Abstract
We used data from a convenience sample of 410 Midwestern United States students from six secondary schools to develop parsimonious models for explaining and predicting precautions and illness related to influenza. Scores for knowledge and perceptions were obtained using two-parameter Item Response Theory (IRT) models. Relationships between outcome variables and predictors were verified using Pearson and Spearman correlations, and nested (student within school) fixed effects multinomial logistic regression models were specified from these using Akaike's Information Criterion (AIC). Neural network models were then formulated as classifiers using 10-fold cross validation to predict precautions and illness. Perceived barriers against taking precautions lowered compliance with the CDC recommended preventative practices of vaccination, hand washing quality, and respiratory etiquette. Perceived complications from influenza illness improved social distancing. Knowledge of the influenza illness was a significant predictor for hand washing frequency and respiratory etiquette. Ethnicity and gender had varying effects on precautions and illness severity, as did school-level effects: enrollment size, proficiency on the state's biology end-of-course examination, and use of free or reduced lunch. Neural networks were able to predict illness, hand hygiene, and respiratory etiquette with moderate success. Models presented may prove useful for future development of strategies aimed at mitigation of influenza in high school youths. As more data becomes available, health professionals and educators will have the opportunity to test and refine these models.
Highlights
The objectives of this study were to: (1) explore the effect of a number of student-level and school-level predictors on experienced illness and compliance level with preventative practice, (2) find the combination of predictors which best model each outcome, and (3) test the efficacy of the models for prediction
We describe theHealth Belief Model and Protection Motivation Theory, two behavior theories which have been developed to explain health-related decisions
Protection Motivation Theory (Rogers, 1975) describes how people respond to fear, simplifying the Health Belief Model by eliminating the variables of social pressure and perceived benefits, leaving three components: (1) perceived severity of the disease; (2) perceived probability of the disease’s occurrence, and (3) the perceived effectiveness of the person’s response
Summary
The objectives of this study were to: (1) explore the effect of a number of student-level and school-level predictors on experienced illness and compliance level with preventative practice, (2) find the combination of predictors which best model each outcome, and (3) test the efficacy of the models for prediction. Protection Motivation Theory (Rogers, 1975) describes how people respond to fear, simplifying the Health Belief Model by eliminating the variables of social pressure and perceived benefits, leaving three components: (1) perceived severity of the disease; (2) perceived probability of the disease’s occurrence, and (3) the perceived effectiveness of the person’s response. The fact that this model was designed under the assumption of fear limits it to analysis of responses to emergency situations such as pandemics where genuine fear exists. Reasons reported by doctors were either informed, including ready availability of neuraminidase inhibitor medications, or not information-based, including inconvenience and forgetfulness
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