Social factors associated with AIDS and SARS.We conducted a survey of 928 New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. area residents to assess knowledge and worry about AIDS and SARS. Specific sociodemographic groups of persons were more likely to be less informed and more worried about contracting the diseases. ********** Public reaction to 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. is a critical factor in controlling the diseases. Informed behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. may be needed to control disease transmission. Negative public reactions, such as stigmatizing persons at risk for the disease, may greatly hamper prevention and treatment efforts (1,2). The current public health strategy to control emerging infectious diseases includes timely and complete public reporting (3). Providing timely and complete information, however, cannot determine public reaction to the information. In this study, we examined contrasting relationships between sociodemographic characteristics and knowledge and worry about AIDS and severe acute respiratory syndrome Severe Acute Respiratory Syndrome (SARS) Definition Severe acute respiratory syndrome (SARS) is the first emergent and highly transmissible viral disease to appear during the twenty-first century. (SARS). AIDS may be considered the prototype of an emerging infectious disease. While AIDS has received considerable public attention since the early 1980s, the strong emotions associated with it create the possibility of nonrational information processing information processing: see data processing. information processing Acquisition, recording, organization, retrieval, display, and dissemination of information. Today the term usually refers to computer-based operations. . The stigmatization stigmatization /stig·ma·ti·za·tion/ (stig?mah-ti-za´shun) 1. the developing of or being identified as possessing one or more stigmata. 2. the act or process of negatively labelling or characterizing another. of persons with or at risk for AIDS has persisted despite public information about the disease (4). In contrast, SARS emerged quite abruptly a·brupt adj. 1. Unexpectedly sudden: an abrupt change in the weather. 2. Surprisingly curt; brusque: an abrupt answer made in anger. 3. in 2002-2003 and received intense public media attention, but the disease was declared contained by the World Health Organization in 2003 (5); little public media attention has been paid to SARS since then. The Study Data for this study came from a cohort cohort /co·hort/ (ko´hort) 1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group. 2. of adults ([greater than or equal to] 18 years of age) who lived in metropolitan New York City (NYC NYC abbr. New York City NYC New York City ). The cohort was recruited through a random digit dial telephone survey conducted from March 25 to June 25, 2002. Additional details on the sampling are provided elsewhere (6,7). The response rate was 56%. This rate is typical for well-conducted telephone surveys (7). A total of 1,832 respondents was interviewed from September 24, 2003, to February 29, 2004, for this study. We first asked if respondents had heard about SARS and AIDS; persons who had heard about the diseases were asked if they had heard "a great deal," "some," or "not much" about the diseases. We also asked respondents if they were "not at all worried," "somewhat worried," or "very worried" about contracting the diseases. The analyses were weighted to correct potential selection bias related to the number of household telephones, persons in the household, and oversampling Creating a more accurate digital representation of an analog signal. In order to work with real-world signals in the computer, analog signals are sampled some number of times per second (frequency) and converted into digital code. . The analyses were also weighted to make the sample demographically similar to the NYC metropolitan area population according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. US Census 2000. The institutional review board of the New York Academy of Medicine The New York Academy of Medicine was founded in 1847 by a group of leading New York City metropolitan area physicians as a voice for the medical profession in medical practice and public health reform. approved the study. Table 1 presents the sociodemographic characteristics of respondents and their relationships to self-reported knowledge of AIDS and SARS. In this analysis, we compared characteristics of respondents who reported knowing "nothing" or "not much" and "some" or "a lot" about the diseases. We considered respondents who reported knowing "nothing" or "not much" to be poorly informed. Five percent of the respondents reported being poorly informed about AIDS, and 21% reported being poorly informed about SARS. Table 2 presents the sociodemographic characteristics of the respondents and shows their relationship to worry about contracting AIDS or SARS. In this analysis, we examined characteristics of respondents who reported that they were "very worried" about contracting AIDS or SARS. There were no meaningful difference in the percentage of subjects who reported being "very informed" about each disease or "very worried" about contracting each disease. The factors associated with being poorly informed and worried about contracting AIDS and SARS varied; respondents in the lower socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. group were likely less informed and more worried about both of the diseases. Particularly, racial/ethnic minority status, lower formal education, and lower income were associated with being poorly informed and worried. Being poorly informed about AIDS and being poorly informed about SARS were strongly related. Of respondents who reported being poorly informed about AIDS, 78% reported also being poorly informed about SARS; 18% of the respondents who reported not being poorly informed about AIDS reported being poorly informed about SARS (p<0.001). A strong relationship existed between being very worried about both diseases. Of the respondents who reported being very worried about AIDS, 16% reported also being very worried about SARS; 5% of the respondents who were not very worried about AIDS were very worried about SARS (p = 0.016). Finally, we examined the relationships between being informed and worried about contracting AIDS/SARS. These analyses were confined con·fine v. con·fined, con·fin·ing, con·fines v.tr. 1. To keep within bounds; restrict: Please confine your remarks to the issues at hand. See Synonyms at limit. to respondents who reported having some information about AIDS/SARS; respondents who reported that they had not heard about the diseases were not asked the follow-up questions. In these respondents, no relationship between having heard and being worried about getting the diseases was shown. Conclusions Given the widespread disparities in health among racial/ethnic and socioeconomic groups in 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. (8), that these factors were associated with being less informed and more worried about contracting AIDS or SARS was not surprising. The data presented here, however, are likely not related to access to healthcare services (particularly for SARS) and suggest more fundamental issues in obtaining information and developing realistic concerns about diseases. The high percentage of Spanish-speaking respondents who were poorly informed about AIDS and SARS and very worried about getting SARS suggests possible language and cultural issues in acquiring and processing information. The data from this study were collected in a major city of an industrialized in·dus·tri·al·ize v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es v.tr. 1. To develop industry in (a country or society, for example). 2. country and should not be generalized gen·er·al·ized adj. 1. Involving an entire organ, as when an epileptic seizure involves all parts of the brain. 2. Not specifically adapted to a particular environment or function; not specialized. 3. to developing and transitional countries. Nevertheless, if obtaining and evaluating information is adversely affected by factors such as low education level, low income, and ethnic minority status, then properly informing the public may be particularly difficult in developing and transitional countries. The epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause of AIDS and SARS has been very different in NYC (>58,097 AIDS cases [9], 9 SARS cases). Despite this difference, strong parallels existed in the relationships of socioeconomic factors to knowledge and worry about both diseases. The limitations of this study included using single items to measure knowledge and worry about AIDS and SARS and the standard limitations of telephone surveys, e.g., inability to contact households without telephones, moderate refusal rates. However, this study strongly suggests that adequate public knowledge and emotional assessment may be critical to control these diseases. Our data suggest that socioeconomic class and race/ethnicity factors may help shape public understanding of emerging infectious diseases. Targeted communication to different population subgroups may be required to achieve public understanding of an emerging infectious disease. Dr Des Jarlais is director of research for the Baron Edmond de Rothschild Chemical Dependency chemical dependency n. A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine. chemical dependency Institute at Beth Israel Medical Center Beth Israel Medical Center is a hospital in New York City. It has four major locations providing health services. It acts as University Hospital and Manhattan Campus for the Albert Einstein College of Medicine of Yeshiva University. , a research fellow with the National Development and Research Institutes National Development and Research Institute, Inc. (NDRI) is an independent New York City based 501(c)(3) non-profit think tank founded in 1967. NDRI specializes in advancing scientific knowledge in the areas of drug and alcohol abuse, treatment and recovery; HIV, AIDS and , Inc., and professor of epidemiology with the department of epidemiology and population health of Albert Einstein College of Medicine
The Albert Einstein College of Medicine (AECOM) is a graduate school of Yeshiva University. It is a private medical school located in the Jack and Pearl Resnick Campus of Yeshiva University in the Morris Park in New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of . He began his research on AIDS in 1982 and is a former commissioner of the National Commission on Acquired Immune Deficiency Syndrome Acquired immune deficiency syndrome (AIDS) A viral disease of humans caused by the human immunodeficiency virus (HIV), which attacks and compromises the body's immune system. . References (1.) Kalichman S, Simbayi L. Traditional beliefs about the cause of AIDS and AIDS-related stigma stigma: see pistil. Stigma mark of Cain God’s mark on Cain, a sign of his shame for fratricide. [O. T.: Genesis 4:15] scarlet letter in South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. . AIDS Care. 2004; 16:572-80. (2.) Klosinski L. HIV testing HIV test Various tests have been used to detect HIV and production of antibodies thereto; some HTs shown below are no longer actively used, but are listed for completeness and context. See HIV, Immunoblot. from a community perspective. J Acquir Immune Defic Syndr. 2000;Suppl 2:S94-6. (3.) United States Department of Health and Human Services United States Department of Health and Human Services (USDHHS), n.pr a cabinet-level government organization comprising 12 agencies, including the Food and Drug Administration and the Centers for Disease Control and Prevention. . Communicating in a crisis: risk communication guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for public officials. Washington: The Department; 2002. (4.) Herek G, Capitanio J, Widaman K. HIV-related stigma and knowledge in the United States: prevalence and trends 1991-1999. Am J Public Health. 2002;92:371-7. (5.) United Nations AIDS/World Health Organization. AIDS Epidemic Update. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : The Programme; 2003. (6.) Des Jarlais DC, Galea S galea /ga·lea/ (ga´le-ah) [L.] a helmet-shaped structure. galea aponeuro´tica the aponeurosis connecting the two bellies of the occipitofrontalis muscle. , Tracy M, Tross S, Vlahov D. Stigmatization of newly emerging infectious diseases: AIDS and SARS. Am J Public Health. In press 2005. (7.) Galea S, Vlahov D, Tracy M, Hoover D, Resnick H, Kilpatrick D. Hispanic ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic and post-traumatic stress disorder post-traumatic stress disorder (PTSD), mental disorder that follows an occurrence of extreme psychological stress, such as that encountered in war or resulting from violence, childhood abuse, sexual abuse, or serious accident. after a disaster: evidence from a general populations survey after September 11. Ann Epidemiol. 2004;14:520-31. (8.) Fiscella K, Williams D. Health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. based on socioeconomic inequities: implications for urban health care. Acad Med. 2004;79:1139-47. (9.) New York City Department of Health and Mental Hygiene mental hygiene, the science of promoting mental health and preventing mental illness through the application of psychiatry and psychology. A more commonly used term today is mental health. . HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. epidemiology program 1st quarter report. New York: The Department; 2005. Address for correspondence: Don C. Des Jarlais, Beth Israel Medical Center, 160 Water St, 24th Floor, New York, NY 10038, USA; fax: 212-256-2570; email: dcdesjarla@aol.com Don C. Des Jarlais, * Jennifer Stuber, ([dagger]) Melissa Tracy, ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) Susan Tross, * and Sandro Galea ([double dagger]) * Beth Israel Medical Center, New York, New York, USA; ([dagger]) Columbia University Columbia University, mainly in New York City; founded 1754 as King's College by grant of King George II; first college in New York City, fifth oldest in the United States; one of the eight Ivy League institutions. , New York, New York, USA; and ([double dagger]) New York Academy of Medicine, New York, New York, USA
Table 1. Survey findings of respondents' knowledge about AIDS and
severe acute respiratory syndrome (SARS) (N = 928) *
Poorly informed
Total, n AIDS,
Characteristic (%) n (%) p value
Sex
Male 402 (45.3) 20 (8.0) 0.016
Female 526 (54.7) 13 (2.5)
Race/ethnicity
White 579 (54.1) 19 (2.9) 0.054
Asian 50 (5.0) 5 (16.3)
Black 133 (18.9) 3 (5.7)
Hispanic 131 (19.5) 3 (6.4)
Other 21 (2.6) 2 (11.9)
Age, y
>65 147 (11.9) 12 (6.6)
55-64 125 (12.4) 5 (9.6)
45-54 185 (18.2) 0 (0.0)
35-44 215 (20.7) 4 (1.8)
25-34 185 (25.8) 7 (3.5)
18-24 61 (11.0) 4 (16.3)
Educational status
Graduate work 173 (13.8) 2 (3.3) 0.460
College degree 306 (30.0) 7 (4.7)
Some college 172 (21.4) 2 1.8)
High school/general education
diploma 186 (25.2) 14 (8.3)
Less than high school 89 (9.6) 8 (7.0)
Marital status
Married 409 (52.9) 14 (5.6) 0.907
Divorced/separated/widowed 214 (15.8) 14 (5.2)
Never married/unmarried couple 298 (31.3) 5 (4.1)
Household income at baseline
[greater than or equal to] 75,000 262 (33.8) 4 (1.3) 0.062
$40,000-$74,999 217 (27.9) 3 (4.1)
$20,000-$39,999 158 (23.2) 9 (7.0)
<$20,000 130 (15.2) 8 (9.6)
Total 928 (100.0) 33 (5.6)
Poorly informed
Characteristic SARS, n (% ) p value
Sex
Male 67 (21.7) 0.716
Female 102 (20.2)
Race/ethnicity
White 79 (14.6) <0.0001
Asian 5 (20.8)
Black 30 (17.5)
Hispanic 45 (40.6)
Other 8 (36.1)
Age, y
>65 52 (37.8)
55-64 24 (24.9)
45-54 18 (15.7)
35-44 30 (14.7)
25-34 29 (19.2)
18-24 12 (19.6) 0.006
Educational status
Graduate work 10 (12.8) <0.0001
College degree 32 (12.8)
Some college 23 (17.4)
High school/general education
diploma 62 (27.2)
Less than high school 41 (48.9)
Marital status
Married 69 (22.4) 0.028
Divorced/separated/widowed 56 (28.5)
Never married/unmarried couple 43 (14.7)
Household income at baseline
[greater than or equal to] 75,000 22 (12.3) 0.002
$40,000-$74,999 24 (12.7)
$20,000-$39,999 42 (28.5)
<$20,000 47 (36.8)
Total 169 (20.9)
* Poorly informed respondents reported knowing "nothing" or "little"
about the disease.
Table 2. Survey findings about respondents' worry about AIDS and severe
acute respiratory syndrome (SARS) *
Very worried
Total, AIDS,
n = 928 n = 917
Characteristic (%) (%) p value
Sex
Male 402 (45.3) 20 (6.3) 0.553
Female 526 (54.7) 25 (5.0)
Race/ethnicity
White 579 (54.1) 8 (1.3)
Asian 50 (5.0) 2 (3.5)
Black 133 (18.9) 15 (8.4)
Hispanic 131 (19.5) 19 (15.4)
Other 21 (2.6) 0 (0.0)
Age, y
>65 147 (11.9) 4 (1.2)
55-64 125 (12.4) 3 (1.7)
45-54 185 (18.2) 8 (7.5)
35-44 215 (20.7) 11 (4.5)
25-34 185 (25.8) 16 (11.0)
18-24 61 (11.0) 3 (1.1) 0.006
Educational attainment
Graduate work 173 (13.8) 1 (1.0) <0.0001
College degree 306 (30.0) 5 (2.0)
Some college 172 (21.4) 7 (1.4)
High school/general education 186 (25.2) 16 (10.4)
diploma
Less than high school 89 (9.6) 14 (18.9)
Marital status
Married 409 (52.9) 15 (4.4) 0.627
Divorced/separated/widowed 214 (15.8) 10 (6.0)
Never married/unmarried couple 298 (31.1) 19 (6.8)
Household income at baseline
[greater than or equal to] $75,000 262 (33.8) 4 (1.6) <0.001
$40,000-$74,999 217 (27.9) 6 (4.2)
$20,000-$39,999 158 (23.2) 11 (4.7)
<$20,000 130 (15.2) 18 (22.8)
Total 928 (100) 45 (5.6)
Very worried
SARS, n = 863 (%) p value
Characteristic
Sex
Male 10 (2.0) 0.006
Female 35 (8.0)
Race/ethnicity
White 13 (2.5) 0.028
Asian 4 (20.0)
Black 11 (7.2)
Hispanic 15 (8.3)
Other 2 (3.8)
Age, y
>65 10 (5.4)
55-64 6 (5.4)
45-54 6 (7.4)
35-44 10 (5.5)
25-34 7 (2.6)
18-24 5 (5.9) 0.723
Educational attainment
Graduate work 4 (1.7) 0.250
College degree 13 (4.9)
Some college 11 (7.2)
High school/general education 8 (3.6)
diploma
Less than high school 9 (13.3)
Marital status
Married 13 (5.5) 0.778
Divorced/separated/widowed 14 (5.4)
Never married/unmarried couple 15 (4.0)
Household income at baseline
[greater than or equal to] $75,000 10 (5.9) 0.197
$40,000-$74,999 6 (1.6)
$20,000-$39,999 10 (6.7)
<$20,000 11 (8.2)
Total 45 (5.2)
* Among those who had heard at least something about AIDS (n = 917) and
SARS (n = 863), respectively.
|
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion