Scope of Knowledge About Zika Among Women in US–Mexico Border Communities

Maternal Zika virus infection (ZIKV) has serious health consequences for unborn offspring. Knowledge about prevention is critical to reducing risk, yet what women in the high-risk US–Mexico border region know about protecting themselves and their babies from ZIKV is mostly unknown. This study aimed to assess knowledge of ZIKV among pregnant and inter-conception women and to identify sources of information that might address knowledge gaps. Clients in five federally-funded, border region Healthy Start programs (N?=?326) were interviewed in late 2016 about their knowledge of ZIKV prevention methods and whether they believed themselves or their babies to be at risk. Sources of information about ZIKV and demographic characteristics were also measured. Chi square tests identified important associations between variables; adjusted odds ratios (AOR) and 95% confidence intervals for knowledge and beliefs were calculated. Among the 305 women aware of ZIKV, 69.5% could name two ways to prevent infection. Only 16.1% of women named using condoms or abstaining from sex as a prevention method. While 75.3% heard about ZIKV first from TV/radio, just 9.5% found the information helpful. Women who received helpful information from health care providers had greater odds of knowing two prevention methods (AOR?=?2.0; 1.1–3.7), when to test for ZIKV (AOR?=?5.2; 2.1–13.2), and how long to delay pregnancy after infection in a male partner (AOR?=?1.9; 1.1–3.2). Those who said web-based and social media sources were helpful had greater odds of knowing when to test for ZIKV (AOR?=?2.8; 1.3–6.3). Results can inform messaging for safe pregnancy and ZIKV prevention.     

Young Women’s Knowledge,Attitudes, and Behaviors Related to Long-Acting Reversible Contraceptives

BackgroundThe present study explored 18- to 30-year-old women’s knowledge and perceptions of the long-acting, reversible contraceptives (LARCs) Mirena and Implanon in a Midwestern state in the United States.MethodsA telephone survey (n = 543) and 18 focus groups (n = 106) were conducted with women across a rural, Midwestern state. During the telephone survey, women answered questions related to their awareness and knowledge of two LARCs. During the focus groups, participants were asked to respond to questions related to their awareness, knowledge, behaviors, and perceptions of LARCs.ResultsIn the telephone survey, half of the women reported hearing of Mirena. Only 8.0% of women had heard of Implanon. In the focus groups, most women reported knowing little about LARCs. Benefits associated with other contraceptives were not associated with LARCs. Women were concerned about potential side effects and problems stemming from using a contraceptive that is new to them.ConclusionIncreased use of LARCs would likely reduce the unintended pregnancy rate. As described, although some young women are aware of these long-term contraceptive options, there is still a need to educate women on their availability, use, and potential benefit.     

Effectiveness of the 2011–12 Influenza Vaccine: Data from US Military Dependents and US-Mexico Border Civilians

Objective

To assess effectiveness of the influenza vaccine among US military dependents and US-Mexico Border populations during the 2011–12 influenza season.

Introduction

As a result of antigenic drift of the influenza viruses, the composition of the influenza vaccine is updated yearly to match circulating strains. Consequently, there is need to assess the effectiveness of the influenza vaccine (VE) on a yearly basis. Ongoing febrile respiratory illness (FRI) surveillance captures data and specimens that are leveraged to estimate influenza VE on an annual basis.

Methods

Data from ongoing FRI surveillance at US Military and US-Mexico border clinics were used to estimate VE. We conducted a case–control study between weeks 3 and 17 of the 2011–12 influenza season. Specimens were collected from individuals meeting FRI case definition (fever ≥ 100.0 F with either cough or sore throat). Cases were laboratory confirmed influenza infection and controls were negative for influenza. Interviewer-administered questionnaires collected information on patient demographics and clinical factors and vaccination status. Logistic regression was used to calculate the crude and adjusted odds ratios (OR) and VE was computed as (1-OR) × 100%. Vaccine protection was assumed to begin 14 days post-vaccination.

Results

A total of 155 influenza positive cases and 429 influenza negative controls were included in the analysis - 72 cases were influenza A(H3N2), 38 cases were influenza A(H1N1), and 45 cases were influenza B. Overall adjusted VE against laboratory-confirmed influenza was 46% (95% CI, 19–64%); unadjusted was 39% (95% CI, 11–58%). Influenza subtype analyses revealed moderate protection against A/H3 and A/H1 and lower protection against B. Lowest estimated VE was seen in older individuals, age 65 and older.

Conclusions

Influenza vaccination was moderately protective against laboratory confirmed influenza in this population. Continued surveillance is important in monitoring the effectiveness of the influenza vaccine.     

Cervical Cancer Screening in the US–Mexico Border Region: A Binational Analysis

Cervical cancer mortality is high along the US–Mexico border. We describe the prevalence of a recent Papanicolaou screening test (Pap) among US and Mexican border women. We analyzed 2006 cross-sectional data from Mexico’s National Survey of Health and Nutrition and the US Behavioral Risk Factor Surveillance System. Women aged 20–77 years in 44 US border counties (n = 1,724) and 80 Mexican border municipios (n = 1,454) were studied. We computed weighted proportions for a Pap within the past year by age, education, employment, marital status, health insurance, health status, risk behaviors, and ethnicity and adjusted prevalence ratios (APR) for the US, Mexico, and the region overall. Sixty-five percent (95 %CI 60.3–68.6) of US women and 32 % (95 %CI 28.7–35.2) of Mexican women had a recent Pap. US residence (APR = 2.01, 95 %CI 1.74–2.33), marriage (APR = 1.31, 95 %CI 1.17–1.47) and insurance (APR = 1.38, 95 %CI 1.22–1.56) were positively associated with a Pap test. Among US women, insurance and marriage were associated (APR = 1.21, 95 %CI 1.05–1.38 and 1.33, 95 %CI 1.10–1.61, respectively), and women aged 20–34 years were about 25 % more likely to have received a test than older women. Insurance and marriage were also positively associated with Pap testing among Mexican women (APR = 1.39, 95 %CI 1.17–1.64 and 1.50; 95 %CI 1.23–1.82, respectively), as were lower levels of education (≤8th grade or 9th–12th grade versus some college) (APR = 1.74; 95 %CI 1.21–2.52 and 1.60; 95 %CI 1.03–2.49, respectively). Marriage and insurance were associated with a recent Pap test on both sides of the border. Binational insurance coverage increases and/or cost reductions might bolster testing among unmarried and uninsured women, leading to earlier cervical cancer diagnosis and potentially lower mortality.     

Breast Cancer Prevention Knowledge, Attitudes, and Behaviors Among College Women and Mother–Daughter Communication

Although breast cancer prevention targets mostly women ages 40 and older, little is known about breast cancer prevention for young women and mother’s advice. The purpose of this study was to examine breast cancer prevention knowledge, attitudes, and behaviors among college women and mother–daughter communication. Hispanic and non-Hispanic students at a southwestern university completed a breast cancer prevention survey with items for mother’s advice, breast self-awareness and risk reduction knowledge, self-efficacy, susceptibility, family history, provider breast self-exam (BSE) recommendation, peer norms, BSE practice, and demographics. An openended item was also used to elicit types of mother’s advice. Logistic regression was used to assess predictors for receiving mother’s advice for breast cancer prevention and BSE practice. Self-reported data using a survey were obtained from 546 college women with a mean age of 23.3 (SD = 7.75). Nearly 36 % received mothers’ advice and 55 % conducted BSE. Predictors for receiving mother’s advice were age, self-efficacy, and family history of breast cancer. Predictors for BSE practice were mother’s advice, age, self-efficacy, and provider BSE recommendation. Family history of breast cancer and knowledge were not significant predictors for BSE practice. Findings support the need for clinicians, community health educators, and mothers to provide breast cancer prevention education targeting college women.     

Establishing a Binational Student-Run Free-Clinic in Tijuana,Mexico: A Model for US–Mexico Border States

In 2011, a bi-national student-run free clinic for the underserved, known as “Health Frontiers in Tijuana” (HFiT), was created in Tijuana, Mexico. Students and faculty from one Mexican and one US medical school staff the clinic and attend patients on Saturdays. Students from both medical schools enroll in a didactic course during the quarter/semester that they attend the free clinic. The course addresses clinical, ethical, cultural, population-specific issues and the structure, financing and delivery of medical care in Mexico. The clinic implements an electronic medical record and is developing telemedicine for consulting on complex cases. Despite challenges related to sustaining adequate funding, this program may be replicated in other border communities.     

