West Nile virus in British Columbia.We investigated personal protective behaviors against West Nile virus West Nile virus, microorganism and the infection resulting from it, which typically produces no symptoms or a flulike condition. The virus is a flavivirus and is related to a number of viruses that cause encephalitis. infection. Barriers to adopting these behaviors were identified, including the perception that DEET (N,N-diethyl-m-toluamide and related compounds) is a health and environmental hazard 'Environmental hazard' is a generic term for any situation or state of events which poses a threat to the surrounding environment. This term incorporates topics like pollution and Natural Hazards such as storms and earthquakes. , Televised public health messages and knowing that family or friends practiced protective behaviors were important cues to action. ********** Personal protective behaviors are the primary means of preventing human illness from West Nile virus (WNV WNV West Nile Virus WNV World Net Visions ) infection (1). To plan effective WNV prevention and control programs, we must know the factors that influence adopting protective behaviors (2). The health belief model is a theoretical framework that has investigated health behaviors related to infectious diseases infectious diseases: see communicable diseases. , including tuberculosis, 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. , influenza, and measles (3-8). The major tenet of this model is that persons will take action to ward off an illness if they believe that they are susceptible, the illness has serious consequences, the course of action is beneficial, or the anticipated benefits of action outweigh the costs (9). To investigate the determinants of engaging in WNV protective behaviors in British Columbia British Columbia, province (2001 pop. 3,907,738), 366,255 sq mi (948,600 sq km), including 6,976 sq mi (18,068 sq km) of water surface, W Canada. Geography (B.C.), we developed a questionnaire using the health belief model as a framework. The Study Participants were randomly selected from a systematic random sample of B.C. residential telephone records. Telephone interviews were conducted from July 2 through August 18, 2003. The study concluded after 309 interviews were completed, a predetermined pre·de·ter·mine v. pre·de·ter·mined, pre·de·ter·min·ing, pre·de·ter·mines v.tr. 1. To determine, decide, or establish in advance: endpoint based on allowable resources. A questionnaire was designed specifically for this study. We measured the frequeney (1 = never to 5 = always) with which participants said they practiced protective behaviors (applied mosquito repellent, eliminated standing water, and avoided mosquitoes). The following predictor items measured concepts of the health belief model: knowledge (mode of transmission, risk groups), susceptibility to illness, severity of illness, barriers to action (safety concerns, cost), benefits of action, and cues to action (behavior of relatives, sources of information). Response options for predictors were measured on a 5-point Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc and signified the respondent's agreement with a statement (1 = strongly disagree to 5 strongly agree) or belief that an event would occur (1 = not at all likely to 5 = very likely). Response options for predictors measured with multiple-choice questions were scored as correct or incorrect. The subscore for a concept was calculated by averaging the scores obtained from questions specific to that concept. The subscore for the knowledge concept was calculated by counting the number of correct responses. We ascertained the participant's sex, age, ethnicity, education, and income. Participants were also asked to report the level of mosquito activity near their residence (low, medium, high). A response rate of 64.6% (307 of 477) was calculated by dividing the number of completed surveys by the number of persons contacted. Respondents were more likely to be women, older, more educated, and in a higher income bracket Noun 1. income bracket - a category of taxpayers based on the amount of their income income tax bracket, tax bracket bracket - a category falling within certain defined limits income bracket n → than the general population. Most respondents said they obtained information about WNV by watching television (n = 180, 62.9%). While almost all (n = 285, 98.6%) were aware that WNV was transmitted by mosquitoes, 57.9% (n = 159) were aware that adults [greater than or equal to] 50 years of age are at greatest risk for serious illness. Of those unaware of this fact, 52.0% (n = 63) were >50 years of age. At least occasional practice of the following specific protective behaviors was reported: 197 (68.2%) removed standing water, 168 (58.1%) practiced mosquito avoidance behavior avoidance behavior, n a conscious or unconscious defense mechanism by which a person tries to escape from unpleasant situations or feelings, such as anxiety and pain. , and 162 (56.0%) used DEET-based mosquito repellents (Figure). When asked if information about WNV had influenced them to remove standing water, agreement or strong agreement was reported by 213 (73.7%) respondents, 147 (50.9%) for using DEET (N,N-diethyl-m-toluamide and related compounds)-based mosquito repellent, and 110 (38.1%) for avoiding mosquitos. [FIGURE OMITTED] The most prominent barriers to practicing protective behaviors were perception that DEET is a health and environmental hazard, the time required to remove standing water, and participating in outdoor leisure activities during peak mosquito hours. Approximately half (n = 113, 45.9%) of respondents claiming to have spent time outdoors during peak mosquito hours did so to participate in leisure activities (walking, playing with kids, gardening). More than one third (n = 101, 35.1%) agreed or strongly agreed that removal of standing water was time consuming. More than one third (n = 101, 35.1%) believed DEET is hazardous to the environment, and more than one quarter (n = 78, 27.1%) disagreed or strongly disagreed that it is safe for human use. The proportional odds ordinal (mathematics) ordinal - An isomorphism class of well-ordered sets. regression model was fit to model the frequency at which persons reported avoiding mosquitoes, applying DEET, and removing standing water (Table). Predictors that were investigated included the composite scores for each of the health belief model concepts, demographic variables (sex, age, area code, education, income, ethnicity), and residential mosquito activity level. Barriers to action and cues to action were important predictors in each of the three models, in addition, perceived susceptibility was significant in modeling the frequency of practicing avoidance of mosquitoes (p < 0.01) and had an associated odds ratio of 1.61 (confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. 1.22-2.12). All other investigated predictors were not significant in multivariate models at the [alpha] = 0.05 level. Conclusions Before the study, the British Columbia Centre for Disease Control and Prevention issued three formal press releases and provided 110 interviews with local or provincial media outlets about WNV and associated protective behaviors. Most respondents in our study cited television as their main source of information, which demonstrates the ability of public health messaging to reach audiences through broadcast media. This finding is consistent with findings from other studies (10) and underscores the important role that this medium plays in educating the public (11). The proportion of respondents who said they used DEET-based mosquito repellent or practiced mosquito avoidance behavior was comparable to the proportion found in similar studies conducted in Connecticut (2,10). Eliminating standing water was not specifically investigated in these studies. A national U.S. study reported smaller proportions of respondents who said that they avoided the outdoors during dawn or dusk (24%), used DEET-based mosquito repellent (31%), and eliminated standing water (31%) (12). Differences may be the result of the varying levels of WNV activity throughout 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. . Regular systematic evaluations of the knowledge, attitudes, and behaviors of the public are needed to ensure the effectiveness of public health messages (2). By using the health belief model as a theoretical framework, we were able to identify barriers to the practice of protective behaviors. The fear that DEET-based mosquito repellents are hazardous to human health and the environment is a barrier of particular concern. These repellents are a mainstay for the personal prevention of WNV (11) and were demonstrated to be an important protective behavior option, given the participation of many respondents in outdoor activities during peak mosquito hours. Instructions for the safe use of DEET are outlined in the literature (13) and should be conveyed to address public fears. Literature on the effects of DEET on the environment is limited. DEET does not readily degrade by hydrolysis hydrolysis (hīdrŏl`ĭsĭs), chemical reaction of a compound with water, usually resulting in the formation of one or more new compounds. at environmental pHs (14) and has been identified as a ubiquitous pollutant in aquatic ecosystems, but the effect of this is unknown (15). A deficiency was also observed in the proportion of respondents who were aware that persons [greater tha or equal to] 50 years of age were at greatest risk for serious illness from WNV. More than half of those unaware were [greater than or equal to] 50 years of age. Making perceptions of susceptibility and severity in this population more consistent with the actual susceptibility and severity could help to influence the adoption of WNV protective behaviors (9). Our study supports the ability of public health education campaigns to influence the practice of WNV protective behaviors. Specifically, we found that most respondents reported that information about WNV influenced them to engage in protective behaviors, and cues to action significantly increased the odds that respondents practiced protective behaviors more frequently. Together, these findings suggest the potential for public health messages that endorse WNV protective behaviors to have a "snowball effect For other uses, see Snowball (disambiguation). Snowball effect is a figurative term for a process that starts from an initial state of small significance and builds upon itself, becoming larger (graver, more serious), and perhaps potentially dangerous or disastrous (a "; public health education can influence persons to practice protective behaviors, and these persons can influence friends and family to do the same. A number of limitations were associated with our study. First, we depended on self-reporting to measure frequency of practicing WNV protective behaviors, and no effort was made to validate the participants' responses. If participants attempted to please interviewers, the frequency of protective behavior practice may have been overestimated. Second, administering the interview by telephone excluded persons who did not have telephones or only had cellular phones, which may have contributed to the observed demographic differences between our study population and the general population. Consequently, findings may not be generalizable outside the study population. Third, information on nonrespondents was not obtained, and differences between them and the study population could not be ascertained. Thus, the effects of this bias could not be determined. Despite these limitations, this study will help public health officials achieve the goal of promoting WNV protective behaviors and reducing the risk for infection.
