Behaviors and Advocacy Related to COVID-19 among Cancer Patients: The Health Belief Model and Opportunities for Messaging and Education.

Cancer patients have an increased risk of severe COVID-19 outcomes and were recommended to be vaccinated, wear a mask, practice social distancing, and increase hand hygiene. We used the Health Belief Model (HBM) to identify constructs that were associated with the likelihood of adhering to and advocating for CDC COVID-19 prevention recommendations. We surveyed adult cancer patients who had an onsite appointment at the Penn State Cancer Institute or at the Hematology and Oncology Associates of Northeastern Pennsylvania. Survey measures included adherence to and informing others of COVID-19 recommendations as well as HBM constructs. Relationships between HBM constructs and outcomes were assessed with Spearman's correlation and multivariable ordinal logistic regression. Of the 106 participants who completed the survey for our objectives of interest, 76% always wore a mask, 29% always practiced social distancing, and 24% washed their hands at least 10 times a day. Limited advocacy behaviors were captured for the COVID-19 vaccine (30%), social distancing (36%), and wearing masks (27%). Perceived benefits, perceived barriers, and cues-to-action were positively associated with the likelihood of adherence or advocacy of COVID-19 recommendations among cancer patients, whereas perceived susceptibility and self-efficacy were negatively associated with the likelihood of adherence or advocacy of COVID-19 recommendations among cancer patients. Perceived benefits may be the strongest predictor for adherence and advocacy for specific COVID-19 guidelines. Future messaging and educational campaigns focused on improving adherence to or advocacy of specific health behaviors should be informed by the HBM and originate from multiple outlets.

Susceptibility to Hepatitis A and B Virus Among Clients at a Syringe Services Program in Philadelphia, 2018.

OBJECTIVES: Although many people who use drugs meet criteria for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV), estimates of susceptibility (ie, lack of immunity) are not well established. This study sought to identify the prevalence of and characteristics associated with HAV and HBV susceptibility among people who use drugs attending an urban syringe services program. METHODS: We initiated this seroprevalence study in 2018 among 438 clients of a syringe services program who met study criteria, including provision of a blood specimen and a self-reported history of drug use. We assessed HAV and HBV susceptibility and infection via serological testing. We examined associations between participant characteristics and serology status by using descriptive statistics and multivariable logistic regression models. RESULTS: Of the initial 438 clients identified, 353 (80.6%) met study criteria. Of 352 participants with conclusive HAV test results, 48.6% (n = 171) were HAV susceptible; of 337 participants with conclusive HBV test results, 32.6% (n = 110) were HBV susceptible, 24.3% (n = 82) showed evidence of past or present HBV infection, and 43.0% (n = 145) had vaccine-derived immunity. Compared with participants born before 1970, participants born during 1980-1989 had 5.90 (95% CI, 2.42-14.40) times the odds of HAV susceptibility and 0.18 (95% CI, 0.06-0.53) times the odds of HBV susceptibility, and participants born during 1990-1999 had 6.31 (95% CI, 2.34-17.00) times the odds of HAV susceptibility. Decreased odds of HAV susceptibility were associated with homelessness (adjusted odds ratio = 0.48; 95% CI, 0.28-0.82). CONCLUSION: Despite applicable HAV and HBV vaccination recommendations, substantial gaps exist in HAV and HBV susceptibility among a population of people who use drugs. These findings highlight the need for increased HAV and HBV vaccination efforts among people who use drugs.

Public Health and the Pope's Visit to Philadelphia, 2015.

Pope Francis visited Philadelphia for 2 days during September 2015. Preparedness functions managed by the Philadelphia Department of Public Health (PDPH) were similar to those of other mass gatherings but also required accommodation of special security arrangements and the location of public events in central areas of the city. Public health planning involved collaborations with multiple city, state, and federal agencies and neighboring jurisdictions. PDPH preparations encompassed incident command procedures, contingency planning, disease surveillance and prevention, food safety, vector control, BioWatch air sampling, volunteer management for first-aid services, and continuity of operations. These were based on, or informed by, existing emergency plans and prior experiences in responding to public health crises, supporting large public events, managing regional preparedness exercises, engaging Medical Reserve Corps volunteers, and executing routine functions. Although the papal visit concluded without the occurrence of a substantial public health or healthcare emergency, lessons learned have and will continue to improve coordination with partner agencies in planning and executing large-scale events, as well as managing regional disease surveillance procedures and medical volunteer engagement. Another area identified for improvement concerns enhancing the role of local health departments in planning for responses to possible BioWatch alerts.

The 49th hour: analysis of a follow-up medication and vaccine dispensing field test.

Anthrax response plans, exercises, and assessments over the past decade have focused almost exclusively on the first 48 hours of the public health response following a jurisdiction-wide exposure and provision of an initial 10-day supply of antibiotics from the Strategic National Stockpile (SNS). But mass dispensing of the subsequent 50-day course of antibiotics and administration of the 3-dose vaccine series have received considerably less attention, although these follow-up activities may prove even more complex. In 2014, the Philadelphia Department of Public Health (PDPH) made its first foray into this next frontier of mass prophylaxis planning by: (1) researching patient safety and adherence considerations relevant to the antibiotics in the SNS; (2) designing a model for a second-visit antibiotic and vaccine point of dispensing (POD), including development of an enhanced screening protocol that assumes a higher level of medical responsibility; and (3) field testing this model during a real seasonal influenza vaccination clinic to assess throughput and accuracy and to evaluate the resources needed to operationalize this model. While the observations and data presented here provide some framework for local long-term mass prophylaxis planning efforts, many areas remain undefined, including the distribution of responsibilities among the public health and healthcare communities to ensure patient safety. In addition to presenting findings, the larger intent of this article is to initiate a dialogue with other stakeholders at the local, state, and federal levels to advance long-term mass prophylaxis planning.

Efficiency and effectiveness of using nonmedical staff during an urgent mass prophylaxis response.

Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. This closed POD had developed and exercised its mass prophylaxis plan in conjunction with the local health department twice before, and the department was interested in assessing the impact of having no onsite department involvement. Two sessions were conducted as part of the overall exercise. In session 1, agency staff ran POD operations with no department involvement. During session 2, department staff provided an hour-long training session and oversaw POD operations. Mean throughput and accuracy rates of the 2 sessions were then compared to a previous health department public POD exercise staffed by department personnel and medical volunteers. The closed POD would be able to process the entire internal population in an estimated mean time of 23.9 hours. The accuracy rates for dispensing the correct medication during session 1 was 84.7% and 92.4% during session 2 (p=0.0012). Overall accuracy was significantly higher in a previous local health department public POD exercise (88.6% vs. 96.9%, p < 0.0001), as was pediatric dosing accuracy (p < 0.0001). We concluded that nonmedical closed PODs are a valuable strategy during a public health emergency that requires large segments of a population to receive medication rapidly. They must be activated judiciously, however, as their use may increase adverse events and potentially result in discontinuation of antibiotic prophylaxis should people choose not to finish the course. Local health department training and oversight reduce errors but may not always be available.

Ready or not: analysis of a no-notice mass vaccination field response in Philadelphia.

Local health departments typically rely on exercises to test preparedness capacity; however, pre-scripted drills often lack the sense of urgency that a real event would engender. No-notice, unscripted exercises that challenge staff to think critically under pressure may provide a mechanism for a more realistic assessment of preparedness capacity. The very active influenza season of 2012-13 presented the Public Health Preparedness Program at the Philadelphia Department of Public Health with the opportunity to conduct an influenza vaccination clinic at a local boarding school. Program leaders used this opportunity to design a no-notice exercise to test the ability of staff to effectively coordinate an emergency field response while simultaneously delivering a real public health intervention. On the day of the exercise, staff members were given 6 hours to plan and execute a vaccination clinic without any guidance from program leaders. Best practices observed during the exercise included: (1) early identification and mitigation of rate-limiting steps, and (2) successful implementation of a previously untested high-throughput vaccination model. Although the primary intent of the exercise was to assess the ability of staff to respond to a no-notice event, this vaccination clinic also functioned as a microcosm of a larger response, revealing several considerations related to vaccine ordering, staff resources, and throughput rates that have broader implications for public health responses to large-scale biological attacks or pandemics.

Elevated ambient air zinc increases pediatric asthma morbidity.

BACKGROUND: Recent studies indicate that the composition of fine particulate matter [PM

College and university planning for pandemic influenza: a survey of Philadelphia schools.

OBJECTIVES: This study was undertaken to assess the current state of college and university planning for pandemic influenza and to inform guidance for these institutions. METHODS: The Philadelphia Department of Public Health developed an interview guide based on CDC guidance and conducted in-depth structured interviews with college and university pandemic planners in Philadelphia. RESULTS: Thirteen of 14 schools contacted participated in interviews. Six schools, or slightly fewer than half, reported having a draft pandemic influenza plan. Schools noted barriers such as insufficient information and financial resources and institutional support. They reported that they lacked concrete policy recommendations suited to different types of institutions (e.g., small colleges) and lacked the political will to tackle a hypothetical threat. Schools requested further guidance on triggers for campus closure, materials to stockpile, and policies for refunding tuition and adjusting credits for missed coursework. CONCLUSIONS: School pandemic planning is in its early stages. Local government can provide recommendations as to the appropriate level of planning detail, disseminate examples of best practices planning, and continue to emphasize the importance of all-hazards approaches to emergency planning.

Field testing a head-of-household method to dispense antibiotics.

OBJECTIVES: Using a simulated anthrax exposure scenario, the Philadelphia Department of Public Health tested how rapidly and accurately a head-of-household (HoH) point of dispensing (PoD) site with an express dispensing line could provide medication to heads of households collecting antibiotics for all household members. METHODS: The 8 pretrained PoD leadership staff trained the other 42 PoD staff in the hour before the field trial. During the 2-hour field trial, proxy-HoHs used scripts with pertinent information describing household members to complete a HoH PoD intake form. PoD staff, 6 with medical training, used the form to direct HoHs to either express dispensing, where only adult dosing of ciprofloxacin was provided for each household member, or to screening, where targeted information was collected before antibiotics were dispensed. RESULTS: In 2 hours, 717 individual HoHs picked up medication for a total of 2,120 household members (average household size = 2.96 persons) with a throughput rate of 1,060 person-medication doses dispensed per hour. Among 616 (86%) HoHs with a recorded PoD transit time, the 294 express-line-eligible HoHs passed through twice as fast as the 322 HoHs who required screening (medians = 3 versus 8 minutes, respectively, p < 0.01). Ninety-seven percent of people were accurately prescribed antibiotics. CONCLUSIONS: HoH PoDs, using a limited number of medically trained staff, can rapidly and accurately provide medication to a large population. The express dispensing line speeded transit time without compromising medication dispensing accuracy. Dispensing medications to HoHs can be an accurate and effective way to reach large populations during a public health emergency.