Risk Factors for Severe Influenza A–Related Pneumonia in Adult Cohort,Mexico, 2013–14

During the 2013–14 influenza season, we assessed characteristics of 102 adults with suspected influenza pneumonia in a hospital in Mexico; most were unvaccinated. More comorbidities and severity of illness were found than for patients admitted during the 2009–10 influenza pandemic. Vaccination policies should focus on risk factors.     

Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US–Mexico Border Region

Objectives. We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States.Methods. We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US–Mexico Study on Alcohol and Related Conditions, 2011–2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations.Results. Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies.Conclusions. People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.During the past 25 years, epidemiological research in the United States has consistently found that alcohol and drug use and disorders of use among Mexican immigrants and Mexican Americans tend to be associated with increasing immersion into US society.1–8 More recently, transnational effects of migration on substance use in both the United States and Mexico have become apparent. First, in a comparable Mexican population without any migration experience as a reference group, it was found that Mexican immigrants in the United States and US-born persons of Mexican origin exhibited increased risk of alcohol and drug use.9,10 Second, it was also shown that, in Mexico, substance use of return migrants and families of migrants was also affected by this immigration flow.11,12 These findings suggest a transnational pattern whereby Mexican immigrants increase their use of substances while in the United States by means of early age at immigration and years living in the United States,13–15 and transmit, directly and indirectly, substance use behaviors back into Mexico. This conceptualization is intriguing, but the data provided so far are limited to studies either in the United States or in Mexico. The only previous binational study9 collected data from a wide range of communities in Mexico and the United States and evidence with greater geographic detail is needed to corroborate and extend our understanding.The border regions of Mexico and the United States are particularly important as settings in which the cultures of the 2 countries come into contact and as transit points for migrants moving in both directions. The border region is also filled with contrasts. The US counties are much richer than the Mexican municipalities, but some of the US counties in the border area are among the poorest in the United States. At the same time, some of the Mexican border municipalities are among the richest when compared with national Mexican averages. Research in this region has documented the impact that US nativity, age at immigration, and years living in the United States have in increasing alcohol and drug use and disorders among those of Mexican ancestry living in the US borderland.8,16–18 On the Mexican side of the border, research generally documented higher prevalence rates for substance use and disorders of use when compared with cities off the border or against national averages.19Previous research nevertheless lacks a binational approach—with a common framework and risk factors. Our project, the first simultaneous study that includes the dynamic experiences of contemporary Mexican immigration on both sides of the border, has started to shed new insights on the alleged differences of alcohol and drug use and disorders of use in the US–Mexico border area.20,21 Our main hypothesis is that with early age of immigration, and increasing time and contact with the US culture, alcohol use, drug use, alcohol use disorders (AUDs) and symptoms of drug use disorder (DUD) will increase along a continuum of immigration experiences in this transnational population. Our main goal is to report the prevalence of, and risk factors for, the occurrence of alcohol use, drug use, AUD, and symptoms of DUD for this population of Mexican ancestry. A second goal is to put these new results in the context of previous findings and to examine the consistency of risk estimates for substance use across the full spectrum of the Mexican immigrant groups.     

HPV Vaccine–Related Knowledge,Beliefs, Acceptability,and Uptake Among Latinas Who Prefer English and Those Who Prefer Spanish

Latinas compose almost 10% of the U.S. population and suffer the highest incidence of and one of the highest mortality rates from cervical cancer. Human papillomavirus (HPV) vaccination can prevent most HPV infections that cause more than 90% of cervical cancer. Unfortunately, limited knowledge and low rates of HPV vaccination persist among Latinas. The current study compared awareness, knowledge, beliefs, acceptability, uptake, and 3-dose series completion of HPV vaccination between Latinas who prefer English (EPL) and those who prefer Spanish (SPL), ages 18–62, living in Southern California. (The 3-dose series completion was based on HPV vaccine completion guidelines at the time of the study. HPV vaccination guidelines do change over time to improve coverage.) More EPL (n = 57) than SPL (n = 150) reported significantly (a) more HPV vaccine awareness and more knowledge of where to access the vaccine and additional vaccine information and (b) greater endorsement of vaccine effectiveness and safety (p < .05). Regardless of language preference, Latinas reporting knowledge of where to access the vaccine and additional information endorsed greater acceptability of the vaccine and more favorable beliefs regarding vaccine safety and effectiveness (p < .05). In multivariate analyses, language and income predicted the outcomes of knowledge regarding accessing the vaccine and additional information. Only 15.6% of all eligible Latinas (n = 45) initiated the HPV vaccine, with 8.9% completion. Interventions seeking to improve HPV vaccination should address linguistic and socioecological differences within Latinas to enhance effectiveness.     