Table. Results of modeling reported frequency of personal protective
behavior with proportional odds ordinal regression (a)
Significant
Outcome modeled predictor variables [beta]
Practicing mosquito Perceived barriers to action -0.77
avoidance behavior Cues to action 1.08
Perceived susceptibility 0.48
Reported frequency Perceived barriers to action -0.70
of using DEET-based Cues to action 1.19
mosquito repellent
Reported frequency Perceived barriers to action -1.25
of eliminating Cues to action 1.27
standing water
Significant
Outcome modeled predictor variables OR (95% CI)
Practicing mosquito Perceived barriers to action 0.46 (0.35-0.62)
avoidance behavior Cues to action 2.96 (2.32-3.77)
Perceived susceptibility 1.61 (1.22-2.12)
Reported frequency Perceived barriers to action 0.50 (0.31-0.79)
of using DEET-based Cues to action 3.30 (2.49-4.38)
mosquito repellent
Reported frequency Perceived barriers to action 0.29 (0.20-0.42)
of eliminating Cues to action 3.56 (2.49-5.09)
standing water
Significant
Outcome modeled predictor variables p value
Practicing mosquito Perceived barriers to action < 0.01
avoidance behavior Cues to action < 0.01
Perceived susceptibility < 0.01
Reported frequency Perceived barriers to action < 0.01
of using DEET-based Cues to action < 0.01
mosquito repellent
Reported frequency Perceived barriers to action < 0.01
of eliminating Cues to action < 0.01
standing water
(a) OR, odds ratio; CI, confidence interval; DEET,
N,N-diethyl-m-toluamide and related compounds.
Acknowledgments We thank Lisan Kwindt for her administrative assistance with this research, Rick White for guidance on statistical issues, and West Coast Research for administering the telephone interviews. This research was funded by the British of Columbia Centre for Disease Control and Prevention. References (1.) Campbell G, Martin A, Lanciotti R, Gubler D. West Nile virus. Lancet Infect Dis. 2002;2:519-29. (2.) 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. . Knowledge, attitudes, and behaviors about West Nile West Nile may refer to:
(3.) Hochbaum G. Public participation in medical screening programs: a sociopsychological so·ci·o·psy·cho·log·i·cal adj. 1. Of or relating to social psychology. 2. Of, relating to, or combining social and psychological factors. study. PHS publication no. 572. Washington: U.S. Government Printing Office; 1958. (4.) Poss v. t. 1. To push; to dash; to throw. A cat . . . possed them [the rats] about. - Piers Plowman. J. Developing an instrument to study the tuberculosis screening behaviors of Mexican migrant farmworkers. J Transcult Nurs. 1999;10:306-19. (5.) Neff JA, Crawford SL. The health belief model and HIV risk behaviours: a causal model A causal model is an abstract model that uses cause and effect logic to describe the behaviour of a system. See also [IMG][1]]
(6.) Nexoe J, Kragstrup J, Sogaard J. Decision on influenza vaccination among the elderly. A questionnaire study based on the health belief model and the multidimensional locus of control locus of control n. A theoretical construct designed to assess a person's perceived control over his or her own behavior. The classification internal locus indicates that the person feels in control of events; external locus theory. Scand J Prim Health Care. 1999;17:105-10. (7.) Blue CL, Valley JM. Predictors of influenza vaccine influenza vaccine Flu vaccine A vaccine recommended for those at high risk for serious complications from influenza: > age 65; Pts with chronic diseases of heart, lung or kidneys, DM, immunosuppression, severe anemia, nursing home and other chronic-care . Acceptance among healthy adult workers. AAOHN AAOHN American Association of Occupational Health Nurses J. 2002;50:227-33. (8.) Pielak KL, Hilton A. University students immunized and not immunized for measles: a comparison of beliefs, attitudes, and perceived barriers and benefits. Can J Public Health. 2003;94:193-6. (9.) Glanz K, Lewis F, Rimer rim·er n. Variant of rhymer. B, editors. Health behavior and health education; theory, research and practice. San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden : Jossey Bass; 1990. p. 37-57. (10.) McCarthy T, Hadler J, Julian K, Walsh S, Biggerstaff B, Hinten S, et al. West Nile virus serosurvey and assessment of personal prevention efforts in an area with intense epizootic ep·i·zo·ot·ic adj. Affecting a large number of animals at the same time within a particular region or geographic area. Used of a disease. ep activity: Connecticut, 2000. Ann NY Acad Sci. 2001;951:307-16. (11.) Centers for Disease Control and Prevention. Epidemic/Epizootic West Nile virus in the United States: guidelines for surveillance, prevention, and control, 3rd revision. Atlanta: Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS ; 2003 (12.) Blendon R, Benson J, DesRoches C, Herrmann M, Mackie E, Weldon K. Working papers working papers pl.n. Legal documents certifying the right to employment of a minor or alien. Noun 1. working papers : project on biological security and the public and West Nile virus. Harvard School of Public Health The Harvard School of Public Health is (colloquially, HSPH) is one of the professional graduate schools of Harvard University. Located in Longwood Area of the Boston, Massachusetts neighborhood of Mission Hill, next to Harvard Medical School and Cambridge, Massachusetts, ; 2003.Available from: http://www.hsph.harvard.edu/press/releases/mosquitoes/top linerelease.pdf (13.) Health Canada Health Canada (French: Santé Canada) is the department of the government of Canada with responsibility for national public health. Health Canada's goal is to improve Canadian life by improving Canadian longevity, lifestyle and use of public healthcare. . Pest Management Regulatory Agency regulatory agency Independent government commission charged by the legislature with setting and enforcing standards for specific industries in the private sector. The concept was invented by the U.S. . Re-evaluation decision document RRD RRD R.R. Donnelley RRD Round Robin Database (a system to store and display time-series data) RRD Removable Rigid Disk RRD Rhegmatogenous Retinal Detachment RRD Radio Regulatory Department RRD Regimental Reconnaissance Detachment 2002-01: personal insect repellents containing DEET (N,N-diethyl-m-toluamide and related compounds). Ottawa, Ontario, Canada: Submission Coordination and Documentation Division, Pest Management Regulatory Agency, Health Canada; 2002. (14.) U.S. Environmental Protection Agency Environmental Protection Agency (EPA), independent agency of the U.S. government, with headquarters in Washington, D.C. It was established in 1970 to reduce and control air and water pollution, noise pollution, and radiation and to ensure the safe handling and , Office of Pesticide Programs. DEET: Reregistration eligibility decision. Washington: U.S. Government Printing Office; 1998. (15.) Weigel S, Kuhlmann J, Huhnerfuss H. Drugs and personal care products as ubiquitous pollutants: occurrence and distribution of clofibric acid, caffeine and DEET in the North Sea. Sci Total Environ. 2002;295:131-41. Mr. Aquino received a Master of Health Science in Community Health and Epidemiology from the Department of Public Health Sciences at the University of Toronto Research at the University of Toronto has been responsible for the world's first electronic heart pacemaker, artificial larynx, single-lung transplant, nerve transplant, artificial pancreas, chemical laser, G-suit, the first practical electron microscope, the first cloning of T-cells, and conducted this research during a placement at the British Columbia Centre for Disease Control and Prevention. Address for correspondence: Murray Fyfe, Epidemiology Services, BC CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation , 655 12th Ave W, Vancouver, BC, V5Z4R4; fax: 604-660-0197; email: murray.fyfe@bccdc.ca Michael Aquino, * Murray Fyfe, ([dagger]) Laura MacDougall, ([dagger]) and Valencia Remple ([dagger]) * University of Toronto, Toronto, Canada; and ([dagger]) British Columbia Centre for Disease Control and Prevention, Vancouver, Canada |
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