Behavioral immune system linked to responses to the threat of COVID-19.

People possess psychological processes that help them avoid pathogens, which is particularly important when novel infectious diseases (e.g., COVID-19) spread through the population. Across two studies we examined whether trait pathogen avoidance (operationalized as perceived vulnerability to disease; PVD) was linked with responses to COVID-19 and preventative behaviors. In Study 1, PVD was positively associated with stronger reactions to the threat of COVID-19, including increased anxiety, perceptions that people should alter their typical behavior, as well as reported importance of engaging in proactive and social distancing behaviors. In Study 2, PVD was again associated with increased anxiety, as well as more vigilant behavior when grocery shopping, fewer trips to the store, and fewer face-to-face interactions. These associations remained significant when controlling for the Big-5 personality traits. Although the two subscales of PVD (germ aversion and perceived infectability) were often parallel predictors, several differences between the subscales emerged. Germ aversion may be more associated with behaviors whereas perceived infectability with vigilance.

We Will Not Compete on Safety: How Children's Hospitals Have Come Together to Hasten Harm Reduction.

BACKGROUND: Launched in 2012, the Children's Hospitals' Solutions for Patient Safety (SPS) Network is a collaborative of children's hospitals in the United States and Canada working together to eliminate patient and employee/staff harm across all children's hospitals. METHODS: The SPS Network, which has grown from 8 to 137 hospitals, has a foundation of leadership engagement, noncompetition, data-driven learning, attention to safety culture, family engagement, and transparency. The SPS Leadership Group, which consists of more than 150 leaders from participating hospitals, forms condition-specific teams to promote the reduction of hospital-acquired harm in a phased design that includes an ongoing focus on both process improvement and safety culture enhancements. Hospital leaders are engaged through monthly reports, executive webinars, in-person meetings, and biannual training opportunities for boards of trustees. SPS has developed extensive opportunities for learning collaboration, including in-person networkwide learning sessions, regional meetings, general and condition-specific webinars, communications, and a shared website. RESULTS: Over time, the portfolio has expanded as SPS has achieved harm reduction targets for some conditions and begun work to reduce harm in other, previously unaddressed areas. In 2017 SPS reported a 9%-71% reduction in eight harm conditions by an initial cohort of 33 hospitals. SPS estimates that more than 9,000 children have been spared harm since 2012, with $148.5 million in health care spending avoided. CONCLUSION: Participation in the SPS Network has been associated with improved safety in children's hospitals. Widespread participation in this or similar collaborations has the potential to dramatically decrease harm to patients, employees, and staff.

Understanding women's hesitancy to undergo less frequent cervical cancer screening.

Inappropriate cervical cancer screening (e.g., screening too often) can result in unnecessary medical procedures, treatment, and psychological distress. To balance the benefits and harms, cervical cancer screening guidelines were recently modified in favor of less frequent screening (i.e., every 3 to 5 years). This study investigated women's acceptance of less frequent cervical cancer screening and their primary concerns about extending the screening interval beyond one year. A national sample of 376 U.S. women ages 21-65 completed an online survey in 2014. Predictors of willingness to get a Pap test every 3 to 5 years were identified using logistic regression. We also examined perceived consequences of less frequent screening. Over two thirds were willing to undergo less frequent screening if it was recommended by their healthcare provider. Nevertheless, nearly 20% expressed discomfort with less frequent screening and 45% were either in opposition or unsure whether they would be comfortable replacing Pap testing with primary HPV testing. Women whose most recent Pap test was (vs. was not) within the past year and women who ever (vs. never) had an abnormal Pap test were less willing to extend the screening interval. Additionally, women who typically saw an obstetrician/gynecologist or nurse practitioner for their Pap test (vs. a family physician) were less accepting of the guidelines. Hesitancy about the longer screening interval appears to stem from concern about developing cancer between screenings. Findings contribute to the growing body of research on cancer overscreening and may inform interventions for improving adherence to cancer screening guidelines.

When Different Message Frames Motivate Different Routes to the Same Health Outcome.

BACKGROUND: Message framing is an effective strategy for promoting health behavior. PURPOSE: We examined the relative effectiveness of framed messages that simultaneously promoted two different health behaviors-eating a calcium-rich diet and taking calcium supplements-for preventing osteoporosis. Because those behaviors are associated with different perceptions of risk, we predicted that gain- and loss-framed messages would have opposite effects. METHODS: In two experiments, participants (N1 = 69; N2 = 219) were randomly assigned to a gain- or loss-framed message presenting two osteoporosis prevention behaviors. RESULTS: A gain-framed advantage was observed for dietary calcium consumption, but the opposite-a loss-framed advantage-was observed for use of calcium supplements. Message frame interacted with baseline calcium consumption behavior for some outcomes. CONCLUSIONS: Both gain- and loss-framed messages increased osteoporosis prevention behavior, but their relative effectiveness depended on the type of behavior. Framed messages can have opposite effects on different behaviors used to achieve a common health goal.

Predictors of provider recommendation for HPV vaccine among young adult men and women: findings from a cross-sectional survey.

