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Objectives: The aim of the study was to assess the association between sociodemographic characteristics and attitudes according to health belief model (HBM) attributes with the intention to vaccinate children in cases of non-mandatory vaccination to support informed decisions in planned revision of our vaccination policy., Study Design: This is a cross-sectional study carried out on a random sample of 3,854 women with young children in Slovenia., Methods: The participants' attitudes were grouped within six HBM attributes (perceived susceptibility, severity, benefits, barriers, clue to action and self-efficacy). Possible associations between the intention to vaccinate children in cases of non-mandatory vaccination and sociodemographic characteristics or attitudinal attributes according to HBM were explored in univariate analyses by calculating odds ratios (ORs) with 95% confidence interval (CI) estimates., Results: Just more than half (56.2%; 95% CI: 53.8-58.5%) of the women reported on their intention to vaccinate their children in the case of non-mandatory vaccination, and 23.4% (95% CI: 21.4-25.5%) were undecided. There were no significant sociodemographic predictor variables in relation to this intention. Those who perceived higher susceptibility to vaccine-preventable diseases or the benefits of vaccination were more likely to intend to vaccinate in the case of non-mandatory vaccination (OR = 5.70; 95% CI: 4.64-7.00) and (OR = 7.62; 95% CI: 5.96-9.76). Perceived barriers to vaccinate (fear of side-effects or lack of comprehensive information from physicians) and parents not getting enough useful information in general as a clue to action were significant predictors of an intention not to vaccinate., Conclusions: Our results show that a mandatory vaccination policy is an important factor in ensuring high levels of vaccination coverage in Slovenia. In future, more comprehensive communication activities focused on vaccine-preventable diseases and the benefits and safety of vaccination (for the education of parents and their healthcare providers) are needed to diminish the reliance on a mandatory vaccination policy., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs., Methods: We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098)., Findings: Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26-32] vs 352 days [256-unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75-90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83-96), occurs during the first 50 days in the community., Interpretation: Opioid-dependent individuals in CDDCs are significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders., Funding: The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, Australian National Health & Medical Research Council, National Institute of Mental Health, and the University of Malaya-Malaysian Ministry of Higher Education High Impact Research Grant., (Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.)

Background: Alcohol abuse among freshmen university students is a major public health issue with associated costs to individuals and the society of substantial morbidity, high-risk negative behaviors (e.g., blackouts, rape, suicide, and violence), and mortality. This longitudinal study compared the effectiveness of a brief motivational intervention (MI) in decreasing alcohol consumption and related consequences among mandated students and voluntary students. Readiness to change drinking behaviors was compared between the groups., Methods: Eligible participants (710 voluntary and 190 mandated, N = 900) received MI at baseline and again at 2 weeks with boosters at 3, 6, and 12 months. Repeated-measures analysis of variance was used to compare the two groups., Results: Alcohol use and related consequences in both groups decreased significantly between baseline and 12 months. At baseline, a significantly larger percent of students from the mandated group than the voluntary group were in the action stage of change (52.1% vs. 27.5%), and a significantly smaller percentage of mandated students were in the precontemplation stage (p < .0001)., Discussion: MI effects were sustained over 12 months. Alcohol consumption and related consequences decreased significantly among the freshmen who were mandated to attend the program as well as among students who volunteered to participate in the study. The findings support the importance of advanced practice nurses conducting MI as an intervention with college students., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This study addresses the issue of valence framing effect in the context of immunization, a preventive behavior often addressed by the equation of benefit versus risk. The authors examined how framing (support vs. oppose) the issue of HPV vaccination in Israel's immunization routine affects attitudes regarding vaccine regulations. The study also examined issue involvement as a moderator of valence framing effect. The results demonstrate that participants in the positive framing condition tended to express greater support for voluntary immunization than participants in the negative framing condition (77.5% and 48.5%, respectively). Among those who supported the mandatory HPV immunization policy, the negative framing condition was more prominent than the positive condition (51.5% and 22.5%, respectively). The analysis of interaction between valence framing and issue involvement showed that the latter tends to moderate the direct effect of framing on attitudes towards vaccination. Findings indicate that even attitudes towards such consequential preventive behaviors as vaccination could be affected by different framing of the issue, especially for those who are less involved. Implications of predilection for freedom of choice regarding vaccination are also discussed.

