Nurses' knowledge and skills in direct current shock management in emergency and intensive care settings: a systematic review.

Delirium is a serious health issue experienced by many hospitalized older adults following orthopaedic surgery. Nurses often do not recognize delirium, attributing symptoms to normal changes associated with aging or dementia. To (a) describe orthopaedic nurses' baseline knowledge about delirium in orthopaedic patients, particularly those aged 65 years, (b) test the effectiveness of an educational intervention based on nationally recommended guidelines, and (c) describe factors associated with differences in (1) nurses' baseline knowledge about delirium and (2) the effectiveness of the educational intervention. A pretest-posttest study design, using an educational evidence-based intervention. Regardless of education, years of experience, or shift worked, orthopaedic RNs had difficulty with questions related to recognition of delirium, predisposing, and precipitating risk factors, and medications that can contribute to delirium. The educational intervention was effective and scores significantly improved from baseline following the intervention. Baseline knowledge assessment confirmed orthopaedic nurses' lack of understanding of delirium. The 1-hr educational intervention, based on nationally recommended standards, improved the nurses' knowledge and could be useful in orthopaedic nursing continuing education.

Objectives: We conducted a community-based education intervention among targeted understudied groups in the New York State Capital Region to assess baseline knowledge of breast cancer and determine the effectiveness of newly developed educational tools in improving knowledge. Methods: We recruited 417 students from five participating colleges/universities and 67 women from four community group organizations. Educational intervention involved about an hour-long lecture on breast cancer using Microsoft PowerPoint® presentations tailored to each of the two participating groups of colleges/universities and community group organizations. Baseline and post-education knowledge was assessed via self-administered questionnaires. In addition to multiple choice questions, pre- and post-education questionnaires designed for college/university students also contained an open-ended question soliciting their suggestions for public health preventive actions against breast cancer. The effectiveness of our education intervention in improving breast cancer knowledge was estimated using a paired t-test. Descriptive and qualitative analyses of demographic variables and answers to the open-ended questions were also conducted. Results: Our analyses revealed a statistically significant improvement (P<0.0001) in mean percentage of correct answers among both participating groups of college/university students (from 39.9% at baseline to 80.8% post-education) and community group members (from 43.5% at baseline to 77.8% post-education). The effectiveness remained statistically significant in stratified analyses (by demographic variables as well as by other variables such as being or knowing a breast cancer survivor or having attended a breast cancer lecture or seminar in the past). Analysis of the answers to the open-ended questions revealed a shift in the attitudes of college/university students, brought about by our education intervention, regarding preventive efforts. While secondary prevention was the major theme pre-education (mentioned by ∼51% of respondents), primary prevention emerged as the major theme post-education (mentioned by ∼80% of respondents). Conclusions: This community-based education intervention was motivated by lack of a readily available breast cancer educational tool as well as lack of information about baseline knowledge of breast cancer among communities in the New York State Capital Region. Our findings of low levels of both baseline knowledge and prior attendance in a breast cancer lecture/seminar by participants in our study underscore the importance of education interventions. Our community-based education intervention was effective in increasing knowledge about breast cancer among college students and community group members in upstate New York. Our findings provide leads for public health prevention strategies. Citation Format: Nur Zeinomar, Roxana Moslehi. Impact of community-based breast cancer education intervention in New York State Capital Region. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2527. doi:10.1158/1538-7445.AM2013-2527

Introduction:The most common reason patients seek medical attention is pain. However, there may be significant delays in initiating prehospital pain therapy. In a 2001 quality improvement (QI) study, we demonstrated improvement in paramedic knowledge, perceptions, and management of pain. This follow-up study examines the impact of this QI program, repeated educational intervention (EI), and effectiveness of a new pain management standard operating procedure.Methods:176 paramedics from 10 urban and suburban fire departments and two private ambulance services participated in a 3-hour EI. A survey was performed prior to the EI and repeated one month after the EI. We reviewed emergency medical services (EMS) runs with pain complaints prior to the EI and one month after the EI. Follow-up results were compared to our prior study. We performed data analysis using descriptive statistics and chi-square tests.Results:The authors reviewed 352 surveys and 438 EMS runs with pain complaints. Using the same survey questions, even before the EI, 2007 paramedics demonstrated significant improvement in the knowledge (18.2%; 95% CI 8.9%, 27.9%), perceptions (9.2%; 95% CI 6.5%, 11.9%), and management of pain (13.8%; 95% CI 11.3%, 16.2%) compared to 2001. Following EI in 2007, there were no significant improvements in the baseline knowledge (0%; 95% CI 5.3%, 5.3%) but significant improvements in the perceptions of pain principles (6.4%; 95% CI 3.9%, 9.0%) and the management of pain (14.7%; 95% CI 11.4%, 18.0%).Conclusion:In this follow up study, paramedics’ baseline knowledge, perceptions, and management of pain have all improved from 6 years ago. Following a repeat educational intervention, paramedics further improved their field management of pain suggesting paramedics will still benefit from both initial and also ongoing continuing education on the topic of pain management.

Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review

BackgroundLead poisoning is associated with physical, cognitive and neurobehavioral impairment in children and many household interventions to prevent lead exposure have been trialled.ObjectivesTo determine the effectiveness of household interventions in preventing or reducing lead exposure in children as measured by reductions in blood lead levels and/or improvements in cognitive development.Search strategyTrials were identified through electronic searches of CENTRAL 2006 (Issue 1), MEDLINE 1966 to March 2006, and thirteen other electronic databases and contacting experts to find unpublished studies.Selection criteriaRandomised and quasi randomised trials of household educational or environmental interventions to prevent lead exposure in children where at least one standardised outcome measure was reported.Data collection and analysisTwo reviewers independently reviewed all eligible studies for inclusion, assessed study quality and extracted data. Triallists were contacted to obtain missing information.Main resultsTwelve studies (2239 children) were included. All studies reported blood lead level outcomes and none reported on cognitive or neurobehavioural outcomes. Studies were subgrouped according to their intervention type. Meta‐analysis of both continuous and dichotomous data was performed for subgroups where appropriate. Educational interventions were not effective in reducing blood lead levels (continuous: WMD 0.13, 95% CI ‐0.30, 0.56, I2 = 41.6; dichotomous ≥ 10µg/dL (≥ 0.48µmol/l): RR 1.02 (95% CI 0.79, 1.30, I2=0); dichotomous ≥ 15µg/dL (≥ 0.72µmol/l): RR 0.60, 95% CI 0.33, 1.09, I2 =0). Meta‐analysis of the dichotomous data for the dust control subgroup found no evidence of effectiveness.The studies using soil abatement (removal and replacement) and combination intervention groups were not able to be meta‐analysed due to substantial differences between studies.Authors' conclusionsCurrently there is no evidence of effectiveness for household interventions for education or dust control measures in reducing blood lead levels in children as a population health measure. There is insufficient evidence for soil abatement or combination interventions.Further trials are required to establish the most effective intervention for prevention of lead exposure. Key elements should include longer term follow up and measures of compliance as well as performing trials in developing countries and differing socio‐economic groups in developed countries.Plain Language SummaryHousehold interventions for prevention of domestic lead exposure in childrenLead poisoning is associated with adverse effects on development and behaviour in children. Many educational and environmental household interventions to prevent lead exposure in children have been studied. This review of 12 studies found that educational and dust control interventions are not effective in reducing blood lead levels of young children. There is currently insufficient evidence that soil abatement or combination interventions reduce blood lead levels and further studies need to address this.

Neonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge. This was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10-14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score. Of the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001). Maternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.

BackgroundNeonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge.MethodsThis was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10–14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score.ResultsOf the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001).ConclusionMaternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.

Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0-12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments.

