Video Telemedicine Experiences In COVID-19 Were Positive, But Physicians And Patients Prefer In-Person Care For The Future.

To help inform policy discussions about postpandemic telemedicine reimbursement and regulations, we conducted dual nationally representative surveys among primary care physicians and patients. Although majorities of both populations reported satisfaction with video visits during the pandemic, 80 percent of physicians would prefer to provide only a small share of care or no care via telemedicine in the future, and only 36 percent of patients would prefer to seek care by video or phone. Most physicians (60 percent) felt that the quality of video telemedicine care was generally inferior to the quality of in-person care, and both patients and physicians cited the lack of physical exam as a key reason (90 percent and 92 percent, respectively). Patients who were older, had less education, or were Asian were less likely to want to use video for future care. Although improvements to home-based diagnostic tools could improve both the quality of and the desire to use telemedicine, virtual primary care will likely be limited in the immediate future. Policies to enhance quality, sustain virtual care, and address inequities in the online setting may be needed.

Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications.

Public health agencies' ability to protect health in the wake of COVID-19 largely depends on public trust. In February 2022 we conducted a first-of-its-kind nationally representative survey of 4,208 US adults to learn the public's reported reasons for trust in federal, state, and local public health agencies. Among respondents who expressed a "great deal" of trust, that trust was not related primarily to agencies' ability to control the spread of COVID-19 but, rather, to beliefs that those agencies made clear, science-based recommendations and provided protective resources. Scientific expertise was a more commonly reported reason for "a great deal" of trust at the federal level, whereas perceptions of hard work, compassionate policy, and direct services were emphasized more at the state and local levels. Although trust in public health agencies was not especially high, few respondents indicated that they had no trust. Lower trust was related primarily to respondents' beliefs that health recommendations were politically influenced and inconsistent. The least trusting respondents also endorsed concerns about private-sector influence and excessive restrictions and had low trust in government overall. Our findings suggest the need to support a robust federal, state, and local public health communications infrastructure; ensure agencies' authority to make science-based recommendations; and develop strategies for engaging different segments of the public.

Getting Critical Information During the COVID-19 Pandemic: Experiences of Spanish and Chinese Speakers With Limited English Proficiency.

People with limited English proficiency in the United States have suffered disproportionate negative health outcomes during the COVID-19 pandemic. Effective communications are critical tools in addressing inequities insofar as they can motivate adoption of protective behaviors and reduce incidence of disease; however, little is known about experiences of communities with limited English proficiency receiving relevant information during COVID-19 or other outbreaks. To address this gap and provide inputs for communication strategies, we completed a study based on 2 novel and nationally representative surveys conducted between June and August 2020 among Spanish and Chinese speakers with limited English proficiency (n = 764 and n = 355, respectively). Results first showed that Spanish and Chinese speakers did not consistently receive information about protective behaviors from key public health and government institutions early in the pandemic. Second, for such information, Spanish and Chinese speakers used a diverse set of information resources that included family and friends, social media, and traditional media from both inside and outside the United States. Third, Spanish and Chinese speakers faced challenges getting COVID-19 information, including receiving media messages that felt discriminatory toward Latinx or Chinese people. Together, these findings suggest gaps in effectively reaching Spanish and Chinese speakers. Data highlight the important role of bilingual materials to support sharing of information between Spanish or Chinese speakers and English speakers within their social networks, and the need for digital news content for traditional and social media. Finally, efforts are needed to address discriminatory messaging in media and to actively counter it in public health communications.

Preventing erosion of oral polio vaccine acceptance: A role for vaccinator visits and social norms.

BACKGROUND: With continued challenges to the timeline for polio transmission interruption in Pakistan, including COVID-19, there is a risk of oral polio vaccine campaign fatigue among caregivers of young children. Renewed efforts to minimize oral polio vaccine acceptance erosion may be needed. This study examines the possible role of social norms in protecting against acceptance erosion and the role of vaccinators in promoting these social norms. METHODS: Data were analyzed from a poll conducted by local interview teams between February 23 and April 5, 2016, among 4,070 parents and other caregivers of children under age 5 living in areas at high-risk for polio transmission in Pakistan. The sample was drawn via a stratified multistage cluster design utilizing random route methods at the household level. We calculated the prevalence of subjective and descriptive social norms around vaccine acceptance; vaccine acceptance and commitment to vaccinate in future; and experiences and views of polio vaccinators across the population. We examined the relationship between these social norms and vaccination behaviors as well as the relationship between experiences with and views of vaccinators and social norms using uncontrolled comparisons (t-tests of proportion) and logistic repressions to control for demographics. RESULTS: Both descriptive and subjective positive social norms were associated with vaccine acceptance and future commitment. Positive experiences with and views of vaccinators (trust, perceived technical knowledge, compassion, and overall pleasantness of the interaction) were associated with both descriptive and subjective positive social norms. CONCLUSIONS: These data support the idea that positive social norms could be protective against erosion of oral polio vaccine acceptance and that positive experiences with, and views of, vaccinators could help promote these positive social norms. Creative community engagement efforts may be able to leverage positive experiences with vaccinators to help foster social norms and protect against the risk of acceptance erosion.

Experiences and Views of Domestic Summer Travelers During the COVID-19 Pandemic: Findings from a National Survey.

Domestic travel creates a serious risk of spreading COVID-19, including novel strains of the virus. Motivating potential travelers to take precautions is critical, especially for those at higher risk for severe illness. To provide an evidence base for communication efforts, we examined the experiences and views of travelers during the summer of 2020 through a telephone survey of 1,968 US adults, conducted in English and Spanish, July 2 through July 16, 2020. The survey found that more than one-quarter (28%) of adults had traveled domestically in the prior 30 days, most commonly for "vacation" (43%), and less than half wore masks (46%) or practiced social distancing (47%) "all of the time." Although high-risk adults were significantly less likely to travel than non-high-risk adults (23% vs 31%; P < .001), they were no more likely to take precautions. Many travelers did not wear a mask or practice social distancing because they felt such actions were unnecessary (eg, they were outside or with friends and family). Although a substantial share of travelers (43% to 53%) trusted public health agencies "a great deal" for information about reducing risks while traveling, more travelers (73%) trusted their own healthcare providers. Findings suggest that outreach may be improved by partnering with providers to emphasize the benefits of layering precautions and provide targeted education to high-risk individuals. Messages that are empathetic to the need to reduce stress and convey how precautions can protect loved ones may be particularly resonant after more than a year of pandemic-related restrictions.

Seasonal Influenza Vaccine in Pregnant Women: Views and Experiences of Obstetrician-Gynecologists.

Background: Seasonal influenza vaccination rates among pregnant women remain well below the Healthy People 2020 target of 80%. Obstetrician-gynecologist (OB/GYN) recommendations are a critical means of encouraging pregnant women to get vaccinated, but there are limited data about their views. Materials and Methods: A nationally representative survey of 506 practicing OB/GYNs was completed between October 26, 2015, and May 8, 2016. Analyses included univariate distributions and comparisons based on age, size of practice, and academic affiliation using all-pairs, dependent t-tests. Results: A majority of OB/GYNs report they "strongly recommend" seasonal influenza vaccination for their pregnant patients in the first (79%) or second and third trimesters (81%). Among those who do not strongly recommend the flu vaccine in the first trimester, many say this is because of their own concerns (28%) or their patients' concerns (44%) about safety. Older OB/GYNs, those in smaller practices, and those without academic affiliation were less likely to recommend the vaccine and more likely to have safety concerns. For example, 72% of those age 60+ strongly recommended the vaccine in the second and third trimester, compared with 86% of those ages 30-44 and 83% of those ages 45-59 (p < 0.05 for all comparisons). Conclusions: OB/GYNs across the country largely support seasonal flu vaccination among pregnant women. Nonetheless, safety is a concern for them and their patients. Outreach to support clinician decisions and conversations with pregnant patients may be most needed among older physicians, those in smaller practices, and those without academic affiliation.

