Beliefs about appropriate antibacterial therapy, California.To our knowledge, previous population-based surveys have not assessed misconceptions about antibacterial antibacterial /an·ti·bac·te·ri·al/ (-bak-ter´e-al) destroying or suppressing growth or reproduction of bacteria; also, an agent that does this. an·ti·bac·te·ri·al adj. drug use over time. We documented a 26.3% decline in a key misconception in California women in 2003 compared to 2000; declines varied significantly by education level. Educational campaigns specifically designed to influence important subpopulations are needed. ********** Antibacterial drug-resistant bacteria pose a substantial challenge to public health. Inappropriate use of antibacterial drugs, such as using them to treat viral respiratory infections, accelerates the emergence of resistant organisms (1,2). Nonclinical factors, such as patient expectation and demand, contribute to inappropriate antibacterial prescribing (3-6). To address patient misconceptions and physician prescribing behavior, the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. , along with states and private health organizations, initiated educational programs and campaigns to encourage the judicious use of antimicrobial antimicrobial /an·ti·mi·cro·bi·al/ (-mi-kro´be-al) 1. killing microorganisms or suppressing their multiplication or growth. 2. an agent with such effects. drugs (7). In 1999, the California Medical Association Foundation initiated the Alliance Working for Antibiotic Resistance antibiotic resistance, n the ability of certain strains of microorganisms to develop resistance to antibiotics. antibiotic resistance Education (AWARE) project. AWARE, a coalition of public and private organizations, was launched to educate physicians and consumers about appropriate antibacterial drug use. In 2003, AWARE worked with a coalition of minority physicians, including Asian physicians, to reduce inappropriate antibacterial use in minority communities (Elissa Maas, pers. comm.). To date, few studies assess the effect of these educational campaigns over time, especially among underserved populations. We surveyed a population-based sample of California women to identify the magnitude of and characteristics independently associated with the misconception that a cold or flu should usually be treated with an antibacterial drug in 2000 and 2003. We assessed temporal trends in the prevalence of this misconception by comparing the prevalence reported in 2003 with that reported in 2000 for the entire study sample and by specific risk characteristics. The Study The California Women's Health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. Survey is an ongoing, monthly telephone survey that collects information on health-related behavior and attitudes from randomly selected adult women (8,9). Trained staff interviewed participants in 2000 (n = 4,012) and 2003 (n = 4,004) in English (n = 7,058) or Spanish (n = 958). Participants reported race, ethnicity, country of birth, year of entrance into the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , and current age, county of residence, number and age(s) of children, educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.[1] The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the , household income, and access to healthcare coverage. We defined the key misconception as an affirmative answer to the following dichotomized question: "Antibiotics, such as penicillin, doxycycline doxycycline /doxy·cy·cline/ (dok?se-si´klen) a semisynthetic broad-spectrum tetracycline antibiotic, active against a wide range of gram-positive and gram-negative organisms; used also as d. calcium and d. hyclate. , or amoxicillin amoxicillin /amox·i·cil·lin/ (ah-mok?si-sil´in) a semisynthetic derivative of ampicillin effective against a broad spectrum of gram-positive and gram-negative bacteria. a·mox·i·cil·lin n. , are used to treat a variety of medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. ; do you believe that a cold or flu should usually be treated with antibiotics?" We calculated the crude proportion of women who held this misconception by year with weighted proportions and Mantel-Haenszel chi-square statistics that adjusted each sample to the age and race distribution of the 1990 California population (8,9). We examined the relationship between the misconception and the characteristics listed in Table 1 by year of study by using prevalence proportions and unconditional logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. . To produce comparable results, multivariate models for 2000 and 2003 included all variables that demonstrated a significant association with the misconception in either year in univariate analyses. We developed a third multivariate model that combined data from both years to assess the independent association between the misconception and year of study. While we used logistic regression to assess for confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor , we present unadjusted prevalence ratios and calculate relative prevalence reductions to measure changes in the misconception over time. We did so because the unadjusted and adjusted results by logistic regression were equivalent (which suggests an absence of confounding) and because the odds ratio did not reasonably approximate the prevalence ratio for women without a high school education (10). We considered p values <0.01 to be significant, but we present 95% confidence intervals (CIs) to facilitate comparing our results to those from other studies. We restricted all models to participants who gave usable responses to all variables (n = 7,430) and assessed models for potential 2-way interactions, goodness of fit Goodness of fit means how well a statistical model fits a set of observations. Measures of goodness of fit typically summarize the discrepancy between observed values and the values expected under the model in question. Such measures can be used in statistical hypothesis testing, e. , and potential colinearity. In California, 21.0% of women surveyed in 2003 believed a cold or flu should usually be treated with an antibacterial drug. Table 1 lists factors independently associated with this key misconception among California women. In both 2000 and 2003, the unadjusted prevalence of the misconception was greatest among women who were Hispanic, 18-34 years of age, had an annual household income [less than or equal to] $14,999, had <12 years of education, resided in central or southern California Southern California, also colloquially known as SoCal, is the southern portion of the U.S. state of California. Centered on the cities of Los Angeles and San Diego, Southern California is home to nearly 24 million people and is the nation's second most populated region, , had lived in the United States for [less than or equal to] 5 years, had children <6 years of age in the household, or had no access to a healthcare plan. We observed a 26.3% decline in the prevalence of the misconception in all women surveyed in 2003 compared with those surveyed in 2000 (21.0% vs. 28.5%, p<0.001). Table 1 shows consistent declines across risk characteristics, with several notable exceptions. First, we detected a strong statistical interaction between education and year (p = 0.007); women with a college diploma were 47.0% less likely and women without a high school diploma A high school diploma is a diploma awarded for the completion of high school. In the United States and Canada, it is considered the minimum education required for government jobs and higher education. An equivalent is the GED. were 17.0% less likely to report the misconception in 2003 than those surveyed in 2000 (Table 2). Women with a high school diploma were as likely to report the misconception in 2000 and 2003. Second, although not significant, after adjusting for other associated factors, Asian women were 55.7% less likely to report the misconception in 2003 compared with those surveyed in 2000. Other women were, on average, 24.0% less likely to report the misconception in 2003 than in 2000. Among women [greater than or equal to] 55 years of age, African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. women were as likely to report the misconception in 2003 as 2000, and their adjusted odds ratio for the misconception increased from 3.1 (95% CI 1.70-5.67) in 2000 to 5.3 (95% CI 2.67-10.52) in 2003 (detailed data on race stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. by age and year not shown). Conclusions Our survey results show a 26.3% decline from 2000 to 2003 in the misconception among California women that a cold or flu should usually be treated with an antibacterial drug. This finding suggests that general educational campaigns before and during this period may have contributed to moderate reductions in the prevalence of misconceptions about antibacterial drug use. Although this study was not designed to evaluate specific interventions, our study period and population-based sample can provide an ecologic assessment of changing beliefs. The decline in the misconception was greatest among women who were non-Hispanic white or Asian, had at least some college education, or had higher household incomes. Among levels of education, why women who graduated from high school had the smallest decline is unclear. This finding may reflect a true unexplained finding, an artifact A distortion in an image or sound caused by a limitation or malfunction in the hardware or software. Artifacts may or