Lead poisoning is associated with physical, cognitive and neurobehavioural impairment in children and trials have tested many household interventions to prevent lead exposure. This is an update of the original review by the same authors first published in 2008. To determine the effectiveness of household interventions in preventing or reducing lead exposure in children as measured by reductions in blood lead levels and/or improvements in cognitive development. We identified trials through electronic searches of CENTRAL (2012, Issue 1), MEDLINE (1948 to January Week 1 2012), EMBASE (1980 to Week 2 2012), CINAHL (1937 to January 2012), PsycINFO (1887 to January Week 2 2012), ERIC (1966 to January 2012), Sociological Abstracts (1952 to January 2012), Science Citation Index (1970 to 20 January 2012), ZETOC (20 January 2012), LILACS (20 January 2012), Dissertation Abstracts (late 1960s to January 2012), ClinicalTrials.gov (19 January 2012), Current Controlled Trials (19 January 2012), Australian New Zealand Clinical Trials Registry (19 January 2012) and the National Research Register Archive. We also contacted experts to find unpublished studies. Randomised and quasi-randomised controlled trials of household educational or environmental interventions to prevent lead exposure in children where at least one standardised outcome measure was reported. Two authors independently reviewed all eligible studies for inclusion, assessed risk of bias and extracted data. We contacted trialists to obtain missing information. We included 14 studies (involving 2656 children). All studies reported blood lead level outcomes and none reported on cognitive or neurobehavioural outcomes. We put studies into subgroups according to their intervention type. We performed meta-analysis of both continuous and dichotomous data for subgroups where appropriate. Educational interventions were not effective in reducing blood lead levels (continuous: mean difference (MD) 0.02, 95% confidence interval (CI) -0.09 to 0.12, I(2) = 0 (log transformed); dichotomous ≥ 10µg/dL (≥ 0.48 µmol/L): relative risk (RR) 1.02, 95% CI 0.79 to 1.30, I(2)=0; dichotomous ≥ 15µg/dL (≥ 0.72 µmol/L): RR 0.60, 95% CI 0.33 to 1.09, I(2) = 0). Meta-analysis for the dust control subgroup also found no evidence of effectiveness (continuous: MD -0.15, 95% CI -0.42 to 0.11, I(2) = 0.9 (log transformed); dichotomous ≥ 10µg/dL (≥ 0.48 µmol/L): RR 0.93, 95% CI 0.73 to 1.18, I(2) =0; dichotomous ≥ 15µg/dL (≥ 0.72 µmol/L): RR 0.86, 95% CI 0.35 to 2.07, I(2) = 0.56). When meta-analysis for the dust control subgroup was adjusted for clustering, no statistical significant benefit was incurred. The studies using soil abatement (removal and replacement) and combination intervention groups were not able to be meta-analysed due to substantial differences between studies. Based on current knowledge, household educational or dust control interventions are ineffective in reducing blood lead levels in children as a population health measure. There is currently insufficient evidence to draw conclusions about the effectiveness of soil abatement or combination interventions.Further trials are required to establish the most effective intervention for prevention of lead exposure. Key elements of these trials should include strategies to reduce multiple sources of lead exposure simultaneously using empirical dust clearance levels. It is also necessary for trials to be carried out in developing countries and in differing socioeconomic groups in developed countries.

Based on current knowledge, household educational interventions are ineffective in reducing blood lead levels in children as a population health measure. Dust control interventions may lead to little or no difference in blood lead levels (the quality of evidence was moderate to low, meaning that future research is likely to change these results). There is currently insufficient evidence to draw conclusions about the effectiveness of soil abatement or combination interventions. No study reported on cognitive or neurobehavioural outcomes or adverse events. These patient-relevant outcomes would have been of great interest to draw conclusions for practice.Further trials are required to establish the most effective intervention for preventing lead exposure. Key elements of these trials should include strategies to reduce multiple sources of lead exposure simultaneously using empirical dust clearance levels. It is also necessary for trials to be carried out in low- and middle-income countries and in differing socioeconomic groups in high-income countries.

