smoking by drug use and psychiatric diagnoses and to explore to what extent a co-occurring diagnosis was associated with current smoking.MethodsData were derived from the most recent National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012–2013; n = 36,309). Cigarette smoking status was examined among those with any past-year or lifetime drug use disorders (i.e., alcohol, cannabis, opioid, cocaine) or affective disorders (i.e., mood, anxiety). Diagnoses were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-5).ResultsAdjusting for sociodemographic characteristics, those with drug use disorders (past-year AOR = 3.3, 95% CI: 3.0, 3.6; lifetime AOR = 3.2, 95% CI: 3.0, 3.5) and those with affective disorders (past-year AOR = 1.7; 95%CI: 1.5, 1.8, lifetime AOR = 1.3, 95% CI: 1.2; 1.4), had higher odds of current cigarette smoking compared to individuals with no diagnosis. The odds of current cigarette smoking was significantly higher in individuals with both drug use disorders and affective disorders compared to those with either a drug use or affective disorder or no disorder (past-year AOR = 5.1; 95% CI: 4.3, 5.9, lifetime AOR = 4.3; 95% CI: 3.8, 4.7).ConclusionsApproximately 30% of the population had a past-year drug use or affective disorder, 17% of whom report both. The combination of both diagnoses produced a 1.5 to 3-fold higher correlation with smoking than either alone.     

Curbing the tobacco epidemic: Employing behavioral strategies or rearranging the deckchairs on the Titanic?

Henningfield brilliantly dissected the deadly comprehensive tactics of the tobacco industry but Food and Drug Administration and WHO strategies against the tobacco epidemic must be questioned. The Food and Drug Administration has the authority to regulate tobacco production (2009 Tobacco Control Act) but fails to ban menthol and reduce cigarettes nicotine content. As little has changed, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to 12% by 2010 in the US will be attained by 2030. The monitoring of the WHO Framework Convention on Tobacco Control (WHO FCTC) is passive, even when governments repeatedly violate the Article 5.3 of the Convention, which specifically requires protecting public policy from tobacco industry interference. Since 2004, the year after the adoption of the Convention, the prevalence of daily smoking has leveled off and the 2012 annualized rate of change in prevalence of daily smoking was almost null. This contrasts with a 2% annual decrease in the prevalence of daily smoking from 1980 to 2004. The tobacco endgame needs acts, not bureaucracies. Two counties have been moving forward, Brazil has banned menthol and Australia has implemented plain packaging.