Background: The objective of this study was to assess the effectiveness of the Australian co-regulatory system in limiting children's exposure to unhealthy television food advertising by measuring compliance with mandatory and voluntary regulations. An audit was conducted on food and beverage television advertisements broadcast in five major Australian cities during children's programming time from 1st September 2010 to 31st October 2010. The data were assessed against mandatory and voluntary advertising regulations, the information contained in an industry report of breaches, and the Australian Guide to Healthy Eating., Results: During the two months of data collection there were a total of 951 breaches of the combined regulations. This included 619 breaches of the mandatory regulations (CTS) and 332 breaches of the voluntary regulations (RCMI and QSRI). Almost 83% of all food and beverages advertised during children's programming times were for foods classified as 'Extras' in the Australian Guide to Healthy Eating. There were also breaches in relation to the amount of advertising repetition and the use of promotional appeals such as premium offers, competitions, and endorsements by popular children's characters. The self-regulatory systems were found to have flaws in their reporting and there were errors in the Australian Food and Grocery Council's compliance report., Conclusions: This audit suggests that current advertising regulations are inadequate. Regulations need to be closely monitored and more tightly enforced to protect children from advertisements for unhealthy foods.

A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status.

Background: Mandatory vaccination has contributed to the success of immunisation programmes but voluntary vaccination allows people to be responsible for their own health. There are benefits from both policies and the arguments between them remain subject to debate within and without the scientific community, both nationally and internationally. The aim of this study is to assess the opinions of those who actually work in the Vaccination Service., Methods: The survey was carried out using a self-administered standardised anonymous questionnaire given to all of the Vaccination Service employees in the Apulia Region., Results: Of 302 completed questionnaire replies, 4.4% stated that mandatory vaccination should be abandoned now, 21.2% that it should be phased out, and 74.4% that it should be retained., Conclusion: An educational program should be set up to explain to Vaccination staff the value and worth of voluntary compared to mandatory vaccination and why high vaccination rates do not have to depend on compulsion.

The web of overlapping requirements, standards, recommendations and policies governing the conduct of clinical trials highlights the intense scrutiny of the ethical, data quality and public access issues raised by human trials that are conducted to demonstrate the safety and efficacy of medical products marketed in the United States. One relatively recent development is the requirement that sponsors register and make public information about their clinical trials and clinical trial results. These clinical trial registration requirements illustrate the interests of patients, providers and researchers in increased visibility, transparency and accessibility of clinical trials and the data they generate. These requirements, however, pose regulatory, logistical and practical hurdles for companies sponsoring clinical trials of drugs and medical devices.

The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5% (n = 171) were mandated to treatment through a pretrial release-to-treatment program. Results indicated a significant interaction between ASPD and CM status, such that patients with ASPD who were voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete time survival analyses to predict days until dropout, using Cox proportional hazards regression, indicated similar findings, with patients with ASPD who were voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining patients with ASPD, as well as the role of ASPD in predicting treatment dropout for individuals who are in treatment voluntarily. Implications, including the potential value of the early implementation of specialized interventions aimed at improving adherence for patients with ASPD who are receiving treatment voluntarily, are discussed.

Previous studies have suggested that voluntary reform of the delivery of primary care services is more likely to occur in affluent areas. Health system reforms that include voluntary participation of GPs may therefore lead to a two-tier service in terms of access to and utilisation of medical services. New primary care organisations in Scotland (local health care co-operatives) were introduced in 1999. These are groups of general practices and membership was voluntary. The aim of this study is to examine whether the voluntary nature of membership was likely to exacerbate or reduce inequalities in the provision of primary care services. Logistic regression analysis was used to identify differences in population, practice, and GP characteristics between general practices that have joined a co-operative and those that have not. The results indicated that practices located in deprived areas and covering populations with high levels of morbidity were more likely to join a co-operative. High workload decreased the probability of membership. General practices that found it difficult to obtain access to local authority residential care homes were more likely to join a co-operative. The number of fee claims for minor surgery sessions per whole-time equivalent GP increased the probability of membership. There is therefore some evidence indicating that general practices located in areas of high need are more likely to join a co-operative. This suggests that voluntary participation in these new primary care organisations may reduce rather than exacerbate inequalities in the provision of primary care.