Migrants in Transit: The Importance of Monitoring HIV Risk Among Migrant Flows at the Mexico–US Border

We conducted a probability-based survey of migrant flows traveling across the Mexico–US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.Previous research indicates that Mexican labor migrants in the United States are at increased risk for HIV infection1–3 and may be a bridge population for increasing rates of HIV/AIDS in rural Mexico.4–6 The behavioral ecological model posits that health behaviors are influenced by a hierarchy of factors, including individual characteristics, features of the proximal context, and broader structural factors.7 The proximal context involves the physical and social conditions in which individuals live, work, learn, and play. The broader environment comprises political, social, and economic structures and cultural factors. Bidirectional influences exist across factors at the individual, contextual, and structural level, with interventions at the structural level having the most far-reaching public health impact.7 Mexican migrants tend to be male and young, have low levels of educational attainment, and report limited HIV prevention knowledge and condom use.8,9 Increased risk for HIV in migrants may result from the interplay between these individual characteristics and the broader contextual and structural factors in migration between Mexico and the United States.10Migration is a complex and multistage process involving 5 phases: predeparture, transit, destination, interception, and return.11 Different constellations of contextual and structural factors may influence risk behaviors for HIV infection among migrants at each of these stages. Research on HIV risk among migrants must cover the different phases involved in the migration process and identify risks as well as prevention and treatment opportunities associated with each of them.12 Much of our knowledge regarding HIV prevalence and behavioral risk factors among Mexican migrants has emanated from surveys conducted among receiving communities in the United States 1^,2^,13–15 and sending communities in Mexico.16^,17 These studies have covered the destination and return phases of migration.Mexican migrants in the United States (i.e., the destination) are exposed to contexts that may heighten their HIV risk. HIV prevalence rates are higher in the United States than in Mexico,18 increasing the probability of coming into contact with the virus. Furthermore, many migrants live in environments characterized by unbalanced gender composition (i.e., male overrepresentation) and limited family- and community-based social behavioral controls.19 They experience loneliness, geographic isolation, social exclusion,20 fear,21 poor living and working conditions, and limited access to health care, including access to HIV testing and other prevention services.2^,16^,19^,21–24 All these factors coalesce to increase the probability of risk behaviors for HIV, such as alcohol and drug use, sex with sex workers, and unprotected sex practices.9,10 Surveys in Mexican sending communities have documented higher rates of behavioral risk factors, such as a higher number of sexual partners and illicit drug use, but also increased rates of condom use, knowledge of HIV transmission, and HIV testing among return migrants, compared to nonmigrants in the same communities.16,25Little research has examined HIV risk among Mexican migrants during the predeparture, transit, and interception phases of the migration process. The same factors that may push migrants away from their sending communities, such as poverty,26 violence,27 and gender power unbalances,28,29 are also structural factors that may increase their HIV risk even before they leave these communities.30 The transit phase is defined as the period when migrants are between their place of origin and their destination.11 For most Mexican migrants, the northern border of Mexico is an intermediate point in their trajectory between the 2 countries. Northbound unauthorized and deported migrants may spend time in this transit location making arrangements to enter or reenter the United States. This region has been described as at heightened risk for infectious diseases such as HIV to occur and is characterized by “an economically disadvantaged population” and “a nexus for drug use, prostitution, and mobility.”^31(p428)Research with injecting drug users and sex workers in Mexican border cities has provided critical evidence of migration as a structural risk factor for HIV infection and substance use as well as the prevention needs of these high-risk groups.14,32 These studies have offered some insights into the potential risks among migrants in this intermediate migration context. Finally, migrants apprehended while trying to enter or after reaching the destination communities (i.e., interception phase) are at a particularly critical stage. Detention in immigration centers or prisons can have detrimental effects on migrants’ health.11 Interception may also be a marker of higher social vulnerability, as migrants who have less economic and social resources are more likely to experience this migration phase. A recent survey found higher rates of HIV infection and behavioral risk factors among deported Mexican migrants in Tijuana, Mexico, than among the US and Mexico populations.33 In general, knowledge concerning HIV risk among migrants at the 5 migration phases is fragmented, and the heterogeneity of sampling and data collection methodologies that previous studies have used creates challenges for comparing data on the different phases.There are an estimated 12 million Mexican migrants in the United States.34 Although not all migrants go through all 5 migration phases (some may never be intercepted, some may settle permanently in the region of destination and never return), many Mexican migrants go through 2 or more of these phases in their lifetime. Data on Mexican migration patterns indicate that circular migration (i.e., traveling back and forth between Mexico and the United States) is relatively common among Mexican migrants.34,35 About 29% of Mexican migrants are estimated to engage in circular migration,36 and 50% of undocumented migrants leave the United States within the first year of immigration.37 Proximity, social and political conditions, transportation costs, and cultural identity make Mexicans more likely to return to their home country than are migrants from other countries. Although the strengthening and stricter enforcement of border policies has lowered this trend in recent years, the incentives to emigrate out of Mexico have also increased.38 These circular migration patterns between Mexico and the United States result in sizable migrant flows traveling across the Mexican border.It is estimated that each year more than 600 000 Mexican migrants arrive in the United States, approximately 400 000 Mexican migrants return from the United States, and approximately 400 000 Mexican migrants are deported to Mexico.39,40 The same individual may arrive, return, or be deported more than once. In 2012, the net rate of Mexicans departing Mexico (mostly to the United States) and entering Mexico (most of whom are return migrants) was 41.9 and 14.3 per 1000, respectively.41 An estimated 300 000 Mexican migrants were admitted to a detention facility and repatriated by US immigration authorities,42 and an additional 266 000 unauthorized Mexican migrants were apprehended at the Mexican border.40 The volume and mix of migrants traveling across the Mexico–US border makes this region an important setting for binational monitoring of the mobile populations’ health. Such monitoring can further our understanding of HIV infection levels and of behavioral and environmental factors that contribute to HIV infection among Mexican migrants representing different phases and contexts of the migration process. Ongoing surveillance of this region can also reveal changes in HIV infection and behavioral risk factors among migrants on the move and inform the need for interventions to reduce HIV risk among Mexican migrants in sending, receiving, and intermediate communities.We estimated and compared the levels of HIV infection, risk behaviors, and contextual factors associated with different migration phases, using data from a survey of migrant flows who traveled across the Mexico–US border region and represented the different phases and geographic contexts of migration between Mexico and the United States.     

Flu and Finances: Influenza Outbreaks and Loan Defaults in US Cities, 2004–2012

Objectives. We examined the association between influenza outbreaks in 83 metropolitan areas and credit card and mortgage defaults, as measured in quarterly zip code–level credit data over the period of 2004 to 2012.Methods. We used ordinary least squares, fixed effects, and 2-stage least squares instrumental variables regression strategies to examine the relationship between influenza-related Google searches and 30-, 60-, and 90-day credit card and mortgage delinquency rates.Results. We found that a proxy for influenza outbreaks is associated with a small but statistically significant increase in credit card and mortgage default rates, net of other factors. These effects are largest for 90-day defaults, suggesting that influenza outbreaks have a disproportionate impact on vulnerable borrowers who are already behind on their payments.Conclusions. Overall, it appears there is a relationship between exogenous health shocks (such as influenza) and credit default. The results suggest that consumer finances could benefit from policies that aim to reduce the financial shocks of illness, particularly for vulnerable borrowers.Seasonal influenza is a viral airborne disease that generally spreads each fall and winter, causing an estimated 1.5 million people to get sick and 200 000 to be hospitalized in a typical year in the United States.1,2 Symptoms can range from mild and hardly distinguishable from a common cold to severe and life-threatening. Influenza accounts for at least 500 000 deaths in the United States in the past 3 decades.3For employed individuals, influenza can make attending work difficult, because of either personal illness or caring for sick household members. This generates significant costs to employers and employees. Estimates from 2007 suggest that annual influenza outbreaks lead to $16.3 billion in lost productivity and wages, and $10.4 billion in medical costs,4 although these costs vary considerably across place.5Although there is a robust literature on the economic costs of influenza, we know little about how such unexpected health shocks are associated with other aspects of the economy, such as loan defaults. We built on existing knowledge of the economic costs of influenza by examining how influenza outbreaks influence credit card and mortgage default rates in US cities.In the wake of the Great Recession, loan defaults have increased, with negative financial consequences for families.6 For loans due on a monthly basis, such as mortgages and credit cards, past-due balances and late fees accumulate each month. Three missed payments (90-day delinquent) is a signal of a loan at high risk for failure and in most states triggers legal collections processes.7In the microeconomic literature, illness is seen as a shock—an unexpected event—that can affect household income and expenses. If the shock results in a disruption to income, households will respond with shifts in consumption and expenditure patterns.8 We contend that influenza, as a health shock, has the potential to trigger loan default by constraining a family’s budget because of personal illness or caretaking burdens. Influenza may also trigger inattention to household financial management and a lack of planning for future bill payments.9–11 This may be especially problematic for borrowers who are already behind on their payments, whom we define as vulnerable borrowers. For these borrowers, who also tend to be economically vulnerable and disadvantaged in other ways,12,13 an influenza outbreak could increase the likelihood of further missed payments. A recent study supports this notion, and shows that economically vulnerable households are more likely to borrow and borrow more in the event of a health shock than less vulnerable households.14 However, this study did not examine credit default.A growing literature examines the complex and potentially multidirectional relationship between health and default.15–19 Most research examines whether defaults influence health,15,19,20 and less examines how health may have an impact on default risk.21 However, a key problem inherent in this literature is that health status is endogenous, and it is difficult if not impossible to disentangle processes of causation, selection, and reverse causation with survey data.Our interest in influenza provides us with a unique opportunity to improve causal estimates of health shocks on default. Influenza occurs to varying degrees in every city and year in the United States, and the intensity of the outbreak is an ostensibly exogenous health shock for communities. Thus, influenza outbreaks provide a natural experiment in which we use variation in influenza severity across time and place to identify the effects of a particular health shock on default. Specifically, we ask whether influenza outbreaks in US metropolitan statistical areas (MSAs) are associated with defaults from the first quarter (March) of 2004 (Q1 2004) to the second quarter (June) of 2012 (Q2 2012).We make 3 contributions with this study. First, we extended the literature on the economic costs of influenza. Second, we contributed to the literature on health shocks and default by providing a stronger test of the potential causal impacts of health shocks on loan default. Third, we considered whether effects vary across types of default, including 30-, 60-, and 90-day defaults. We predicted that influenza may have the greatest effect on borrowers who are already in default, such that the association between influenza and default should be stronger for borrowers who are farther behind.     

Poison or Prevention? Understanding the Linkages between Vaccine-Negative Individuals’ Knowledge Deficiency,Motivations, and Active Communication Behaviors

The last few decades have seen growing concerns among parents regarding the safety of childhood vaccines, arguably leading to the rise of the anti-vaccine movement. This study is an effort to understand situational and cross-situational factors that influence individuals’ negative attitudes toward vaccines, referred to as vaccine negativity. In doing so, this study elucidated how situational and cross-situational factors influence vaccine negativity. Specifically, this study tested how knowledge deficiency, or acceptance of scientifically inaccurate data about vaccines, and institutional trust influenced negative attitudes toward vaccines. Using the situational theory of problem solving as the theoretical framework, this study also identified and tested a knowledge–attitude–motivation–behavior framework of vaccine negative individuals’ cognitions and behaviors about the issue.     

Acute Viral Hepatitis in the United States–Mexico Border Region: Data from the Border Infectious Disease Surveillance (BIDS) Project, 2000–2009

Little is known about the characteristics of acute viral hepatitis cases in the United States (US)–Mexico border region. We analyzed characteristics of acute viral hepatitis cases collected from the Border Infectious Disease Surveillance Project from January 2000–December 2009. Over the study period, 1,437 acute hepatitis A, 311 acute hepatitis B, and 362 acute hepatitis C cases were reported from 5 Mexico and 2 US sites. Mexican hepatitis A cases most frequently reported close personal contact with a known case, whereas, US cases most often reported cross-border travel. Injection drug use was common among Mexican and US acute hepatitis B and C cases. Cross-border travel during the incubation period was common among acute viral hepatitis cases in both countries. Assiduous adherence to vaccination and prevention guidelines in the US is needed and strategic implementation of hepatitis vaccination and prevention programs south of the border should be considered.