Obstetrician-Gynecologist Views of Pregnancy-Related Medication Safety.

Background: Medication use among pregnant women is widespread, despite limited evidence about the teratogenicity of most medications. Improved physician-patient communication about pregnancy-related medication safety has been identified as a strategy to address this critical issue; however, little is known about physicians' knowledge, attitudes, and practices that could inform tools for information access and sharing to support such communication. The primary objective of this study is to address gaps in what is known about obstetrician-gynecologist views, practices, and needs related to accessing and sharing pregnancy-related medication safety information with patients. Materials and Methods: The basis for this study is a nationally representative, randomized survey of 506 practicing obstetrician-gynecologists. The survey was completed by mail or online between October 26, 2015 and May 8, 2016 with a 52% response rate. Data were weighted to population parameters to reduce the risk of potential nonresponse biases. Analyses included univariate distributions and comparisons between physicians in different residency cohorts using all-pairs dependent t-tests. Results: Findings point to critical features of obstetrician-gynecologist access and sharing of medication safety information. Obstetrician-gynecologists often retrieve medication safety information during a clinical visit. There is widespread provision of potentially problematic "safe lists" to patients, particularly by younger cohorts, and limited counseling for reproductive-aged patients not actively planning a pregnancy. Conclusions: To improve clinical care, physician-patient communication may be enhanced with technical and policy solutions, including improved digital information tools for retrieving and discussing information in the clinical setting; evidence-based, written information for physicians to share with patients; and encouragement for counseling all women of reproductive age receiving teratogenic medications.

Methodology of the Discrimination in the United States survey.

OBJECTIVE: To describe survey methods used to examine reported experiences of discrimination against African Americans, Latinos, Asian Americans, Native Americans, women, and LGBTQ (lesbian, gay, bisexual, transgender, and queer) adults. DATA SOURCE AND STUDY DESIGN: Data came from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We examined the survey instrument, sampling design, and weighting of the survey, and present selected survey findings. PRINCIPAL FINDINGS: Examining reported discrimination experienced by multiple groups in a telephone survey requires attention to details of sampling and weighting. In health care settings, 32 percent of African Americans reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Also, 51 percent of LGBTQ adults, 42 percent of African Americans, and 38 percent of Native Americans reported identity-based violence against themselves or family members; 57 percent of African Americans and 41 percent of women reported discrimination in pay or promotions; 50 percent of African Americans, 29 percent of Native Americans, and 27 percent of Latinos reported being discriminated against in interactions with police. CONCLUSIONS: Even the small selection of results presented in this article as examples of survey measures show a pattern of substantial reported discrimination against all six groups studied.

Views and Experiences of Travelers from US States to Zika-Affected Areas.

Travelers to areas with Zika virus transmission are at risk of infection and of transmitting the virus after returning home. While protective behaviors during and after travel can reduce these risks, information about traveler practices or underlying views is limited. We examined these issues using data from the first representative poll of travelers from US states to Zika-affected areas, including US territories and Miami, Florida, conducted December 1 to 23, 2016. We analyzed results among all travelers (n = 1,285) and 2 subgroups at risk for pregnancy-related complications: (1) travelers in households where someone was pregnant or considering pregnancy (n = 72), and (2) other travelers of reproductive age (n = 631). We also examined results among those with different levels of awareness and knowledge about Zika virus. Results show that in households where someone was pregnant or considering pregnancy, awareness of Zika in the destination, concern about infection, and adoption of protective behaviors was relatively high. That said, sizable shares of travelers as a whole did not know information about asymptomatic and sexual transmission or post-travel behaviors. Further, concern about getting infected during travel was low among travelers as a whole, including other travelers of reproductive age. Few travelers consistently adopted protective behaviors during or after travel. Even among travelers who were aware of Zika in their destination and knew how to protect themselves, adoption of protective behaviors was only slightly higher. Findings from this poll suggest communications may be more effective if tailored to different levels of true and perceived risk. To address gaps in knowledge about transmission and post-travel protective behaviors, messaging should include facts and acknowledge the complexities of novel information and social context. Consideration should also be given to emphasizing other benefits of Zika protective behaviors or prioritizing behaviors that are most feasible.

Parents' Perceptions of the Challenges to Helping Their Children Maintain or Achieve a Healthy Weight.

Introduction: Parents play a critical role in their children's weight. This paper examines parents' perceptions about the challenges to helping their kids maintain or achieve a healthy weight. Methods: We analyzed data in 2017 from a U.S. telephone poll conducted during October-November 2012 among parents or caregivers of children aged 2-17 years using a nationally representative sample of households. It included 667 White, 123 Black, and 167 Hispanic parents. Multiple logistic regressions were used to examine parent perceptions about the individual- and environmental-level challenges to helping their children maintain or achieve a healthy weight. Results: Overall, 45% of children have parents who reported challenges helping the child eat to maintain or achieve a healthy weight, and 35% have parents who reported challenges for exercise. According to parents, most children consumed snacks between 3 pm and bedtime during the school week (83%), and 63% of those children had an unhealthy snack. Parents did not express much concern about unhealthy snacks; 80% of children had parents who said that they did not mind since their child generally ate healthy food. Children with Hispanic and Black parents were more likely than those with White parents to have parents reporting environment challenges, such as unhealthy foods in schools. Conclusions: Helping children maintain a healthy weight through diet is a problem for many parents, regardless of their race or ethnicity. Differences by race/ethnicity in parent perceptions of food environment challenges to helping their child maintain or achieve a healthy weight suggest possible areas for future interventions.

Threats to oral polio vaccine acceptance in Somalia: Polling in an outbreak.

BACKGROUND: Using a survey conducted during the 2013-2014 polio outbreak in Somalia, this study examines attitudinal and knowledge-based threats to oral polio vaccine acceptance and commitment. Findings address a key gap, as most prior research focuses on endemic settings. METHODS: Between November 19 and December 21, 2013, we conducted interviews among 2003 caregivers of children under 5 years in select districts at high risk for polio transmission. Within each district, sample was drawn via a multi-stage cluster design with random route household selection. We calculated the percentage of caregivers who could not confirm recent vaccination and those uncommitted to future vaccination. We compared these percentages among caregivers with varying knowledge and attitudes, focusing on variables identified as threats in endemic settings, using controlled and uncontrolled comparisons. We also examined absolute levels of threat variables. RESULTS: Only 10% of caregivers could not confirm recent vaccination, but 32% were uncommitted to future vaccination. Being unvaccinated or uncommitted were related to multiple threat variables. For example, compared with relevant counterparts, caregivers were more likely to be unconfirmed and uncommitted if they did not trust vaccinators "a great deal" (unconfirmed: 9% vs. 2%; uncommitted: 49% vs. 28%), which is also true in endemic settings. Unlike endemic settings, symptom knowledge was related to commitment while rumor awareness was low and unrelated to past acceptance or commitment. Levels of trust and perceptions of OPV effectiveness were high, though perceptions of community support and awareness of logistics were lower. CONCLUSIONS: As in endemic settings, outbreak responses will benefit from communications strategies focused on enhancing trust in vaccinators, institutions and the vaccine, alongside making community support visible. Disease facts may help motivate acceptance, and enhanced logistics information may help facilitate caregiver availability at the door. Quelling rumors early may be important to prevent them from becoming threats.

Pharmacist Views on Alternative Methods for Antiviral Distribution and Dispensing During an Influenza Pandemic.

Antiviral drugs are likely to be a frontline countermeasure needed to minimize disease impact during an influenza pandemic. As part of pandemic influenza preparedness efforts, the Centers for Disease Control and Prevention, in coordination with state health departments, has plans in place to distribute and dispense antiviral drugs from public stockpiles. These plans are currently under review and include evaluation of the benefits of commercial distribution and dispensing through community pharmacies. To ensure this alternative distribution and dispensing system is viable, it is critical to assess pharmacist acceptability and to understand the pharmacist perspective on dispensing these antivirals during a response. In this study, we examine community pharmacist reactions to the proposed alternative antiviral distribution and dispensing system using a nationally representative survey of pharmacists. Overall, pharmacists were highly receptive to this alternative system and voiced a willingness to participate personally, and most thought their own pharmacy would participate in such an effort. This was true across pharmacists with different personal and professional backgrounds, as well as those in different pharmacy settings. However, sizable shares of pharmacists said they were worried about facing shortages of the antivirals, the risk of exposure to disease for themselves and their families, managing their usual patients who need their prescriptions filled for medications other than antivirals, keeping order in the pharmacy, and potential liability concerns. These findings should be interpreted as an indication of acceptability of the concept, encouragement for the next steps in alternative distribution and dispensing system design, and a guide to potential barriers that may need to be addressed proactively.

Public Views on Alternative Methods for Antiviral Distribution and Dispensing During an Influenza Pandemic.

Antiviral drugs could play a crucial role in minimizing the impact of a severe influenza pandemic. The Centers for Disease Control and Prevention, in coordination with state health departments, has plans to distribute antiviral drugs from federal stockpiles in the case of a pandemic. These plans are currently under review and include evaluation of the benefits of pharmaceutical supply chain distribution and dispensing of antivirals through community pharmacies. While research has shown wide acceptance among pharmacists, public acceptability of going to community pharmacies for stockpiled antivirals in an influenza pandemic is unknown. This study uses the first nationally representative survey of US adults to assess public views of this approach. Overall, there was widespread support for the proposed system, and a majority predicted they would be likely to get antivirals in pharmacies compared to public health clinics. However, preference for using pharmacies dropped substantially when even modest fees were introduced. Those without insurance were less likely to say they would get antivirals and, along with those in lower income groups, were more likely than others to use public health clinics at all cost points. Further, sizable proportions expressed concerns about side effects, a desire to wait until symptoms got worse, and hesitation about using drugs beyond the labeled expiration dates. These factors could decrease uptake of antivirals from any source. Findings should be interpreted as broad acceptability of the concept, encouragement for next steps in system design, and a guide to potential barriers to be addressed.

Understanding threats to polio vaccine commitment among caregivers in high-priority areas of Afghanistan: a polling study.

BACKGROUND: Eradication of poliovirus from endemic countries relies on vaccination of children with oral polio vaccine (OPV) many times a year until the age of 5 years. We aimed to determine caregivers' commitment to OPV in districts of Afghanistan at high risk for polio transmission and to examine what knowledge, attitudes, or experiences could threaten commitment. METHODS: We designed and analysed a poll using face-to-face interviews among caregivers of children under 5 years of age. The sample was drawn via a stratified multistage cluster design with random route household selection. We calculated the percentage of committed and uncommitted caregivers. All percentages were weighted. We then compared percentages of uncommitted caregivers among those with varying knowledge, attitudes, and experiences, using logistic regression to control for possible demographic confounders. FINDINGS: Between Dec 19, 2014, and Jan 5, 2015, we interviewed 1980 caregivers, 21% of whom were "uncommitted" to accepting OPV. Multiple measures of knowledge, attitudes, and experiences are associated with lack of commitment. For example, compared with their relevant counterparts, caregivers are more likely to be uncommitted if they did not trust vaccinators "a great deal" (54% vs 9%), if they do not know that polio spreads through contaminated water (41% vs 14%), or if they believe rumours that OPV is not halal (50% vs 21%). INTERPRETATION: To enhance OPV commitment, it might be useful to consider a multifactorial approach that highlights building trust in vaccinators, providing facts about transmission, sharing positive messages to overcome key rumours, and strengthening community support for vaccination. FUNDING: Harvard T H Chan School of Public Health and UNICEF.

Physician Emergency Preparedness: A National Poll of Physicians.

OBJECTIVE: To provide a more comprehensive view than previously available of US physician preparedness for public health emergencies, this study examined physicians' assessments of their preparedness, training, participation in institutional activities, information practices, and experiences with patient education. Four kinds of public health emergencies were considered: natural disasters, major airborne infections, major foodborne illness outbreaks, and chemical, biological, radiological, nuclear, or explosives (CBRNE) incidents. METHODS: Between October 19, 2011, and January 11, 2012, researchers conducted a national poll among 1603 practicing physicians in a range of specialties in hospital and nonhospital settings. RESULTS: More than one-half of physicians felt prepared to handle a natural disaster, a major outbreak of an airborne infection, or a major foodborne illness outbreak, whereas one-third (34%) felt prepared to handle a CBRNE incident. About one-half of physicians (55%) had participated in training or a conference related to emergencies in the past 2 years. Sizable fractions of physicians were unaware of emergency response tools in their care setting. For example, nearly one-half in hospitals (44%) did not know whether their care setting had an emergency response plan, and less than one-quarter had participated in a drill using such a plan in the past 2 years. Less than one-third (31%) of physicians had signed up to receive alerts in the case of future emergencies. One in 10 reported sharing emergency information with patients at least "sometimes." CONCLUSIONS: Significant gaps remain in physician preparedness for public health emergencies, as well as in related training and participation in institutional activities. New efforts, with a focus on possible collaborations between public health institutions and health system leaders combined with effective use of online resources, are needed to bring more physicians on board and to develop relevant and useful key tools. New approaches, including those that rely on different types of care providers, may be needed to enhance patient education regarding emergency preparedness.

Threats to polio eradication in high-conflict areas in Pakistan and Nigeria: a polling study of caregivers of children younger than 5 years.

BACKGROUND: Elimination of poliovirus from endemic countries is a crucial step in eradication; however, vaccination programmes in these areas face challenges, especially in regions with conflict. We analysed interviews with caregivers of children living in two polio-endemic countries to assess whether these challenges are largely operational or also driven by resistance or misinformation in the community. METHODS: We designed and analysed polls based on face-to-face interviews of a random sample of parents and other caregivers of children younger than 5 years in regions of Pakistan and Nigeria at high risk for polio transmission. In both countries, the sample was drawn via a stratified multistage cluster design with random route household selection. The questionnaire covered awareness, knowledge, and attitudes about polio and oral polio vaccine (OPV), trust in vaccination efforts, and caregiver priorities for government action. We assessed experiences of caregivers in accessible higher-conflict areas and compared their knowledge and attitudes with those in lower-conflict areas. Differences were tested with two-sample t tests. FINDINGS: The poll consisted of 3396 caregivers from Pakistan and 2629 from Nigeria. About a third of caregivers who responded in higher-conflict areas of Pakistan (Federally Administered Tribal Areas [FATA], 30%) and Nigeria (Borno, 33%) were unable to confirm that their child was vaccinated in the previous campaign. In FATA, 12% of caregivers reported that they were unaware of polio, and in Borno 12% of caregivers reported that vaccinators visited but their child did not receive the vaccine or they did not know whether the child was vaccinated. Additionally, caregivers in higher-conflict areas are less likely to hold beliefs about OPV that could motivate acceptance and are more likely to hold concerns than are caregivers in lower-conflict areas. INTERPRETATION: Beyond the difficulties in reaching homes with OPV, challenges for vaccination programmes in higher-conflict areas extend to limited awareness, negative attitudes, and gaps in trust. Vaccination efforts might need to address underlying attitudes of caregivers through direct communications and the selection and training of local vaccinators. FUNDING: Harvard T H Chan School of Public Health and UNICEF.

Adoption of preventive behaviors in response to the 2009 H1N1 influenza pandemic: a multiethnic perspective.

BACKGROUND: As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications. OBJECTIVES: This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic. PATIENTS/METHODS: Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA. RESULTS: People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values <0.05). Exceptions included avoiding others with influenza-like illnesses and receiving 2009 H1N1 and seasonal influenza vaccinations. After we controlled the data for socioeconomic status, demographic factors, healthcare access, and illness- and vaccine-related attitudes, nearly all racial/ethnic differences in behaviors persisted. CONCLUSIONS: Minority groups appear to be receptive to several preventive behaviors, but barriers to vaccination are more pervasive.

The Perspectives of Six Latino Heritage Groups About Their Health Care.

The Latino population in the US is projected to grow substantially in the years ahead. Although often referred to as a single group, Latinos are not homogeneous. This article, based mainly on a national telephone survey of 1,478 Latino adults, examines the perspectives of six Latino heritage groups on the health care issues they face. The six groups differ in their reported health care experiences in: the types facilities they use in getting medical care, their ratings of the quality of care they receive, their experiences with discrimination in getting quality care, the level of confidence they have in being able to pay for a major illness. One thing the heritage groups agree on is that diabetes is the biggest health problem facing their families. Community health leaders, particularly at the state level, need to focus on the specific Latino groups in their state or area and their unique situations.

Public response to an anthrax attack: a multiethnic perspective.

The 2001 anthrax attacks emphasized the need to develop outreach that would more effectively support racial/ethnic minority populations during a bioterrorism incident. Given the importance of antibiotic prophylaxis in a future anthrax attack, it should be a priority to better support racial/ethnic minorities in mass dispensing programs. To examine the needs and perspectives of racial/ethnic minorities, this study used a nationally representative poll of 1,852 adults, including 1,240 whites, 261 African Americans, and 282 Hispanics. The poll examined public reactions to a ''worst-case scenario'' in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within 48 hours. Findings suggest willingness across all racial/ethnic groups to comply with recommendations to seek prophylaxis at dispensing sites. However, findings also indicate possible barriers for racial/ethnic minorities, including greater concern about pill safety and multiple attacks as well as lesser knowledge about inhalation anthrax. Across all racial/ethnic groups, roughly half would prefer to receive antibiotics at mass dispensing sites rather than through the US Postal Service. People in racial/ethnic minority groups were more likely to say this preference stems from a desire to speak with staff or to exchange medication formulation or type. Findings suggest the need for tailored outreach to racial/ethnic minorities through, for example, emphasis on key messages and enhanced understandability in communications, increased staff for answering questions in relevant dispensing sites, and long-term trust building with racial/ethnic minority communities.

Public response to an anthrax attack: reactions to mass prophylaxis in a scenario involving inhalation anthrax from an unidentified source.

An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, delays in initiation of antibiotics may decrease survival chances. Because a rapid response would require cooperation from the public, there is a need to understand the public's response to possible mass dispensing programs. To examine the public's response to a mass prophylaxis program, this study used a nationally representative poll of 1,092 adults, supplemented by a targeted focus on 3 metropolitan areas where anthrax attacks occurred in 2001: New York City (n=517), Washington, DC (n=509), and Trenton/Mercer County, NJ (n=507). The poll was built around a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings from this poll provide important signs of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance, including misinformation about the contagiousness of inhalation anthrax; fears about personal safety in crowds; distrust of government agencies to provide sufficient, safe, and effective medicine; and hesitation about ingesting antibiotic pills after receiving them. In general, people living in areas where anthrax attacks occurred in 2001 had responses similar to those of the nation as a whole.