The Lifestyle Management Class (LMC) was evaluated as a universal and targeted alcohol prevention program among voluntary and mandated college students. The relative efficacy of peer- and professional-led group interventions was also tested in this randomized, controlled design. LMC participants showed decreases in driving after drinking relative to control participants. Changes in heavy drinking varied as a function of treatment condition, readiness to change, and gender, with a trend toward larger decreases among voluntary LMC participants high in readiness to change and a comparable though nonsignificant advantage for male LMC participants in the mandated sample. The LMC was comparably effective for mandated and voluntary students, with no clear advantage for peer- or professional-led groups., (Copyright 2004 APA.)

Research has demonstrated that participation in an interlock program significantly reduces the likelihood of subsequent driving while intoxicated (DWI) convictions at least so long as the interlock device is installed in the vehicle. Despite the growing number of jurisdictions that allow interlock programs and the demonstrated success of these programs, the proportion of DWI offenders who actually have the device installed is minimal. In an effort to increase the proportion of offenders using interlocks, some jurisdictions require offenders to install an interlock as a condition of license reinstatement whereas others merely offer offenders a reduction in the period of hard suspension if they voluntarily participate in an interlock program. The objective of the present study was to determine the extent to which voluntary interlock participants are more or less successful in terms of subsequent recidivism than those for whom interlock program participation has been mandated. The issue was addressed using data from the interlock program in Alberta, Canada, which provides for both mandatory and voluntary participation. The recidivism experience of voluntary and mandatory interlock participants was examined both during and after the period of interlock installation. Cox regression revealed that, after controlling for (or equating) the number of prior DWI offenses, the survival rates of DWI offenders who were ordered to participate in the interlock program did not differ from those of voluntary participants. These results suggest that further use of mandatory interlock programs should be just as successful as voluntary programs when offenders share characteristics with those studied in Alberta.

This article briefly describes the historical conditions in the origin and development of outpatient commitment that framed the discourse on its merits and the empirical studies on its outcomes. It divides those empirical studies into two sets on the basis of the questions addressed and critically reviews them. The review pays particular attention to the latest studies that were able to randomize subjects to experimental and control conditions and that were able to offer enhanced services. Finally, this article presents issues not addressed by the empirical studies on outpatient commitment but that need to be addressed in order to understand the choice of using the law to force persons with mental illness to comply with treatment and receive services in the community.

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist.

Deborah Mathieu's proposal for state intervention in the lives of pregnant substance abusers in order to prevent serious harm to their future children sparked a lively debate in this journal. The present discussion characterizes the three main arguments offered against her proposal as (a) the "uncertainty principle"--the inability to predict which fetuses will be affected, (b) the "father factor"--gender bias with respect to prenatal damage, and (c) "critical periods"--the vulnerability of the embryo/fetus at different times of pregnancy. Each of these arguments is examined in the specific context of fetal alcohol syndrome (FAS). Since the birth of a child with FAS is a virtual certainty if a woman has previously given birth to a child with FAS, since no father has ever sired a child with FAS unless his spouse is an alcoholic, and since the most damaging effects are those associated with exposure throughout and especially late in pregnancy, none of the arguments offered against Mathieu's proposal are relevant in this particularly narrow set of circumstances. While Mathieu's proposal seems pertinent in this situation, her proposal would be even more effective if modified as suggested here.

Should vaccination of physicians against hepatitis B, as well as subsequent screening for the virus, be mandatory? The CMA says no: the voluntary route is the way to go. But Health Canada disagrees. Its new guidelines call for mandatory vaccination and subsequent screening of exposure-prone physicians for the virus.

Most countries promote mass immunisation programmes. The varying policy details raise a raft of philosophical issues. I have two broad aims in this paper. First, I hope to begin to remedy a rather curious philosophical neglect of immunisation. With this in mind, I take a broad approach to the topic hoping to introduce rather than settle a range of philosophical issues. My second aim has two aspects: I argue that the states should have pro-immunisation policies, and I advance a view of the subsequent and more specific question as to which sorts of pro-immunisation policies they should prefer. I use the immunisation policies of the United States and New Zealand to frame my discussion of these substantive questions. Immunisation is effectively compulsory in the United States. New Zealand, by contrast, requires evidence not of immunisation but of immunisation status upon school enrolment: New Zealand's policy effectively makes immunisation choice compulsory. I argue that, as between the pro-immunisation policies of the United States and New Zealand, the latter should be preferred. Though the threshold question as to whether states should have pro-immunisation policies should be answered affirmatively, the move to compulsory immunisation cannot be justified.

The published literature tends to find that the outcome of mandatory treatment for alcohol dependence is no worse than that for 'voluntary' treatment. Supervised disulfiram has been shown to improve outcome in Court-referred patients. When offenders take treatment offered as part of probation or a deferred sentence, they choose to do so, rather than face a penalty. It is not a 'free' choice in the usual sense, but the outcome can be beneficial to the offender as well as to society and this helps to justify its use. Coping and social skills therapy have value, as probably have antipsychotic and antidepressant drugs in some cases. Supervised disulfiram has a role supported by controlled studies.

A cocaine vaccine, currently under investigation by several laboratories, would be an innovative and exciting means of treating and preventing cocaine addiction. However, an approved vaccine will raise at least two major areas of concern. (1) Loss of privacy: cocaine antibodies might be used as a marker to identify, penalize, and stigmatize vaccinated individuals. (2) Selection for vaccination: should immunization be voluntary or compelled: should immunization be restricted to addicts, to those at risk of addiction, or should it be universal; should immunization be used in children? I propose to analogize cocaine addiction to an infectious disease which poses a major public health problem. This approach can provide an ethical and legal foundation on which we may begin to formulate a societal approach to the use of the cocaine vaccine.

The paper advances a consequence-based argument in support of the American Medical Association's policy that a physician may not ethically refuse to treat a person with HIV solely because the patient is seropositive. A limited number of alternative arguments, both in support of and in opposition to this policy are also considered, but are found wanting. The paper then concludes with a discussion of some of the other obstacles to quality health care that persons with HIV must often confront.

Evidence that families requested to permit organ donation refuse half the time has led to proposals for mandated choice. Under mandated choice, a person's donation wishes would be collected and retrieved at death, and requests to families would be avoided. There are both ethical and logistic problems with mandated choice. The view of the family should be respected in organ requests, even when patient wishes are known. Public sentiment against overriding family wishes could cause low rates of pro-donation registration. Caregivers have usually refused to take organs when families oppose donation. Logistic issues with mandated choice include the cost and complexity of maintaining a national database on donors and the enforcement of registration. No such database of adults currently exists, even for tax purposes. Two states that have mandated choice programs through departments of motor vehicles report relatively low number of pro-donation registrants compared with nondonors or undecided persons. Public education and voluntary donor identification hold more potential to increase donation.

Throughout the 1980s and into the 1990s, HIV prevention has been closely associated with the protection of individual human rights. Traditional public health measures such as compulsory testing and isolation have largely been rejected as ineffective in public health terms and inappropriate in the context of human rights protection. HIV prevention has been based instead chiefly on elective measures --information, education, counselling, and voluntary testing. In the past five years there have been important clinical, epidemiological, and social developments in the AIDS epidemic. These changes, combined with a growing recognition of possible weaknesses inherent in a strictly voluntarist approach to HIV prevention, may herald a new approach to AIDS control which places more weight on social responsibility in the context of HIV prevention.

The resurgence of tuberculosis confronts policy-makers with difficult legal and ethical questions about the proper use of state power and resources to protect public health. This chapter examines the implications of expanded use of invasive or coercive measures-including directly observed therapy, involuntary detention of noncompliant patients, and forced administration of medications--designed to reduce the risk of tuberculosis transmission and to ensure that those with TB are fully treated. These measures focus attention on the limitations of government power and obligation and on the delicate balance between the demands of civil liberty and the demands of public health.

The reappearance of tuberculosis as a serious public health threat points up the fallacy of the widely held assumption that medical science had conquered the communicable diseases that were once leading causes of morbidity and mortality. In devising a strategy to prevent the spread of TB, public policymakers must adapt traditional TB control measures to reflect the current problem. Such a strategy can and should include the appropriate use of governmental coercion to compel observance of public health TB control measures. Public health approaches to control of human immunodeficiency virus, with their emphasis on the voluntary cooperation of those infected and at high risk for infection, are not a model for effective TB control. Additional resources, while needed, will not alone enable public health agencies to bring TB and other communicable diseases under control. In the present debate over health care reform, little attention has been paid to the importance of public health agencies in protecting the public health. The resurgence of TB is a warning of the consequences of neglecting public health agencies and ignoring the socioeconomic problems that underlie it and other communicable diseases.

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the categories of mandated reporters. I develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect.