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BACKGROUND: Racial/ethnic minorities face stark inequalities in lung cancer incidence, treatment, survival, and mortality compared with U.S. born non-Hispanic Whites. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is effective at reducing lung cancer mortality in high-risk current and former smokers and is recommended by the U.S. Preventive Services Task Force (USPSTF). This study sought to assess primary care providers’ (PCPs’) knowledge, attitudes, beliefs, and practice related to LCS and the recent USPSTF guidelines in five high risk immigrant communities in New York City. METHODS: We surveyed 83 eligible PCPs between December 2016 and January 2018 through surveys sent by mail, email, and fax, administered by phone or in-person. The survey included questions about providers’ clinical practice, knowledge, attitudes and beliefs related to LCS and the USPSTF guidelines. Information about patient demographics, PCPs’ training background and practice type were also collected. RESULTS: Sixty-seven percent of respondents reported that they did not have established guidelines for LCS at their practice and 52% expressed that “vague” screening criteria influenced their referral processes for LCS. Barriers to LCS with LDCT included concerns that LDCT is not covered by insurance, patients’ fears of screening results, and patients’ concerns regarding radiation exposure. DISCUSSION: Targeted educational interventions for both PCPs and patients may increase access to recommended LCS, especially for populations at disproportionate risk for lung cancer.

BACKGROUND: Hospitalizations for complications related to opioid use disorder (OUD) are increasing. Hospitalists care for most hospitalized patients in the United States, yet little is known about their attitudes, beliefs, and clinical practices regarding OUD-related care. METHODS: We distributed an online survey to hospitalists in the United States to measure how access to addiction specialists affected attitudes and beliefs regarding hospital-based OUD care, OUD screening practices, naloxone prescribing, and buprenorphine initiation. RESULTS: Among 262 respondents, 67.9% (n=178) reported having access to addiction specialists. While 84.5% (n=221) reported often or always caring for patients with OUD, 48.2% (n=126) rarely or never screened for OUD, 57.1% (n=149) rarely or never prescribed or recommended naloxone as harm reduction, and 88.9% (n=233) rarely or never initiated buprenorphine. In multivariable analyses, compared to hospitalists without access to addiction specialists, hospitalist with access to addiction specialists were more likely to feel supported to screen and refer patients to treatment (aOR = 4.4, 95% CI 2.1 – 9.1; ρ

Healthcare clinical decision makers’ (CDMs) attitudes, beliefs, and biases can negatively contribute to both clinical conversations and subsequent inequitable management decisions in persistent mus...

Background Acupuncture during pregnancy and the perinatal period aims to increase normal birth and enhance a woman’s birth experience by decreasing intervention and adverse birth outcomes. Acupuncture in Australian maternity services has not been well accepted, and there is limited research evidence as to whether women are supportive of acupuncture treatment. Objective The aims of this study were to understand childbearing aged women’s attitudes, beliefs and practices to using acupuncture during pregnancy and the perinatal period, and possible acceptance of a midwife providing acupuncture treatments. Design A descriptive/explorative quantitative methodology was used to gather data from childbearing aged women using an online survey. Statistical analysis was used for quantitative data and content analysis for the free-text responses. Recruitment of respondents took place in 2017 via Facebook birth and parenting groups and pages. Findings Of 304 respondents, 68% (n = 206) had used acupuncture, and of these, 68% (n = 140) used acupuncture for concerns during pregnancy and the perinatal period. The majority of respondents indicated they would consider acupuncture during pregnancy and the perinatal period (89%) and 62% indicated they would have a midwife provide a treatment. The free-text responses provided mostly positive comments on the outcomes and satisfaction of acupuncture treatments (84% n = 199). Conclusion The majority of respondents would consider acupuncture during pregnancy and the perinatal period, were positive to trying acupuncture for various concerns, and were positive towards a midwife providing treatments. These findings raise awareness of women’s desire for the choice of an acupuncture treatment during pregnancy and the perinatal period.

Vaccine coverage for maternal vaccines is suboptimal; only about half of pregnant women received influenza and Tdap vaccines in 2018. We explored knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines among pregnant women. Between June 2017 and July 2018, we surveyed 2196 pregnant women recruited from geographically and socio-demographically diverse prenatal care practices in Georgia and Colorado (56% response rate). Fifty-six percent of pregnant women intended to receive both influenza and Tdap vaccines during pregnancy and 68% intended to vaccinate their baby with all recommended vaccines on time. Attitudinal constructs associated with intention to vaccinate include confidence in vaccine safety (ORs: 16–38) and efficacy (ORs: 4–19), perceived risk of vaccine-preventable diseases (ORs: 2–6), social norms (ORs: 4–10), and trust in sources of vaccine information. Women pregnant with their first child were less likely than women who had prior children to intend to vaccinate themselves and their children, more likely to be unsure about their intentions to receive both maternal and infant vaccines, and less likely to report feeling they had enough knowledge or information about vaccines and vaccine safety (p < .01). This demonstrates an opportunity for vaccine education to increase vaccine confidence and informed decision-making, especially among first-time pregnant women.

Skin cancers are the most common malignancies diagnosed worldwide. In Gulf Cooperation Council (GCC) countries, skin cancer remains a significant health burden. Multiple studies have attempted to elucidate patient knowledge and attitudes regarding skin cancer risks and behavioral interventions to reduce risks. A systematic literature search of relevant articles was conducted in PubMed, ScienceDirect, and the Saudi Digital Library databases. A narrative analysis of relevant study results was conducted. A total of 12 studies were reviewed across GCC. These studies revealed common themes among GCC populations. Many study participants were aware that excess sun exposure represents a threat to health and increases cancer risk. Several studies reported sun exposure, with a mean of 19.13 h per week. More studies reported patients engaging in lower or no sunscreen use rather than regular sunscreen use. There are discrepancies in the understanding of sun exposure risk and risk mitigation practices among the study populations. Skin cancer poses a significant burden to patients in GCC countries and improved patient education will enhance population health.

Background Negative health-care provider attitudes are a contributing factor to the myriad health disparities faced by people with intellectual disabilities (ID). Nursing comprises the nation's largest health-care profession, yet no integrative review on this topic is found. Purpose To organize findings of studies exploring nurses' attitudes, beliefs, and emotions about caring for adults with ID, to identify areas for future research, and to discuss recommendations for nursing practice. Methods Whittemore and Knafl's integrative review method guided this study. Results Twenty studies were conducted across eight countries, dichotomized according to mainstream or ID nursing specialty, and were mostly setting-specific. Common themes included: "knowing the person," "paternalism/infantilization," "communication challenges," "organizational support," "time," and "ID-specific knowledge and experience." Mainstream nurses' emotions were primarily negative, whereas ID nurses experienced conflicting positive and negative emotions. Antecedents and effects of nurse attitudes and emotions on the quality of care of adults with ID were identified. Conclusions/implications Despite recent increased research on this topic across multiple countries, further research is needed. The findings of this study will aid the development of strategies to address negative nurse attitudes toward caring for adults with ID and act as a foundation for future research beyond the descriptive stage.

Introduction In the USA, nearly one in three people will experience herpes zoster (HZ) in their lifetime. Underserved communities may be at even higher risk due to several factors, including access to healthcare, education, and co-morbid conditions. The purpose of this study was to investigate current knowledge, attitudes, beliefs and practices (KABP) relative to HZ and HZ vaccines in a large urban city. Methods A cross-sectional KABP survey was conducted via in-person interview among 381 participants aged ≥ 50 years in Detroit, MI, USA, from June to August 2018. Survey results were stratified into two groups [

Background Advances in research suggest the possibility of improving routine clinical care for preeclampsia using screening (predictive) and diagnostic tests. The views of women should be incorporated into the way in which such tests are used. Therefore, we explored the views of women with experience of preeclampsia and other hypertensive disorders in pregnancy (HDPs) about predictive and diagnostic tests, treatment risks, and expectant management. Method Eight hundred and seven women with experience of preeclampsia or other HDPs completed an online questionnaire. These women were participants in the Preeclampsia Registry (USA). The questionnaire contained 22 items to elicit women’s views about predictive tests (n = 8); diagnostic tests (n = 5); treatment risks (n = 7), and expectant management (n = 2). An optional text box allowed participants to add qualitative open-ended comments. Levels of agreement with the statements were reported descriptively for the sample as a whole, and a preliminary investigation of the role of lived experience in shaping women’s views was conducted by comparing subgroups within the sample based on time of HDP delivery (preterm/term). The qualitative data provided in the optional text box was analysed using inductive thematic analysis to examine participants’ responses. Results Women generally favored predictive and diagnostic testing, although not because they would opt for termination of pregnancy. Participants generally disagreed that taking daily low-dose aspirin (LDA) would make them nervous, with disagreement significantly higher in the preterm delivery subgroup. A high proportion of participants, especially in the preterm delivery subgroup, would take LDA throughout pregnancy. The majority of participants would be more worried about the possibility of preeclampsia than about the risks of treatments to their health (60%), and that proportion was significantly higher in the preterm delivery subgroup. There were no differences between subgroups in the views expressed about expectant management, although opinion was divided in both groups. Overall, most participants opted to put the baby’s interests first. Conclusion Women with experience of hypertensive disorders were enthusiastic about improved predictive and diagnostic tests. However, varied views about treatment options and expectant management suggest the need for a shared decision-making tool to enable healthcare professionals to support pregnant women’s decision-making to maximize the utility of these tests and interventions.

Introduction: The response to a health threat, such as acute coronary syndrome symptoms (ACS), is determined by the patient\'s ability to identify the symptoms, establish the relationship with the disease and respond appropriately. This important ability of people with type 2 diabetes, who are at risk of having this syndrome, can be better understood by assessing the knowledge, attitudes, and beliefs concerning the ACS and the response to it. Objectives: To evaluate the perceived knowledge, attitudes, and beliefs of type 2 diabetes clients toward acute coronary syndrome; to explore the association between the measures of the perceived acute coronary syndrome and their sociodemographic and clinical characteristics; and to explore the correlations between the measures of the perceived acute coronary syndrome and the measures of anxiety and depression symptoms. Methods: The study was carried out at Linden, Guyana, with 60 type 2 diabetes clients using a sociodemographic and clinical data questionnaire, the Hospital Anxiety and Depression Scale questionnaire, and Acute Coronary-Response Index. All questionnaires were completed by the researcher during a face to face interview with each client. Descriptive analyses were performed for all variables. The Mann-Whitney test was used to compare the scores of the ACS Response Index subscales and the HADS anxiety and depression symptoms with sex, age, time since diabetes diagnosis and body mass index (not overweight or overweight). Comparisons were made between the measures of the ACS - Response Index subscales and educational levels (primary, secondary, university and professional) using the Kruskal-Wallis test for multiple comparisons. The Spearman\'s correlation coefficient was used to calculate the correlations between the scores of the ACS - Response Index subscales and the anxiety and depression symptoms. The significance level for all the tests that were conducted was set at 0.05. Results: The total mean score of the Knowledge subscale was 9.12 (S.D.=3.4). Two participants had more than 70% of the correct answers. The number of participants who recognized the main symptoms of acute coronary syndrome varied from 27.1% to 49.2%. The total mean score of the Attitudes subscale was 11.2 (S.D.=3.5) and for beliefs 21.3 (S.D.=4.5). Clients with university level had better knowledge when compared to clients with clients who had primary level (p=0.043). Strong and positive correlation was found between knowledge and symptoms of depression, but not significant (r=0.63; p=0.67). The correlation between Attitudes and Beliefs was negative and weak and not significant. The correlation between symptoms of anxiety and beliefs was statically significant, negative, and strong (r=-0.53; p