may not be easily detectable. Under intense inspection, one might find artifacts all the time, but a few pixels out of balance or a few milliseconds of abnormal sound of the sample (selection or information bias), or chance. The inverse relationship A inverse or negative relationship is a mathematical relationship in which one variable decreases as another increases. For example, there is an inverse relationship between education and unemployment — that is, as education increases, the rate of unemployment between the misconception and the presence of children <6 years of age in the household in 2000 may indicate success in initial educational campaigns focused on pediatricians and mothers with young children; that this relationship becomes less significant in 2003 may indicate that other women are "catching up." Our findings, drawn from a large, ethnically diverse, population-based sample, show that 21.0% of California women in 2003 still held the misconception, particularly women who were younger, black, or Hispanic; had lower educational attainment or household income; resided in central and southern California; or had no healthcare coverage. Although not restricted to women, other studies identified similar demographic and socioeconomic risk groups (11,12). Social services social services Noun, pl welfare services provided by local authorities or a state agency for people with particular social needs social services npl → servicios mpl sociales intended to reach persons with these characteristics may be important venues for education on appropriate antibacterial drug use. Cultural and social perspectives of disease, including differences in antibacterial drug regulations that affect the availability and cost of drugs in immigrants' countries of birth, can play an important role in misconceptions about antibacterial drugs (13,14). We documented racial and ethnic variation in California women with the misconception, despite adjusting for selected socioeconomic factors; the remaining variation likely reflects unmeasured socioeconomic or cultural factors. We note, in particular, the persistent prevalence of the misconception in African American women and the decreased prevalence of it in Asian women. While this study could not evaluate specific interventions, some California AWARE activities were focused on Asian physicians during 2003. Other research has documented racial and ethnic variation in parental expectations of antibacterial drugs (15). New intervention studies intervention studies, n.pl the epidemiologic investigations designed to test a hypothesized cause and effect relation by modifying the supposed causal factor(s) in the study population. and campaigns aimed at educating and influencing women in specific minority, education, and income subgroups about appropriate antibacterial drug use are needed. Our study has several limitations. First, although women may be more likely to be the health decisionmakers for young children and for the household, we do not know if our results can be generalized to men. Second, we did not have sufficient sample size to explore specific subgroups within the Asian race category. Third, we only included women in households with telephones who spoke either Spanish or English and chose to participate. Fourth, we were only able to interview women in Spanish or English, which may limit comparability between immigrant Hispanic and Asian women. Finally, this misconception may not equivocate e·quiv·o·cate intr.v. e·quiv·o·cat·ed, e·quiv·o·cat·ing, e·quiv·o·cates 1. To use equivocal language intentionally. 2. To avoid making an explicit statement. See Synonyms at lie2. to antibacterial drug expectation or demand. In conclusion, our surveys document a decline in a key misconception in California women about appropriate antibacterial drug use and support continuation of educational campaigns to address this public health problem. Further refining and focusing of these educational efforts are needed to reach minority women and women with lower educational attainment and lower household incomes.
Table 1. Factors associated with the misconception that cold or flu
should be treated with antibacterial drugs, California, 2000 and 2003 *
% in 2000 ([dagger]) (n = 3,703)
Characteristic (OR ([double dagger]) 95% CI)
Race/ethnicity
Black, non-Hispanic 40.6 (2.57, 1.88-3.52)
Hispanic 46.2 (2.00, 1.58-2.52)
Asian/other 37.1 (2.67, 1.94-3.67)
White, non-Hispanic 19.4 (referent)
Age (y)
18-34 36.1 (2.13, 1.74-2.61)
35-54 18.9 (referent)
[greater than or equal to] 55 28.5 (1.59, 1.27-1.97)
Annual household income ($US)
[less than or equal to] 14,999 46.9 (2.48, 1.91-3.22)
15,000-24,999 36.8 (2.03, 1.56-2.64)
25,000-49,999 25.9 (1.62, 1.30-2.03)
[greater than or equal to] 50,000 12.9 (referent)
Education
<12 y 52.2 (3.03, 2.23-4.10)
High school graduate/GED 31.8 (1.91, 1.50-2.44)
Some college 20.5 (1.33, 1.04-1.69)
College graduate 13.9 (referent)
Region of California ([section])
Central 28.2 (1.34, 1.04-1.74)
Southern 29.9 (1.40, 1.16-1.70)
Northern 18.7 (referent)
Years in United States
[less than or equal to] 5 57.1 (2.03, 0.86-4.79)
6-10 50.8 (1.52, 0.98-2.35)
>10 36.6 (0.98, 0.77-1.23)
US-born 21.9 (referent)
Children <6 y in household
Yes 28.9 (0.61, 0.49-0.76)
No 25.0 (referent)
Access to health plan
No 44.1 (1.06, 0.84-1.35)
Yes 22.9 (referent)
% in 2003 ([dagger]) (n = 3,727)
Characteristic (OR ([double dagger]), 95% CI)
Race/ethnicity
Black, non-Hispanic 32.5 (2.82, 1.98-4.08)
Hispanic 39.5 (1.96, 1.51-2.53)
Asian/other 19.7 (1.78, 1.21-2.62)
White, non-Hispanic 13.8 (referent)
Age (y)
18-34 26.7 (1.55, 1.23-1.94)
35-54 14.5 (referent)
[greater than or equal to] 55 19.7 (1.24, 0.97-1.58)
Annual household income ($US)
[less than or equal to] 14,999 41.9 (3.10, 2.34-4.10)
15,000-24,999 29.3 (1.94, 1.44-2.62)
25,000-49,999 20.3 (1.70, 1.32-2.19)
[greater than or equal to] 50,000 8.5 (referent)
Education
<12 y 43.1 (3.16, 2.26-4.44)
High school graduate/GED 29.3 (3.08, 2.34-4.07)
Some college 15.7 (1.79, 1.35-2.36)
College graduate 7.3 (referent)
Region of California ([section])
Central 24.8 (1.65, 1.25-2.17)
Southern 21.4 (1.38, 1.10-1.71)
Northern 13.1 (referent)
Years in United States
[less than or equal to] 5 42.7 (1.58, 0.97-2.58)
6-10 34.6 (1.24, 0.79-1.94)
>10 29.6 (1.11, 0.85-1.44)
US-born 15.3 (referent)
Children <6 y in household
Yes 24.9 (0.86, 0.68-1.09)
No 17.5 (referent)
Access to health plan
No 37.2 (1.30, 1.02-1.65)
Yes 16.4 (referent)
* OR, odds ratio; CI, confidence interval, GED, general equivalency
diploma.
([dagger]) Percent represents number of respondents with misconception
divided by total number of respondents. Percentages for race/ethnicity
and age are weighted to the 1990 California population; all other
percentages are unweighted.
([double dagger]) Adjusted for all characteristics listed in the table.
([section]) Central = Fresno, Kern, Kings, Madera, Merced, Monterey,
San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus,
and Tulare Counties; southern = Imperial, Los Angeles, Orange,
Riverside, San Bernardino, San Diego, and Ventura counties;
northern = all remaining counties.
Table 2. Decline in the misconception, by education level, that
cold or flu should be treated with antibacterial drugs, California,
2000 and 2003 *
% decrease
Education level % ([dagger]) (PR, 95% CI) ([double dagger])
<12 y
2003 study 43.1 (0.83, 0.72-0.95) 17.0
2000 study 52.2 (referent)
High school
graduate/GED
2003 29.3 (0.92, 0.80-1.06) 8.0
2000 31.8 (referent)
Some college
2003 15.7 (0.77, 0.64-0.92) 23.0
2000 20.5 (referent)
College graduate
2003 7.3 (0.53, 0.42-0.67) 47.0
2000 13.9 (referent)
* PR, unadjusted prevalence ratio; CI, confidence interval, GED,
general equivalency diploma.
([dagger]) Number respondents with misconception divided by total
number respondents.
([double dagger]) Percent decrease from 2000 to 2003.
Acknowledgments We thank Elissa Maas and the AWARE steering committee steer·ing committee n. A committee that sets agendas and schedules of business, as for a legislative body or other assemblage. steering committee Noun for thoughtful input on the findings and for their work on antibacterial resistance education in California The California education system consists of a full range of public and private schools in California, from the University of California system, to well-known private colleges, to an extensive network of secondary and primary education schools. , and Layla Cummings for her assistance on the analysis of the 2000 data. References (1.) Kunin CM. Resistance to antimicrobial drugs: a worldwide calamity. Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med. 1993;118:557-61. (2.) Neu HC. The crisis in antibiotic resistance. Science. 1992;257:1064-73. (3.) MacFarlane MacFarlane or Macfarlane is a surname shared by:
lung - either of two saclike respiratory organs in the chest of vertebrates; serves to remove carbon dioxide and provide oxygen to the blood illness in general practice: questionnaire study. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift . 1997;315:1211-4. (4.) Barden L, Dowell S, Schwartz B, Lackey C. Current attitudes regarding use of antimicrobial agents Antimicrobial agents Chemical compounds biosynthetically or synthetically produced which either destroy or usefully suppress the growth or metabolism of a variety of microscopic or submicroscopic forms of life. : results from physicians and parents' focus group discussions. Clin Pediatr (Phila). 1998;37:665-72. (5.) Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. antimicrobial prescribing behavior. Pediatrics. 1999;103:711-8. (6.) Dosh SA, Hickner JM, Mainous AGI (Artificial General Intelligence) A machine intelligence that resembles that of a human being. Considered impossible by many, most artificial intelligence (AI) research, projects and products deal with specific applications such as industrial robots, playing chess, , Ebell MH. Predictors of antibiotic prescribing for nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik) 1. not due to any single known cause. 2. not directed against a particular agent, but rather having a general effect. nonspecific 1. upper respiratory infections Noun 1. upper respiratory infection - infection of the upper respiratory tract respiratory infection, respiratory tract infection - any infection of the respiratory tract , acute bronchitis acute bronchitis Pulmonology A lower RTI–up to 95% of which are viral–that causes reversible bronchial inflammation Clinical Cough, fever, sputum, wheezing, rhonchi DiffDx Asthma, aspergillosis, occupational exposure, chronic bronchitis, sinusitis, , and acute sinusitis sinusitis Inflammation of the sinuses. Acute sinusitis, usually due to infections such as the common cold, causes localized pain and tenderness, nasal obstruction and discharge, and malaise. ; a UPRNet study. J Fam Pract. 2000;49:407-13. (7.) Centers for Disease Control and Prevention. Preventing emerging infectious diseases An emerging infectious disease (EID) is an infectious disease whose incidence has increased in the past 20 years and threatens to increase in the near future. EIDs include diseases caused by a newly identified microorganism or newly identified strain of a known microorganism (e.g. ; addressing the problem of antimicrobial resistance: a strategy for the 21st Century. [cited 2005 Jan 23]. Available from http://www.cdc.gov/ncidod/ emergplan/antiresist/antimicrobial.pdf (8.) California Department of Health Services Department of Health Services may refer to:
(9.) California Department of Health Services and the Public Health Institute. California Women's Health Survey. SAS dataset documentation and technical report. 2003. (10.) Deeks J. When can odds ratios mislead? Odds ratios should be used only in case-control studies and logistic regression analyses [letter]. BMJ. 1998;317:1155-6. (11.) Eng JV, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, et al. Consumer attitudes and use of antibiotics. Emerg Infect Dis. 2003;9:1128-33. (12.) Corbett KK, Gonzales R, Leeman-Castillo BA, Flores Flores, town, Guatemala Flores (flōrəs), town (1990 est. pop. 2,200), capital of Petén department, N Guatemala. Flores was built on an island in the southern part of Lake Petén Itzá and on the site of the E, Maselli J, Kafadar K. Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language. Prev Med. 2005;40:162-9. (13.) Harbarth S, Albrich W, Brun-Buisson C. Outpatient antibiotic use and prevalence of antibiotic-resistance pneumococci in France and Germany: a sociocultural so·ci·o·cul·tur·al adj. Of or involving both social and cultural factors. so  ci·o·cul perspective. Emerg Infect Dis. 2002;8:1460-7.(14.) McKee MD, Mills L, Mainous AG 3rd. Antibiotic use for the treatment of upper respiratory infections in a diverse community. J Fam Pract. 1999;48:993-6. (15.) Mangione-Smith R, Elliott MN, Stivers T, McDonald L, Heritage J, McGlynn EA. Racial/ethnic variation in parent expectations for antibiotics: implications for public health campaigns. Pediatrics. 2004;113:385-94. Kate C. Cummings, * Jon Rosenberg, * and Duc J. Vugia * * California Department of Health Services, Berkeley, California Berkeley is a city on the east shore of San Francisco Bay in Northern California, in the United States. Its neighbors to the south are the cities of Oakland and Emeryville. To the north is the city of Albany and the unincorporated community of Kensington. , USA Ms. Cummings is an infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. epidemiologist at the Division of Communicable Disease communicable disease n. A disease that is transmitted through direct contact with an infected individual or indirectly through a vector. Also called contagious disease. Control, California Department of Health Services. Her research interests include the epidemiology of emerging infections, drug-resistant organisms, and application of evidence-based control measures. Address for correspondence: Kate C. Cummings, California Department of Health Services, Immunization immunization: see immunity; vaccination. Branch, Division of Communicable Disease Control, 2151 Berkeley Way, Room 715, Berkeley, CA 94704, USA; fax: 510-883-6015; kcumming@dhs.ca.gov |
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion