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Mathematical modeling of infectious diseases can help public health officials to make decisions related to the mitigation of epidemic outbreaks. However, over or under estimations of the morbidity of any infectious disease can be problematic. Therefore, public health officials can always make use of better models to study the potential

Mathematical modeling of infectious diseases can help public health officials to make decisions related to the mitigation of epidemic outbreaks. However, over or under estimations of the morbidity of any infectious disease can be problematic. Therefore, public health officials can always make use of better models to study the potential implication of their decisions and strategies prior to their implementation. Previous work focuses on the mechanisms underlying the different epidemic waves observed in Mexico during the novel swine origin influenza H1N1 pandemic of 2009 and showed extensions of classical models in epidemiology by adding temporal variations in different parameters that are likely to change during the time course of an epidemic, such as, the influence of media, social distancing, school closures, and how vaccination policies may affect different aspects of the dynamics of an epidemic. This current work further examines the influence of different factors considering the randomness of events by adding stochastic processes to meta-population models. I present three different approaches to compare different stochastic methods by considering discrete and continuous time. For the continuous time stochastic modeling approach I consider the continuous-time Markov chain process using forward Kolmogorov equations, for the discrete time stochastic modeling I consider stochastic differential equations using Wiener's increment and Poisson point increments, and also I consider the discrete-time Markov chain process. These first two stochastic modeling approaches will be presented in a one city and two city epidemic models using, as a base, our deterministic model. The last one will be discussed briefly on a one city SIS and SIR-type model.
ContributorsCruz-Aponte, Maytee (Author) / Wirkus, Stephen A. (Thesis advisor) / Castillo-Chavez, Carlos (Thesis advisor) / Camacho, Erika T. (Committee member) / Kang, Yun (Committee member) / Arizona State University (Publisher)
Created2014
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Introduction. Human papillomavirus (HPV) is the most common sexually transmitted infections globally. HPV is responsible for several health concerns including genital warts, cancer of the cervix, vulva, penis, anus, and oropharynx. In China, HPV infection accounts for 69.1% of invasive cervical cancer. Currently, there is no treatment for HPV infection,

Introduction. Human papillomavirus (HPV) is the most common sexually transmitted infections globally. HPV is responsible for several health concerns including genital warts, cancer of the cervix, vulva, penis, anus, and oropharynx. In China, HPV infection accounts for 69.1% of invasive cervical cancer. Currently, there is no treatment for HPV infection, but HPV vaccination has been proven to be effective against HPV-related diseases. Given the highest rate of contracting HPV and suboptimal vaccination rate in college students including international students in the U.S., it is important to investigate key factors associated with vaccine uptake among Chinese international students. Purpose. This study aimed to investigate knowledge and awareness of HPV and the vaccine, attitudes, and vaccination intention in this population. We conducted a cross-sectional online survey via REDCap. Methods. Participants who were (1) Chinese international student at Arizona State University; (2) 18 and older; (3) able to read, speak and write in Chinese or English were recruited from Arizona State University. Descriptive statistics (mean, standard deviation, frequency) and inferential statistics (Chi-square test, independent t-test) were conducted using SPSS 26.0. Results. One hundred and ten participants were included in this study (56.4% female, mean age = 24, SD = 3.7). Female students had significantly higher HPV vaccination rate than males (p = 0.000). The mean knowledge score was 8.09 (SD = 1.35); female students were more likely to receive HPV education than males (p = 0.001). The most common source of education was friends (50.7%). Three most common perceived risks were not being sexually active, being male, and not having any physical signs and symptoms. The three most common facilitators were infection prevention, access to vaccination, and ability to afford vaccination. The three most common barriers were the cost, safety, and efficacy of HPV vaccine. In conclusion, gender disparities exist among Chinese<br/>international students’ HPV vaccine uptake and HPV related education. Implication. Although Chinese international students possess moderate to high level of knowledge about HPV and HPV vaccines, they lack education from credible sources. Culturally and gender appropriate education is needed in order to address barriers of getting HPV vaccination.

ContributorsChen, Weiqi (Author) / Chen, Angela Chia-Chen (Thesis director) / Reifsnider, Elizabeth (Committee member) / Han, SeungYong (Committee member) / Edson College of Nursing and Health Innovation (Contributor, Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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Description
Aims: The aim of this research is to identify factors that would lead to increased utilization of the HPV vaccine among college students.
Methods: We conducted 11 focus groups with a total of 28 students, averaging 3 per group. Using an inductive approach, we hand-coded focus group transcripts, developed a coding

Aims: The aim of this research is to identify factors that would lead to increased utilization of the HPV vaccine among college students.
Methods: We conducted 11 focus groups with a total of 28 students, averaging 3 per group. Using an inductive approach, we hand-coded focus group transcripts, developed a coding structure, and discussed themes as they emerged from the data.
Results: Although more than half of the students had never heard of the HPV vaccine, students generally held positive views about vaccines. Barriers to receiving the HPV vaccine included lack of awareness and knowledge about the HPV vaccine, as well as lack of perceived need for the vaccine. When asked about the most important information that they needed in order to make an informed decision about whether or not to get the vaccine, participants mentioned the following: 1) prevalence of HPV, 2) HPV-related diseases, 3) what the HPV vaccine protects against, 4) HPV vaccine safety, 5) HPV vaccine efficacy, and 6) how they can access the vaccine. Participants differed in their preferences for types of health education, from an in-person informative lecture, to YouTube videos, to posters placed in dorms or in bathrooms. They preferred the conveyor of this information to be a trustworthy source; they identified healthcare providers, professors/researchers, and other students who have received the vaccine as credible sources. In terms of message appeal, many students described wanting the facts, statistics about HPV prevalence and the vaccine as well as narratives from students who have been diagnosed with HPV and those who have experience receiving the vaccine.
Conclusions: Although this cancer prevention resource has been commercially available since 2006, college students still a lack of awareness and perceived need for the HPV vaccine. Future health education efforts should utilize participants’ recommendations to increase students’ understanding of HPV and the HPV vaccine and, therefore, impact their perceived susceptibility to HPV, the benefits of the vaccine to their health, and therefore increase utilization of this resource. Strategies to increase vaccination should include health education and vaccine implementation strategies, as well as strategies to reduce the cost of the vaccine for college students, thereby increasing the accessibility of the vaccine for this population.
ContributorsSilvestro, Kenneth (Co-author) / Li, Rina (Co-author) / Koskan, Alexis (Thesis director) / Helitzer, Deborah (Committee member) / Watts College of Public Service & Community Solut (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Modeling and leveraging intuitive theories to improve vaccine attitudes
Description

Much of the richness of human thought is supported by people’s intuitive theories—mental frameworks capturing the perceived structure of the world. But intuitive theories can sometimes contain and reinforce misconceptions, such as misconceptions about vaccine safety that discourage vaccination. We argue that addressing misconceptions requires awareness of the broader conceptual

Much of the richness of human thought is supported by people’s intuitive theories—mental frameworks capturing the perceived structure of the world. But intuitive theories can sometimes contain and reinforce misconceptions, such as misconceptions about vaccine safety that discourage vaccination. We argue that addressing misconceptions requires awareness of the broader conceptual contexts in which they are embedded. Here, we developed a cognitive model of the intuitive theory surrounding vaccination decisions. Using this model, we were able to make accurate predictions about how people’s beliefs would be revised in light of educational interventions, design an effective new intervention encouraging vaccination, and understand how these beliefs were affected by real-world events. This approach provides the foundation for richer understandings of intuitive theories and belief revision more broadly.

ContributorsPowell, Derek (Author) / Weisman, Kara (Author) / Markman, Ellen M. (Author)
Created2021
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Background: The COVID-19 pandemic has been causing high rates of hospitalization and death among the marginalized Asian American Pacific Islander (AAPI) community. Disaggregated data revealed low COVID-19 vaccine uptake among Korean Americans/Immigrants (KA/I) due to vaccine-related fears unaddressed by cultural and linguistic barriers. Prior evidence demonstrates that digital storytelling (DST)

Background: The COVID-19 pandemic has been causing high rates of hospitalization and death among the marginalized Asian American Pacific Islander (AAPI) community. Disaggregated data revealed low COVID-19 vaccine uptake among Korean Americans/Immigrants (KA/I) due to vaccine-related fears unaddressed by cultural and linguistic barriers. Prior evidence demonstrates that digital storytelling (DST) is an effective medium to improve recommended vaccine intent and uptake among AAPIs. Objective: This DNP project aimed to assess the effect of DST intervention on improving KA/I’s COVID-19-related vaccine hesitancy, intent, and uptake. Methods: A quasi-experimental design was conducted, with participants (n=4) self-identifying as KA/I adults with English or Korean fluency residing in the U.S. Participants were recruited online via convenience sampling from CARE (Collaborative Approach for AAPI Research and Education). Individuals who had already received COVID-19 vaccines were excluded. The intervention included two first-person audiovisual stories documenting the personal experience of receiving the COVID-19 vaccine. Outcomes were measured via a pre-post-1-month-follow-up survey utilizing a modified Vaccine Hesitancy Scale (? = 0.72) and Narrative Quality Assessment Tool (? = 0.78-0.81). Results: DST intervention had a marginally significant effect on lowering post-COVID-19 vaccine hesitancy scores (p = 0.068). Participants (n=2) who rated the DST videos with a higher score indicated vaccine uptake at one-month follow-up. Conclusion: This cost-effective, sustainable, and scalable DST evidence-based project has the potential to promote COVID-19 vaccination among KA/I and other AAPI groups with appropriate modification.
Created2022-05-01
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Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each

Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each year in the United States (US) from vaccine-preventable diseases, and nine billion dollars are spent on associated healthcare costs and lost productivity (ADHS, 2015; Wilson et al., 2019). To improve adult vaccination rates, the National Vaccine Advisory Committee recommends the Standards for Adult Immunization Practices, including regular assessment, recommendation, delivery or referral, and documentation during follow-up on vaccination (Orenstein et al., 2014; CDC, 2016). Local problem: A free clinic in Arizona serving uninsured, undocumented Latin American immigrants had low vaccination rates and a deficiency in vaccination documentation in electronic medical records. Methods: An evidence-based quality improvement project was conducted to address low vaccination rates and provider practices using a multi-component intervention. The effect and usage were evaluated through chart audits and pre- post-intervention surveys. Interventions: A vaccination questionnaire was administered at all in-person primary care visits. Brief educational videos were provided to providers and office staff before the intervention addressing the questionnaire's use, purpose, and goals. Adult immunization schedule printouts were made available in all patient rooms and provider charting areas. Additionally, a resource sheet on local free immunization programs was created for providers and patients. Results: The intervention's effect was unable to be determined due to a breakdown in the protocol after the second week of implementation. However, 92% of completed questionnaires reviewed indicated the patient needed one or more vaccination. Sixty-five percent of electronic medical records reviewed had no vaccination documentation historically for assessment, recommendation, referral, follow-up, or scanned vaccination records. No charts reviewed had these areas documented regularly. Conclusion: Vaccination rates and the Standards of Adult Immunization Practices are low at the free clinic. Further quality improvement measures are indicated addressing barriers present.
Created2021-04-27
Description
Was Israel’s early successful vaccine rollout enough to get their population vaccinated in a timely and sufficient manner? This paper will dive into this question by approaching it from the lens of supply and demand. Factors that enabled their successful supply chain management of vaccines will be contrasted against demand

Was Israel’s early successful vaccine rollout enough to get their population vaccinated in a timely and sufficient manner? This paper will dive into this question by approaching it from the lens of supply and demand. Factors that enabled their successful supply chain management of vaccines will be contrasted against demand constraints to illustrate that while Israel was successful in obtaining vaccines for their population, they ultimately, similarly to other countries, faced issues with vaccine hesitancy and reaching full coverage.
ContributorsMcCartan, Megan (Author) / Don, Rachael (Thesis director) / Moodley Naidoo, Roshini (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution & Social Change (Contributor) / Dean, W.P. Carey School of Business (Contributor)
Created2024-05
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Description

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

Local Problem: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

Methods: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

Results: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

Conclusion: MI can be an effective part of a strategy to increase vaccination rates.

ContributorsWermers, Rita (Author) / Ostroski, Tammy (Author, Thesis advisor) / Hagler, Debra (Author, Thesis advisor)
Created2019-04-26
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Description
Background: Healthy People 2020, a government organization that sets health goals for the United States, has established the benchmark objective of 70% influenza vaccination coverage. National trends show immunization rates are a dismal 41.7% for the adult population. Persons
experiencing homelessness are a vulnerable population in which access to preventative health

Background: Healthy People 2020, a government organization that sets health goals for the United States, has established the benchmark objective of 70% influenza vaccination coverage. National trends show immunization rates are a dismal 41.7% for the adult population. Persons
experiencing homelessness are a vulnerable population in which access to preventative health care services is lacking. Prevention of acute illness, whenever possible, is crucial to maintaining the health of this population. The purpose of this project is to increase influenza vaccinations through staff education at a homeless clinic.

Methods: Eighty-eight volunteer staff, at a student led homeless clinic, received education on the influenza vaccinations. The education occurred at the first orientation meeting of the fall semester in 2016 and consisted of; the importance of immunizations, goals of Healthy People 2020, and an emphasis on addressing patient objections. The effectiveness of the program
compared the percentage of patients immunized from August - December 2016 to 2015.

Results: Post intervention, 44% of the clinic patients were immunized against influenza,
compared to 18% (pre-intervention). This finding resulted in a statistically significant increase in
vaccinations (Z= -5.513, p= < .001, Wilcoxon signed rank test). Eighty-eight volunteers were
present at the influenza vaccination educational intervention and 82 returned their surveys
(response rate 93%). The average score of the posttest was 96% (range 70-100%).

Conclusions: These findings support staff education on influenza vaccinations as a strategy for
increasing vaccination in the homeless population. Such interventions provide promise to
increase influenza vaccinations, however, they fall short of meeting the goals of Healthy People
2020. Identifying innovative interventions is critical to meet the goals of Healthy People 2020.
ContributorsVossoughi, Tiffany (Author) / Harrell, Liz (Thesis advisor)
Created2017-04-17
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Description
Objectives: To assess whether a web-based video education addressing barriers to the human papillomavirus (HPV) vaccine will increase first and second dose administration rates and health care provider intent to vaccinate.

Study Design: Ten health care providers from Vaccines for Children (VFC) clinics in New Mexico were included in this pretest/posttest

Objectives: To assess whether a web-based video education addressing barriers to the human papillomavirus (HPV) vaccine will increase first and second dose administration rates and health care provider intent to vaccinate.

Study Design: Ten health care providers from Vaccines for Children (VFC) clinics in New Mexico were included in this pretest/posttest study. Providers were given a questionnaire adapted from the Determinants of Intent to Vaccinate (DIVA) questionnaire. Only two subscales were utilized for this project (total of 10 items): Adaptation to the Patient’s Profile and General Practitioner’s Commitment to the Vaccine Approach. Martinez et al. (2016) suggest that PCP’s commitment to the vaccination approach” can be used as a stand-alone tool with a Cronbach’s alpha > .70. Following the pretest, which served as consent, providers viewed a short, four video series addressing common barriers to the HPV vaccine, followed by the same questionnaire. First and second dose rates of the HPV vaccine were measured prior to the intervention and three months post intervention using the New Mexico Immunization Information System (NMSIIS).

Results: A Wilcoxon Ranks test was used for statistical analysis of the survey responses. Alpha was set at ≤ .10. Four of the 10 questions were statistically significant for increasing provider intent to vaccinate. HPV first dose rates increased in all three clinics and second dose rates increased in two out of the three clinics.

Conclusions: Web-based education is a successful intervention for increasing
provider intent to vaccinate and first and second dose HPV administration rates. Not only can the intervention be used for the HPV vaccine, but to help increase administration rates of all other vaccines.
ContributorsGonzalez, Jessica (Author) / Velasquez, Donna (Thesis advisor)
Created2018-05-02