Objectives: To identify attitudes, beliefs and barriers to adherence to the hyposodic diet in patients with heart failure and associated factors. Methods: Cross-sectional study with 41 individuals. The Dietary Sodium Restriction Questionnaire was used. Fisher's test was applied for analysis. Results: Attitudes were based on family and professional relationships; in the beliefs, it was highlighted to believe in the diet to improve health. As barriers, insufficient efforts were found to change the diet and taste of low salt foods. It was associated with adherence among the components factors such as: income, perception of cardiac improvement with the diet, family history of renal and heart failure and family adherence to the diet. Conclusions: The identified attitudes and beliefs refer, respectively, to social relationships and trust in the diet to improve health status. The barriers were: insufficient effort to modify the diet and food palatability. Economic, family and clinical factors were associated with hyposodic adherence. RESUMEN Objetivos: Identificar actitudes, creencias y barreras para la adhesión a la dieta de hiposodio en pacientes con insuficiencia cardíaca y factores asociados. Métodos: Estudio transversal con 41 individuos. Se utilizó el Cuestionario de restricción de sodio en la dieta. La prueba de Fisher se aplicó para el análisis. Resultados: Las actitudes se basaron en las relaciones familiares y profesionales; En las creencias, se destacó creer en la dieta para mejorar la salud. Como barreras, se encontraron esfuerzos insuficientes para cambiar la dieta y el sabor de los alimentos bajos en sal. Se asoció con la adherencia entre los factores componentes como: ingresos, percepción de mejoría cardíaca con la dieta, antecedentes familiares de insuficiencia renal y cardíaca y adherencia familiar a la dieta. Conclusiones: Las actitudes y creencias identificadas se refieren, respectivamente, a las relaciones sociales y la confianza en la dieta para mejorar el estado de salud. Las barreras fueron: esfuerzo insuficiente para modificar la dieta y la palatabilidad de los alimentos. Factores económicos, familiares y clínicos se asociaron con baja adherencia al sodio. RESUMO Objetivos: Identificar atitudes, crenças e barreiras para a adesão à dieta hipossódica em pacientes com Insuficiência Cardíaca e fatores associados. Métodos: Estudo transversal com 41 indivíduos. Utilizou-se o Questionário de Restrição de Sódio na Dieta. Para análise aplicou-se o teste de Fisher. Resultados: As atitudes basearam-se nas relações familiares e com profissionais; nas crenças destacou-se acreditar na dieta para melhoria da saúde. Como barreiras, encontrou-se empenho insuficiente para mudança dietética e sabor dos alimentos com pouco sal. Associou-se à adesão entre os componentes fatores como: renda, percepção da melhora cardíaca com a dieta, histórico familiar de insuficiência renal e cardíaca e adesão familiar à dieta. Conclusões: As atitudes e crenças identificadas referem-se, respectivamente, às relações sociais e à confiança na dieta para melhorar a condição de saúde. As barreiras foram: empenho insuficiente em modificar a dieta e a palatabilidade alimentar. Fatores econômicos, familiares e clínicos estiveram associados à adesão hipossódica.

In this study the relationship between treatment outcomes and antiretroviral treatment (ART) recipients’ knowledge, attitudes and beliefs towards HIV/AIDS was analysed. The study employed the positivist paradigm, guided by the Health Belief Model in explaining the intricate relationship between disease, sick-role behaviour and the expected outcome of treatment. The target population comprised ART recipients at Mthatha, South Africa. This study made use of a purposive sample of 112 participants, inclusive of male and female adult recipients. The respondents in this study raised a number of positive and negative issues. The results of the study revealed a significant relationship between ART recipients’ knowledge of HIV/AIDS treatment, their view that taking HIV drugs is a waste of time, and the recipients’ results of HIV/AIDS treatment. This implies that a significant difference exists between those who have a better CD4, the same CD4, and a worse CD4, based on their knowledge about taking ARVs. The study did not establish a significant relationship between treatment outcomes and some variables of recipients’ attitudes towards HIV/AIDS, which means there is no difference between the recipients based on all the attitude variables. While a significant difference exists among recipients of different treatment outcomes (CD4 counts), based on their belief that “Having HIV is a death sentence,” no significant difference was found among recipients of different CD4 counts based on their beliefs, such as: whether HIV treatment prolongs life; if a traditional healer can heal HIV; if prayer can heal HIV; that HIV has serious consequences on health; and that practising preventive actions can reduce HIV transmission.

Background: The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy. Methods: In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy. Results: Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden. Conclusions: Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.

17 Background: While the National Lung Screening Trial (NLST) has shown a relative reduction in mortality from lung cancer with the application of the United States Preventative Services Task Force (USPSTF) guidelines for the use of Low-Dose Computed Tomography (LDCT) in a select high risk population, many studies have shown that the rate of screening has been below the national average in minority population. Furthermore, lung cancer mortality still appears to be disproportionately higher amongst minority populations. With this study, we aim to evaluate the attitudes, beliefs and values towards lung cancer screening with LDCT in a predominantly Black and Hispanic population in our outpatient clinic. Methods: A survey was conducted over a 3-month period in our outpatient department at an urban inner-city safety net hospital. We included high risk smokers, aged 50 to 80 years who reported no evidence of symptoms. The survey consisted of 20 questions; these included utilizing the Health Belief Model to assess beliefs on perceived susceptibility, severity, benefits and barriers to screening, questions exploring fears of cancer screening and questions assessing overall willingness to undergo lung cancer screening with LDCT. We also included a question on the willingness of participants to engage in educational sessions with regards to lung cancer screening and risk reduction. Results were collected and analyzed via univariate logistic regression model to compare patient populations. Results: 67 patients participated in our survey. 62% were Black, 34% were Hispanic and 4% were Asian/Pacific Islanders. The mean age of our population was 64.5 years and they had an average of 27.2 pack-years of smoking. Issues related to insurance coverage and co-pay were identified as the most significant concern with regards to the unwillingness to undergo screening (p < 0.05). Other concerns identified were the fear of a positive screening result, fear of radiation exposure and lack of understanding of the association with smoking history and lung cancer (p = 0.12). All participants responded yes to being open to be educated on reducing their risk of lung cancer (p < 0.05). Conclusions: While many factors still exist with regards to lung cancer screening in minority populations, the cost of medical care, fear of radiation exposure and anxiety were identified as potential barriers to willingness to screen. Structured educational programs were identified as a possible measure that can be implemented to address these factors, with the potential to increase the willingness to undergo screening in a high risk minority population.

Non-invasive prenatal testing (NIPT) for a panel of 25 single gene disorders became available in Western Australia in 2020 and potentially may be able to test for panels of hundreds of disorders as is the case with reproductive carrier screening. How this information would be used by parents in a population screening model is unknown. We used a phenomenological approach to explore retrospectively whether mothers of children with single gene or chromosomal disorders would have wanted to know about their child’s genetic diagnosis prior to delivery. Themes were identified such as having a child with a de novo disorder and effect on pregnancy outcomes in hypothetical situations, impact on family function, the diagnostic journey and personal growth. These themes related to both the concept of expanded NIPT (ENIPT) and the situation of having a child with a de novo genetic disorder that could now hypothetically be detected through ENIPT. Opinions were divided about whether participants would have wanted to know about their affected child’s condition, indicating any expanded NIPT testing panels would need to be offered in the context of an appropriate comprehensive counselling program. How this would be provided on a population screening level and the role of genetic counselling needs further exploration.

Providing antenatal and postnatal support for women who drink alcohol in pregnancy is only possible if those at risk can be identified. However, screening will only be helpful if women feel comfortable with the method used. We conducted a survey of pregnant women and their partners to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. Pregnant women and their partners attending antenatal clinics in North-East England were asked to complete a short survey regarding their alcohol consumption in pregnancy, their beliefs about safe levels of alcohol in pregnancy and whether they would be happy to have their blood or their baby’s meconium analysed for alcohol biomarkers. The data were summarised using descriptive statistics and thematic analysis. A total of 171 pregnant women and 41 partners participated. Of the pregnant women, 153 (89.5%) felt women should abstain from alcohol consumption, although only 70 (40.9%) reported not drinking in pregnancy. Of 96 women who reported drinking in pregnancy and reported when they stopped, all but six (6.3%) stopped drinking when they found out they were pregnant. Of women and partners who recorded an answer, 177 (87.2%) said they would consent to blood biomarker analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear.

Despite well-established links between exposure to ultraviolet radiation (UVR) and skin cancer, UVR-based tanning behaviors persist among college students. Understanding tanning motivations, perceptions, barriers, and demographic characteristics of this population is critical to modifying these behaviors, but is limited by variability in study design, sample size, and outcomes measured in the current literature. To help clarify the tanning behaviors of this population and provide a concise reference for future studies, this review examines existing reports to determine the comparability of tanning behaviors across multiple U.S. college populations. A systematic review of the literature was performed in July 2016 to identify studies investigating tanning behaviors among U.S. college students. Twenty-three studies met inclusion criteria. High rates of indoor tanning (IT) and outdoor tanning (OT) were found among college students. Key motivators included appearance, emotion, health perceptions, and the influence of parents, peers, and the media. Misconceptions regarding skin protection, low rates of sun protective behaviors, and tanning dependence were barriers against safe UVR exposure. Understudied demographic factors may account for variance in observed tanning behaviors, emphasizing the need for standardization efforts to consistently identify trends associated with geographical region, age, year in college, and sex. The findings presented in this review reaffirm that college students are at high risk for tanning-associated skin cancer, emphasizing the critical need for effective, targeted interventions. Improved interventions will reduce the burden of skin cancer within this group, ultimately contributing to longer, healthier lives.

Purpose The current study examined mothers' knowledge, beliefs, attitudes, and intention to socially integrate children with Down syndrome (DS) in the family, with children without disabilities and school system. Design and Methods A questionnaire based on a descriptive, cross-sectional design was administered to Jewish and Muslim mothers. The questionnaire included demographics, knowledge, beliefs, attitudes, and intention to integrate children with DS. Analysis included a regression test of intention to integrate children with DS and a one-way ANOVA for differences between Jewish and Muslim mothers. Results Nearly all the Jewish mothers (93.7%) and about half the Muslim mothers (52.8%) had performed screening tests for DS during their pregnancy. All mothers displayed low knowledge level about DS. Being Jewish (t = 2.89; p = 0.005) and holding more positive beliefs (t = 3.39; p = 0.001) were associated with a higher intention to socially integrate children with DS. Significant positive correlations were found between beliefs and attitudes (r = 0.65; p Conclusions This study shows that Jewish and Muslim mothers' beliefs and attitudes towards social inclusion of children with DS are quite positive and the intention to integrate children with DS in the family, with children without disabilities, and in the mainstream school system is high. However, their level of knowledge about DS is low. Practice Implications Nurses, as a critical source of information about DS, should develop an ethno-cultural sensitivity to diverse populations in order to influence attitudes and beliefs regarding the social integration of children with DS.

During an outbreak of invasive meningococcal B disease on a university campus, we explored the knowledge, attitudes, beliefs, and behaviors of members of the university community in relation to the disease, the vaccine, and the vaccination program.All students, faculty and staff were invited by email to participate in a 71-item online survey, which was administered after completion of the mass clinics for the first and second doses of a meningococcal B vaccination program.A total of 404 individuals responded to the survey; 75.7% were students. Knowledge about meningococcal disease and vaccine was generally high; more than 70% correct responses were received on each knowledge question except for one question about the different meningococcal serogroups. Gender (female) and higher knowledge scores were significantly associated with either being immunized or intending to be immunized (p0.05). Positive attitudes about immunization, concern about meningococccal infection, a sense of community responsibility, and trust in public health advice also correlated with being vaccinated or intending to be vaccinated (p0.05).A successful mass vaccination program in a Nova Scotia university was associated with high levels of knowledge, positive attitudes toward vaccination, and positive attitudes toward public health recommendations.

Background Italian National Immunization Plan (NIP) 2017-2019 has introduced new recommendations regarding immunization practices during pregnancy. In this cross-sectional study, we documented specific knowledge, attitudes, and practices (KAP) in a sample of obstetrician-gynecologists (OBGYN). Methods A total of 68 OBGYN (39.7% of males, mean age of 47.7±9.3 years old) compiled a structured online questionnaire. Participants were asked about: knowledge of vaccine issues (both in general and regarding NIP recommendations for pregnant women); actual performance/recommendation of seasonal influenza (SID) and tetanus-diphtheria-acellular pertussis vaccinations (Tdap); risk perception about SID and pertussis. Eventually, a regression analysis was performed in order to identify predictive factors for vaccine propensity. Results Although most OBGYN were aware of official recommendations, only 57.4% and 55.9% correctly recalled the appropriate timing for vaccinations shots for SID and Tdap. Overall, 79.4% and 67.6% of participants usually delivered or recommended SID and Tdap to pregnant women, respectively. Main perceived barriers were identified by OBGYN in patients' fear of side effects (89.7%), their low risk perception (82.3%), insufficient awareness of official recommendations among pregnant women (75.0%). Significant predictors of Tdap practice were identified in higher risk perception (OR 6.466, 95% CI: 1.077; 38.803) and better knowledge of official recommendations (OR 7.310, 95% CI: 1.195; 44.704), whereas SID was apparently unrelated with individual characteristics of participants. Conclusions Sampled OBGYN were largely favorable towards vaccination of pregnant women. As knowledge of official recommendations was identified as a main predictor of appropriate behavior at least for Tdap practice, future educational interventions could eventually improve immunization rates.

Background: Indigenous women in New South Wales Australia are nearly four times more likely to die from cervical cancer than non-Indigenous women due to lower screening rates. We aimed to understand Indigenous women's cervical screening awareness, behaviours, knowledge, perceptions, motivators and barriers since the December 2017 National Cervical Screening Program changed to HPV testing, new screening age and screening interval, and introduced the new self-collection test. Methods: A qualitative study was conducted with 94 Indigenous women 25 to 74 years of age across metropolitan, regional and remote New South Wales. A team of six specialist researchers conducted the fieldwork, analysis and reporting. All data were coded thematically. Findings: Participants showed limited awareness of the renewed cervical screening program and the role of cervical screening in cervical cancer prevention, with most having a strong negative attitude towards cervical screening. Several motivators and behavioural barriers to screening were identified into four audience segments based on key characteristics. Most participants eligible to self-collect were unwilling to, due to concerns they would administer it incorrectly, injure themselves or have to return for a more invasive test. Interpretation: This study demonstrates the complex and heterogenous nature of attitudes and behaviours, among Indigenous women and highlights the intrinsic negative attitudes and social norms that are currently shaping community discourse and ultimately limiting screening. Our findings support the need for enhancing positive sentiment and community advocacy. Funding: Cancer Institute NSW Cervical Screening Program

Objective: The purpose of the study was to assess the knowledge, attitudes, beliefs, and factors associated with the uptake of the influenza (flu) vaccination in women within Saudi Arabia during their pregnancy period. Methods: A cross-sectional prospective survey was conducted on 1085 pregnant women at the antenatal clinic over a period of 6 weeks with the provision of influenza vaccination. The questionnaire collected demographic and other data; it included 12 questions on their general knowledge and assessed their attitude toward influenza vaccination, and their awareness of vaccine risk and the potential benefits during pregnancy. The knowledge score obtained was then calculated and compared. Results: A total of 998 patients took part in the questionnaire with a response rate of 92%. There was poor awareness that the flu vaccine is safe to administer during pregnancy (130, 13.1%) and that all pregnant women should receive the flu vaccine (190, 19.1%). Pregnant women with flu vaccine knowledge score of ⩽5 (range 0–12) were significantly less likely to take the vaccine (OR 3.78, 95% CI 2.68–5.26, p

Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is linked to cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. In the U.S. territory of Guam, the incidence of cervical cancer is six times higher in Micronesians and over three times higher for CHamorus than the U.S. population. Though nasopharyngeal cancer has other contributing factors beyond HPV infection such as smoking and drinking, the CHamorus, who are the Indigenous people of Guam, have an incidence rate of nasopharyngeal cancer 20 times that of the U.S. population. In Guam, HPV vaccination rate is sub-optimally short of the National Healthy People 2020 goal to have at least 80% of females and males between the ages 13-15 years complete the HPV vaccine series. In 2016, 55.8% females and 33.2% males completed the HPV vaccination. Objective Our study sought to analyze a representative sample of Guam residents to examine their knowledge, attitudes, beliefs, practices regarding HPV, and barriers to HPV vaccination. Methods The cross-sectional survey of 776 respondents included 38% males and 62% females. The three major ethnic groups in the sample were CHamoru (48%), Filipino (26%), and Micronesians (11%). Sixty-eight percent of the respondents had at least one child. The aggregated scores were calculated for the following scale items: attitude (A), knowledge (K), subjective norms (SN), and perceived behavioral control (PBC) regarding HPV. Results Almost 45% of respondents admitted that they do not have enough knowledge to have their children vaccinated. However, 88% of those respondents stated that they would have their children vaccinated if the doctor told them. Women had significantly higher mean scores than men for A, K, and PBC/SN. Participants with more than high school education and higher incomes have significantly higher mean scores for all three measures. There were significant differences among different ethnic groups, with Micronesians having the lowest average score for all three measures. There were no significant differences between participants who had their children vaccinated and those who did not. Only 48% of respondents with children reported having their children vaccinated. Only ethnicity and having insurance were significant predictors of HPV vaccination. The respondents with medical insurance were almost three times as likely to have their children vaccinated for HPV (OR=2.8; 95% CI: 1.4, 5.2) Conclusions The results highlighted the significance of the physician’s role in having the HPV vaccination. Our results will serve as a guide to implement effective strategies for the development of targeted behavioral interventions and to develop appropriate interventions to increase the HPV vaccination uptake on Guam. Citation Format: Ana Joy Mendez, Lilnabeth Somera, Grazyna Badowski, Angelina Mummert, Lucy Castro, Angrenilda Antolin. Knowledge, attitudes, beliefs, practices regarding human papillomavirus (HPV), and barriers to vaccination against HPV infection: A cross-sectional survey of Guam residents [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-070.

Construction workers (CWs) are both more exposed to tetanus and at higher risk to be inadequately immunized. Our aim was to evaluate tetanus immunization status and knowledge/attitudes towards tetanus vaccination in CWs in Italy. In this field report, the immunization status of 554 unskilled CWs (i.e. labourers). Immunization status was assessed recalling immunization booklets/certificates. Attitudes and knowledge were collected through a standardized questionnaire. In 240/554 CWs, immunization status was inadequate/not documented: in 184 subjects (33.2%), the last vaccination shot was older than 10 years, whereas basal immunization was incomplete in 20 cases, more frequently in foreign-born people (FBP) than in Italian born (IBP) (OR=7.116). In 198 cases (35.7%), an Occupational Physician (OPh) performed last booster, usually with monovalent (T, n=173) vaccine. The main reason for inadequate immunization was having forgotten the periodic booster (148/554; 26.7%), whereas 42 subjects (7.6%) deliberately avoided tetanus vaccine because of personal/religious beliefs, more frequently in FBP than in IBP (OR=3.182). In summary, the prevalence of inadequate immunization status was relatively high (43.4%): the high prevalence of “forgotten boosters” enlightens the key role of OPh in recalling and promoting vaccination policies. Moreover, the inappropriate use of Td vaccine points out the opportunity for educational campaigns in OPh.

Background: Acute Coronary Syndrome (ACS)-associated mortality is considered high and still raising, where outcomes can be improved through immediate treatment initiation. Knowledge, attitudes, beliefs and perceived risk are cognitive factors that can affect patient’s decision to seek care immediately. Therefore, this study aimed to explore knowledge, attitudes, beliefs, and perceived risk for future ACS event among Jordanian ACS patients. Methods: A descriptive, cross-sectional, correlational design was used to conveniently recruit 160 ACS patients from CCUs and medical floors at three Jordanian hospitals using the Modified ACS Response Questionnaire. Results: Almost, 65% of participants had low level of ACS knowledge, specifically regarding untraditional ACS symptoms. Some negative attitudes and beliefs toward ACS were found. There was a moderate positive correlation between knowledge score and all of attitudes, beliefs and perceived risk score (r = 0.549, p < 0.01, r = 0.563, p < 0.01, r = 0.545, p < 0.01). Conclusion: Inadequate ACS knowledge, negative attitudes and beliefs toward ACS were associated with low perceived risk for future ACS event. Therefore, it is a priority to develop strategies that consider improving ACS patients’ knowledge, attitudes, beliefs and perceived risk. This could be effective to enhance patient’s decision to seek care and reduce ominous outcomes.

Objective: To evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes and the predictors of its promotion in the case of adults at risk of HIV. Methods: A cross-sectional survey was conducted between 2013–2016 at the Medical University in Szczecin, Poland, among final year Polish/foreign students from Northern Europe, using a standardized questionnaire. Results: There were 539 participants, median age 25 years, 40.8% males, and 66.8% were Polish nationals. The MC rate was 16.7%. Regarding HIV/AIDS knowledge, 66.6% of the students scored more than 75%; and, 34.2% knew that MC reduces the risk of HIV infection. One in eleven respondents (9.1%) believed that circumcised men felt more intense sexual pleasure. More than half of the respondents (54.8%) declared that they would recommend MC to adult patients at risk for HIV. The belief that circumcised men felt more intense sexual pleasure, and knowledge on MC regarding HIV risk reduction was associated with greater odds of recommending adult MC (OR = 3.35 and OR = 2.13, respectively). Conclusions: Poor knowledge of its benefits and a low willingness to promote the procedure—strongly dependent on personal beliefs—suggest that medical students may need additional training to help them to discuss MC more openly with adult men at risk for HIV infection. Knowledge may be an effective tool when making decisions regarding MC promotion.

Objective To evaluate the conduct and reporting of views of pregnant women on the acceptability, attitudes, beliefs and their experiences in randomised trials on diet and lifestyle interventions. Study design We undertook a systematic review of literature of randomised trials identified from our previous search in major electronic databases (until February 2017) without language restrictions. We included trials on diet and lifestyle interventions that reported acceptability, attitudes, beliefs and experiences of pregnant women. The quality of papers was evaluated using the Critical Skills Appraisal Programme (CASP) framework. Data were extracted for the following domains: acceptability, intention, behaviour, attitudes and factors influencing participation. The proportion of studies that reported the various components in each domain was reported in percentages. Results Of the 110 trials on diet and lifestyle in pregnancy, 24 reported on views of pregnant women. Acceptability of the provided information to the woman was reported in 84% (20/24), compared to 12% (3/24) on acceptability to partner or to family. Mother’s intention to adhere to intervention in pregnancy was reported in 68% (17/24) of studies vs.only 16% (4/24) on family’s intentions to support adherence. Changes in mother’s behaviour were reported for consuming specific components of diet such as nuts (8%, 2/24), olive oil (12%, 3/24) and fruit (40%, 10/24) vs. 16% (4/24) of trials reporting changes in family’s behaviour. While knowledge of food ingredients (72%, 18/24), and attitude to gestational weight gain were commonly reported (66%, 16/24) in over two-thirds of studies, only half assessed attitude to participation in research (45%, 11/24). All studies reported facilitators for uptake of intervention such as personalised support (100%, 24/24), with half (52%, 13/24) on beliefs about weight, and less than 10% (2/24) about baby’s health. Conclusion The focus on studies is mainly on the mother, and less on family. Further studies are needed with a holistic approach to ensure that such interventions when implemented are accepted by women and their families.

Objective To determine attitudes, beliefs, and barriers related to adequate milk consumption in low-income women ages ≥ 60 years. Methods Nine focus groups were conducted with a convenience sample of 59 women at congregate meal sites in a metropolitan area. Grounded in Social Cognitive Theory, focus group questions were used to explore personal, behavioral, and environmental factors associated with milk consumption. Results Key response themes indicated a positive attitude for the taste of milk (except for low-fat), a primary belief that milk was important for bones and health, and a primary barrier of gastrointestinal side effects. Conclusions and Implications Knowledge regarding the benefits of milk and the dislike of its taste were not the primary reason for the lack of consumption. Instead, gastrointestinal side effects seemed to be the major barrier to adequate consumption. Future nutrition campaigns should test strategies for lactose intolerance management when communicating with low-income older women.

Objective This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers. Methods Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables. Results Students reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors. Conclusions Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.

Background:Overweight and obesity among Aboriginal women is a growing concern, with increasing prevalence rates linked to a sedentary lifestyle. Physical inactivity is a modifiable risk factor for unhealthy body weight; however before addressing health enhancing behaviors, understanding lifestyle practices, attitudes and beliefs are important.Methods:A mixed methods approach assessed physical activity (PA) practices (n = 58), and attitudes and beliefs (n = 19) among First Nations women. The Modifiable Activity Questionnaire assessed PA, and a focused ethnography explored attitudes and beliefs.Results:Self-reported PA was highest in the youngest age group. Both total and leisure-time PA decreased when house-related activities were not accounted for. Younger participants reported sport-related activities, while older participants reported traditional activities (eg, berry picking, fishing). Participants’ believed PA promoted good health, yet personal (ie, lack of time), community-specific (ie, lack of opportunities/encouragement) and environmental (ie, inclement weather, safety) factors acted as barriers. Age-specific, women-only programs were highlighted as potential enablers.Conclusions:The findings highlight the need to assess cultural specific practices, attitudes and beliefs as PA programs that focus on reducing barriers identified in the community and are designed based on expressed interest and preferences may improve leisure-related PA levels among all age groups.

Objectives To develop a model of heart failure patients’ attitudes, beliefs, expectations, and experiences based on published qualitative research that could influence the development of self-management strategies. Methods A synthesis of 19 qualitative research studies using the method of meta-ethnography. Results This synthesis offers a conceptual model of the attitudes, beliefs, and expectations of patients with heart failure. Patients experienced a sense of disruption before developing a mental model of heart failure. Patients’ reactions included becoming a strategic avoider, a selective denier, a well-intentioned manager, or an advanced self-manager. Patients responded by forming self-management strategies and finally assimilated the strategies into everyday life seeking to feel safe. Discussion This conceptual model suggests that there are a range of interplaying factors that facilitate the process of developing self-management strategies. Interventions should take into account patients’ concepts of heart failure and their subsequent reactions.

This study explores perceptions of mental illness in a sample of Ethiopian community members, healthcare workers and traditional healers. Specifically, the attitudes, beliefs and practices associated with the symptoms, causes and treatment of mental illness were investigated. A total of 115 participants were interviewed using a semi-structured questionnaire to explore their perceptions of depression, anxiety and psychosis. Qualitative analysis of the interview responses indicated a range of beliefs about the recognition and etiology of mental illness. Nine themes were identified in response to the questions how do you identify and what causes mental illness: Psychocultural appropriateness, Religious/spiritual, Social difficulty, Behavioral disturbance, Cognitive-emotional impairment, Disaster and economic deprivation, Adaptive functioning, Substance abuse and Physical/medical. The most frequent response for how to identify depression and anxiety was negative emotions, while the most frequent answer for re...

Introduction: The rate for new infections of HIV and other sexually transmitted infections (STIs) has increased for Hispanic males. Method: This descriptive correlational study describes knowledge, attitudes, and beliefs of HIV and other STIs and explores the relationship between age and HIV and STI knowledge among young adult Hispanic males. A sample of 179 Hispanic men aged 18 to 64 years attending college completed the 80-item Community Health Packet, the 18-item Brief HIV Knowledge Questionnaire, and the 27-item STD Knowledge Questionnaire. Results: Almost half of the participants were involved in some form of high-risk sexual practices such as having multiple sex partners, holding apathetic views on condom use, showing low rates of HIV testing, having incorrect knowledge of STI transmission, and holding misconceptions about HIV. Findings included a moderate positive relationship between age ( M = 24.05; SD = 7.08) and HIV knowledge scores ( M = 13.21; SD = 4.04), r(175) = .43, p < .00, as well as a positive relationship between age ( M = 24.05; SD = 7.08) and STI total scores ( M = 14.47; SD = 7.20), r(173) = .31, p < .00. Conclusion: Study findings reveal the need to continue HIV and STI prevention education programs on college campuses to increase knowledge and help decrease new cases of STIs and HIV in Hispanic men.

Introduction The purpose of this study is to assess the attitudes, beliefs, perceptions, and practices regarding tobacco use and exposure among pregnant women in the Dominican Republic. Methods The survey was conducted in two public health hospitals in Santiago, Dominican Republic, and was administered to a convenience sample of 192 women during prenatal care visits. Analyses examined pregnant women's tobacco use, secondhand smoke exposure (SHS), knowledge about risks of smoking and benefits of quitting, and attitudes toward women's tobacco use. All data were collected between April and August 2009. Results Respondents' age ranged from 18 to 41 years, with a mean age of 25 years (SD = 4.59), a high literacy level (82%), low educational levels (48% less than high school education), and a high unemployment rate (65%). Levels of ever having experimented with cigarettes were 14%, and 5% had ever been a regular smoker. Among all respondents, 3% of women reported being current smokers. When respondents were asked if they would try smoking next year, 7% responded yes, maybe, or don't know. Rates of self-reported SHS among pregnant women were 16%, and 14% reported their young children being exposed to secondhand smoke. More than half of the pregnant women in this study allowed smoking in their home (76%). Conclusions This study provides a preliminary understanding of tobacco use and exposure among pregnant women and its potential impact on the Dominican Republic's public health efforts that include improving maternal and child health.

A total of 157 persons with spinal cord injury completed the Spirituality and Spinal Cord Injury Survey in relation to their spiritual and/or religious attitudes, beliefs, and practices in terms of adapting to their disability. Factor analysis accounting for 69% of the variance revealed four factors related to Spiritual Help and Improvement (36%), Spiritual Decline (22%), Punishment/Atonement (6%), and Body/Mind Improvements (5%). Participants were further classified by time since injury, which statistically indicated that some individuals tend to become more focused on religious or spiritual practices and beliefs regarding cure soon after injury; however, these behaviors and beliefs tend to dissipate over time. The majority of participants expressed overall satisfaction with God or a Spiritual Power (G/SP) and that G/SP helped them cope, gave them meaning, and was a source of happiness in their lives. Implications for rehabilitation counselors and educators are discussed.

Background Although treatment of erectile dysfunction improves clinical outcomes and quality-of-life, a significant proportion of men remain undiagnosed with this disorder and male attitudes towards sexual experiences are poorly understood. Being uncomfortable about discussing these issues with others may contribute to men not seeking appropriate medical care. We sought to increase understanding of male attitudes, beliefs, and values regarding “better” sexual experience and to use these outcomes to develop a novel patient-reported outcomes questionnaire capturing important aspects of such experiences. Methods We conducted focus groups and individual in-depth interviews in Germany, Spain, the United Kingdom, and the United States in treatment-naive men with erectile dysfunction, treatment-experienced men with erectile dysfunction, and men without erectile dysfunction. Sexually active men aged 35–69 years were recruited from a research database, by newspaper advertisement, and at physician offices....

As severe obesity (BMI40kg/m(2)) and its surgical treatment rise, primary care physicians (PCPs) will more frequently evaluate, refer, and oversee the long-term medical management of bariatric patients. A cross-sectional mail survey was conducted to assess the attitudes, knowledge, and bariatric referral practices among family and internal medicine physicians in North Carolina.Forty-seven percent of 611 randomly chosen PCPs returned a self-completed questionnaire. The effect of demographics, PCP attitudes, and PCP knowledge on referral practices was evaluated.Over 85% (221) of PCPs have treated operated bariatric patients within the last year and 76% (203) have referred patients for surgical evaluation. Thirty-five percent of practitioners felt unprepared to provide good quality long-term medical care to operated patients, and just 45% felt competent to address medical complications of bariatric surgery. Compared with nonreferring PCPs, referring physicians provided medical care to a greater number of severely obese (mean 9.9 versus 7.5, P0.001) and postoperative (mean 4.6 and 2.3, P0.001) bariatric patients. Referring providers were younger (46 versus 49, P = 0.02), had higher BMI (25.3 versus 23.5, P = 0.001), were more familiar with NIH guidelines (14.7% versus 3.0%, P = 0.02), and had completed more bariatric continuing medical education (49.8% versus 34.9%, P = 0.03). Also, they reported better resources (71.4% versus 35.4%, P0.001) and competency to provide good quality long-term care to postoperative bariatric patients (54.2% versus 15.4%, P0.001) than nonreferring peers.Bariatric surgeons will optimize referrals and postoperative care for patients by working cooperatively with PCPs and by providing educational resources.

Zambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy.Health care workers in urban and rural districts of Zambia completed a self-administered, 48-item questionnaire containing items addressing demographics, personal experience with epilepsy, social tolerance, willingness to provide care, epilepsy care knowledge, and estimates of others' attitudes. Analyses were conducted to assess characteristics associated with more epilepsy care knowledge and social tolerance.The response rate was 92% (n=276). Those who had received both didactic and bedside training (P=0.02) and more recent graduates (P=0.007) had greater knowledge. Greater knowledge was associated with more social tolerance (P=0.005), but having a family member with epilepsy was not (P=0.61). Health care workers were generally willing to provide care to this patient population, but approximately 25% would not allow their child to marry someone with epilepsy and 20% thought people with epilepsy should not marry or hold employment. Respondents reported that people with epilepsy are feared and/or rejected by both their families (75%) and their community (88.8%).Knowledge gaps exist particularly in acute management and recognition of partial epilepsy. More recent graduates were more knowledgeable, suggesting that curriculum changes instituted in 2000 may be improving care. Health care workers expressed both personal and professional reservations about people with epilepsy marrying. In addition to improving diagnosis and treatment skills, educational programs must address underlying attitudes that may worsen existing stigmatizing trends.

Excessive sun exposure can cause sunburn, suntan, skin photoaging, and even skin cancer. Skin photoaging conflicts with the human pursuit of a young and beautiful appearance. Some research data indicate that the incidence of skin cancer in the Chinese has been increasing, although it remains lower than in whites. To estimate the prevalence of sun protection used on Chinese children aged 3-13 years and identify its predictors, a population-based cross-sectional questionnaire was given to 3684 parents/guardians of children in Guangzhou, China, of which 3083 questionnaires were returned. Of those returned, 35.5% of parents/guardians reported regularly using sun protection on their children and the primary reason cited was to prevent sunburn. Hats and handheld umbrellas were the most frequently used measures; sunscreen was less common, and when used, 48.8% of parents/guardians still reapplied sunscreen on their children every 2.0-3.0 h. Parental age, parents using sun protection measures themselves when outdoors, and the child's sex were factors associated with regular use of sun protection on children. These results suggest that sun protection campaigns targeted toward parents and children need to be conducted in Guangzhou, or throughout China, to strengthen awareness about sun protection and address any inadequate protocols of sun protection.

The aim of the study was to evaluate data on behavioural indicators in relation to HIV/AIDS/STD prevention and occurrence in a rural adult population in South Africa. A representative community sample of adults (n=398) using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from adults using ten focus group discussions. The survey sample included 398 adults: 155 (38.9%) male and 243 (61.1%) female, whose ages ranged from 25 to 49 years ( M=37.1 years, SD=12.6). The questionnaire included 71 items on HIV-related knowledge, attitudes, beliefs and behaviours. The results indicated a mean HIV/AIDS knowledge score of 6.77 (range: 0 to 9), indicating a moderately adequate knowledge. HIV/AIDS knowledge was identified as a predictor for HIV-risk behaviour. Forty-six percent of the men and 21.4% of the women indicated that they had had a non-regular sexual partner in the last 12 months, and 53.4% of the women and 45.6% men said that they had never used a condom with their non-regular, non-commercial partner during the preceding 12 months. Among female adult women, 15.4% reported having been victims of enforced sex during the last 12 months. There was a high incidence of self-reported genital discharge/ulcers/sores within the preceding 12 months among the participants (19.7% in men and 11% in women). The study's findings are discussed in relation to implications for health education.