Trans and gender-nonconforming children and their caregivers: Gender presentations, peer relations, and well-being at baseline.

This study, involving a community-based sample of 45 predominantly white primary caregivers of 45 trans and gender-nonconforming (TGNC) children between 6 and 12 years of age, provides descriptive data on children's gender presentations, peer relations, and well-being. Most (n = 31; 69%) of the children were cross-gender identified (CGI). That is, 17 of 28 children assigned male at birth explicitly and consistently identified as girls, and 14 of 17 children assigned female at birth explicitly and consistently identified as boys. The 14 remaining children appeared to have nonbinary gender identities (e.g., "boy-girl") or to identify with the sex and gender they were assigned at birth but were gender-nonconforming, or their gender identities were uncertain. This subgroup was labeled non-CGI. Most of the children were in the normal range for internalizing (64%), externalizing (67%), and total behavior problems (62%), yet a sizable minority were in the borderline-clinical/clinical range for these symptoms. Children in the CGI group had fewer internalizing and total problems than children in the non-CGI group. Child's degree of gender conformity, caregiver's level of anxiety, and child's peer relations were correlated with children's well-being; children in the CGI group were reported to have better peer relations than children in the non-CGI group. Caregivers' rates of depression and anxiety appeared to be similar to normative samples, although anxiety may have been slightly elevated. Findings from this study add to a small but growing body of literature that documents the well-being of TGNC children growing up in supportive and affirming familial environments. (PsycINFO Database Record

Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys.

OBJECTIVE: Understanding the current status of parents' vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children. METHODS: We conducted a web-based national poll of parents of children <7years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines. RESULTS: In 2012, 89.2% (95% CI, 87.3-90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5-6.6%) reported intentionally delaying one or more, and 5.4% (4.1-6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3-92.1%), 5.6% (4.6-6.9%), and 3.6% (2.8-4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2-6years) but not younger children (0-1years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1-94.1%) and a significant decrease in intentional ongoing refusal (5.0-2.1%). Vaccine delay increased in the Northeast (3.2-8.8%). CONCLUSIONS: Nationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically.

Childhood immunizations: First-time expectant mothers' knowledge, beliefs, intentions, and behaviors.

INTRODUCTION: This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. METHODS: This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. RESULTS: Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. CONCLUSIONS: Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions.

Childhood Immunizations: First-Time Expectant Mothers' Knowledge, Beliefs, Intentions, and Behaviors.

INTRODUCTION: This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. METHODS: This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. RESULTS: Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. CONCLUSIONS: Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions.

Development and psychometric assessment of the healthcare provider cultural competence instrument.

This study presents the measurement properties of 5 scales used in the Healthcare Provider Cultural Competence Instrument (HPCCI). The HPCCI measures a health care provider's cultural competence along 5 primary dimensions: (1) awareness/sensitivity, (2) behaviors, (3) patient-centered communication, (4) practice orientation, and (5) self-assessment. Exploratory factor analysis demonstrated that the 5 scales were distinct, and within each scale items loaded as expected. Reliability statistics indicated a high level of internal consistency within each scale. The results indicate that the HPCCI effectively measures the cultural competence of health care providers and can provide useful professional feedback for practitioners and organizations seeking to increase a practitioner's cultural competence.

Effects of information framing on human papillomavirus vaccination.

BACKGROUND: In June 2006, the first vaccine to prevent human papillomavirus (HPV) transmission was approved for use in females in the United States. Because the vaccine was approved for females as young as 9, its success depends on parents' and individuals' willingness to accept vaccination. Little is known about how attitudes toward this vaccine will be influenced by the way the vaccine is portrayed in the media or in public debate. METHODS: To assess the effects of information framing on intentions to vaccinate self or female children, if appropriate, 635 adults read one of three short descriptive paragraphs about the vaccine, each of which emphasized a different aspect of the vaccine. Participants were then asked about their intentions to vaccinate under cost or no-cost conditions. RESULTS: Women who read that the vaccine protects only against cervical cancer had significantly higher intentions to vaccinate themselves when the vaccine was available at little or no cost compared with women who read alternate versions of the descriptive paragraph, F(2,325) = 5.74, p = 0.004. CONCLUSIONS: How the HPV vaccine is framed may affect vaccination intentions under certain conditions. Women may be more receptive to the vaccine if it is framed as a cervical cancer prevention tool rather than a sexually transmitted infection (STI) prevention tool.

Examining the dimensions of cancer-related information seeking and scanning behavior.

Recent decades have witnessed a growing emphasis on patients as active consumers of health information. The literature about cancer-related information focuses on active and purposeful information seeking, but a great deal of exposure to cancer-relevant information may happen less purposively (termed information scanning). This article presents results from an in-depth interview study that examined information seeking and scanning behavior in the context of cancer prevention and screening decisions among a diverse sample of people living in a major metropolitan area. Results suggest that information scanning is quite common, particularly for information related to screening tests. Information seeking is rarer and occurs primarily among those who also are information scanners. Respondents report using a greater variety of sources for information scanning than for information seeking, but participants were much more likely to report that their decisions were influenced by information received through seeking than through scanning. These findings shed new light on how individuals navigate the media environment and suggest future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.