BACKGROUND: Although physician recommendation is one of the strongest predictors of human papillomavirus (HPV) vaccination, it is unclear for whom physicians are recommending the vaccine. To help guide intervention efforts, this study investigated predictors of participant-reported physician recommendation for HPV vaccine among young adults in the USA. METHODS: Women and men (N=223) aged 18-26 years were recruited online through Craigslist, a popular classified advertisements website. Ads were posted in the 25 largest US cities from September 2013 to March 2014. Participants completed a survey that assessed demographic and sociopolitical characteristics, sexual history, HPV vaccination history, and whether they had ever received a recommendation for HPV vaccine from a physician or healthcare provider. RESULTS: Fifty-three per cent reported receiving a recommendation for HPV vaccine and 45% had received ≥1 dose of HPV vaccine. Participants who received a recommendation were over 35 times more likely to receive ≥1 dose of HPV vaccine relative to participants without a recommendation. Bivariable and multivariable correlates of provider recommendation were identified. Results from the multivariable model indicated that younger (aged 18-21 years), female, White participants with health insurance (ie, employer-sponsored or some other type such as military-sponsored) were more likely to report receiving a recommendation for HPV vaccine. CONCLUSIONS: Results suggest that physician recommendation practices for HPV vaccination vary by characteristics of the patient. Findings underscore the key role of the healthcare provider in promoting HPV vaccination and have important implications for future HPV vaccine interventions with young adults.

The blame game: cervical cancer, knowledge of its link to human papillomavirus and stigma.

This two-study paper examined stigma toward women with cervical cancer. Cervical cancer is caused by human papillomavirus (HPV), a sexually transmitted infection (STI). For Study 1, participants (N = 352) were randomly assigned to one of four conditions in which they read a brief description of a patient with either cervical or ovarian cancer in which the cause of the patient's cancer was either specified (cervical: HPV, a STI vs. ovarian: family history) or unspecified. Participants in the cervical cancer/cause-specified condition rated the patient as more dirty, dishonest and unwise, and reported feeling more moral disgust and 'grossed out' than participants in the cervical cancer/cause-unspecified condition. For Study 2, participants (N = 126) were randomly assigned to read a vignette about a patient with cervical cancer in which the cause of cancer was either specified or unspecified. Consistent with Study 1, participants in the cause-specified condition rated the patient as more unwise, and reported feeling more moral disgust and 'grossed out' than participants in the cause-unspecified condition. These effects were mediated by attributions of blame toward the patient. Findings suggest that women with cervical cancer may be stigmatised and blame may play a role in this process.

Increasing human papillomavirus vaccine acceptability by tailoring messages to young adult women's perceived barriers.

BACKGROUND: Human papillomavirus (HPV) vaccination is a safe and effective primary prevention strategy for cervical cancer. Despite the need for effective HPV vaccination interventions, relatively few have been tested. Moreover, existing interventions have tended to use a one-size-fits-all educational approach. We investigated whether tailoring intervention materials to young adult women's perceived barriers to HPV vaccination-a known psychosocial predictor of vaccine uptake-would increase women's intentions to receive the HPV vaccine. METHODS: Young adult women (N = 94; aged 18-26 years) who had not been vaccinated against HPV were randomly assigned to read either a nontailored message about HPV vaccination or a message that was individually tailored to participants' perceived barriers to HPV vaccine uptake (e.g., safety concerns, cost, and not sexually active). Participants' intentions to receive the HPV vaccine in the next year were assessed before and after delivery of the intervention and served as the primary outcome variable. RESULTS: The most commonly selected barrier and primary reason for not getting vaccinated was concern about vaccine adverse effects (endorsed by 55%). Knowledge about HPV vaccination increased after exposure to the intervention but did not differ by experimental condition. Although HPV vaccination intentions increased from pretest to posttest in both conditions, participants in the tailored condition reported greater increases in intentions than did participants in the nontailored condition (F1,90 = 4.02, P = 0.048, partial η = 0.043). CONCLUSIONS: Findings suggest that tailoring intervention materials to women's individual barriers is a potentially promising strategy for increasing HPV vaccination among young adult women.

The multidimensional nature of perceived barriers: global versus practical barriers to HPV vaccination.

OBJECTIVE: Perceived barriers are one of the strongest determinants of health behavior. The current study presents a novel conceptualization of perceived barriers by testing the following hypotheses: (a) perceived barriers are multidimensional and thus should cluster into distinct factors; (b) practical barriers should be salient for individuals intending to engage in a particular health behavior, whereas global barriers should be salient for individuals not intending to enact the behavior; and (c) whereas global barriers should be negatively associated with behavioral intentions, practical barriers should be positively related to intentions. METHODS: The context for this investigation was young adult women's perceived barriers to human papillomavirus (HPV) vaccination. Two months after viewing an educational video about HPV vaccination, women (aged 18-26) who had not received any doses of the HPV vaccine (n = 703) reported their perceived barriers to HPV vaccination and intentions to receive the vaccine. RESULTS: Relative to the conventional single-factor approach, a five-factor model provided a better fit to the data and accounted for a larger proportion of variance in vaccination intentions. The relative salience of different perceived barriers varied as a function of women's intentions. Participants who were not intending to get vaccinated cited global concerns about vaccine safety and low perceived need for the vaccine. In contrast, participants intending to get vaccinated cited practical concerns (cost, logistical barriers) related to carrying out their intentions. Moreover, whereas global perceived barriers were associated with lower intentions, practical barriers were associated with higher intentions. CONCLUSIONS: Perceived barriers are multidimensional and vary systematically as a function of people's behavioral intentions.

Message framing, it does a body good: effects of message framing and motivational orientation on young women's calcium consumption.

We investigated the effects of gain-framed versus loss-framed messages and motivational orientation on calcium consumption. After completing a motivational orientation scale (behavioral inhibition system/behavioral activation system), undergraduate women (N = 141) were randomly assigned to read a gain-framed or loss-framed pamphlet promoting calcium consumption. Calcium consumption was assessed 1 month later. For calcium supplement behavior, a gain-framed advantage was observed for behavioral activation system-oriented individuals, whereas a loss-framed advantage was observed for behavioral inhibition system-oriented individuals. For dietary calcium intake, a gain-framed advantage was observed among behavioral activation system-oriented individuals; however, no framing effect emerged for behavioral inhibition system-oriented individuals. The success of framed messages depends on the message recipient's motivational orientation.