Lead poisoning is associated with physical, cognitive and neurobehavioural impairment in children and trials have tested many household interventions to prevent lead exposure. This is an update of the original review by the same authors first published in 2008. To determine the effectiveness of household interventions in preventing or reducing lead exposure in children as measured by reductions in blood lead levels and/or improvements in cognitive development. We identified trials through electronic searches of CENTRAL (The Cochrane Library, 2010, Issue 2), MEDLINE (1948 to April Week 1 2012), EMBASE (1980 to 2012 Week 2), CINAHL (1937 to 20 Jan 2012), PsycINFO (1887 to Dec week 2 2011), ERIC (1966 to 17 Jan 2012), Sociological Abstracts (1952 to 20 January 2012), Science Citation Index (1970 to 20 Jan 2012), ZETOC (20 Jan 2012), LILACS (20 Jan 2012), Dissertation Abstracts (late 1960s to Jan 2012), ClinicalTrials.gov (20 Jan 2012), Current Controlled Trials (Jan 2012), Australian New Zealand Clinical Trials Registry (Jan 2012) and the National Research Register Archive. We also contacted experts to find unpublished studies. Randomised and quasi-randomised controlled trials of household educational or environmental interventions to prevent lead exposure in children where at least one standardised outcome measure was reported. Two authors independently reviewed all eligible studies for inclusion, assessed risk of bias and extracted data. We contacted trialists to obtain missing information. We included 14 studies (involving 2656 children). All studies reported blood lead level outcomes and none reported on cognitive or neurobehavioural outcomes. We put studies into subgroups according to their intervention type. We performed meta-analysis of both continuous and dichotomous data for subgroups where appropriate. Educational interventions were not effective in reducing blood lead levels (continuous: mean difference (MD) 0.02, 95% confidence interval (CI) -0.09 to 0.12, I(2) = 0 (log transformed); dichotomous ≥ 10µg/dL (≥ 0.48 µmol/L): relative risk (RR) 1.02, 95% CI 0.79 to 1.30, I(2)=0; dichotomous ≥ 15µg/dL (≥ 0.72 µmol/L): RR 0.60, 95% CI 0.33 to 1.09, I(2) = 0). Meta-analysis for the dust control subgroup also found no evidence of effectiveness (continuous: MD -0.15, 95% CI -0.42 to 0.11, I(2) = 0.9 (log transformed); dichotomous ≥ 10µg/dL (≥ 0.48 µmol/L): RR 0.93, 95% CI 0.73 to 1.18, I(2) =0; dichotomous ≥ 15µg/dL (≥ 0.72 µmol/L): RR 0.86, 95% CI 0.35 to 2.07, I(2) = 0.56). When meta-analysis for the dust control subgroup was adjusted for clustering, no statistical significant benefit was incurred. The studies using soil abatement (removal and replacement) and combination intervention groups were not able to be meta-analysed due to substantial differences between studies. Based on current knowledge, household educational or dust control interventions are ineffective in reducing blood lead levels in children as a population health measure. There is currently insufficient evidence to draw conclusions about the effectiveness of soil abatement or combination interventions.Further trials are required to establish the most effective intervention for prevention of lead exposure. Key elements of these trials should include strategies to reduce multiple sources of lead exposure simultaneously using empirical dust clearance levels. It is also necessary for trials to be carried out in developing countries and in differing socioeconomic groups in developed countries.

BACKGROUND: Understanding the costs associated with healthcare is an essential component of being an effective physician and has been recognized as one of the five essential competencies of systems-based practice. Despite this level of importance, there is little published about assessing knowledge associated with sterilization costs or strategies to educate trainees about cost. This project was designed to perform a needs assessment, create a curriculum to teach residents about costs of sterilization, and to determine the impact of the educational intervention. METHODS: Obstetrics and Gynecology residents and faculty were surveyed regarding their baseline knowledge and attitudes of the cost of sterilization and long-term contraceptive options. An interactive curriculum was designed for the residents around cognitive gaps, and the residents were resurveyed after the educational session. RESULTS: Twelve residents including PGY-2 (n=3), PGY-3 (n=4) and PGY-4 (n=5) and 15 faculty members participated in the study. Residents considered it important to understand the cost of comparable sterilization options (mean: 4.14; scale: 1–5) but did not feel knowledgeable about these costs (mean: 1.83; scale 1–5). Faculty also felt this topic was important (mean: 4.3; scale 1–5) but felt more knowledgeable (mean: 3.0; scale 1–5). After implementation of the curriculum, residents felt significantly more knowledgeable (mean: 3.25 versus 1.83, P&lt;.01). DISCUSSION: Residents recognize the knowledge deficit associated with sterilization costs and consider understanding costs to be important. Using an educational intervention, we demonstrate improved knowledge about costs and plan to reassess in 6 months to determine retention.

Introduction: Traumatic dental injuries (TDIs) present a significant challenge for healthcare professionals. Nurses, often the first point of contact for patients, may lack essential knowledge in dental trauma first aid, as noted in the existing literature. Objective: To assess the knowledge of traumatic dental injuries (TDIs) among undergraduate nursing students before and after a targeted educational intervention. Materials and Methods: This quasi-experimental study evaluated the effectiveness of an educational intervention involving 300 nursing students from two universities in Seville. The educational intervention was led by specialist dentists. A pre-test survey was administered to assess students’ baseline knowledge. The session included a lecture on TDI management, followed by a simulation in which students practiced emergency splinting techniques for referral to a dentist. A post-test survey was then conducted to measure changes in students’ knowledge and attitudes towards dental trauma. Results: Only 25.4% of students had prior training in dental trauma. After the intervention, there was a significant improvement in students’ self-assessed knowledge of first aid for TDIs (p < 0.05). A high percentage of students also reported increased confidence in their ability to reimplant a tooth. Statistical analysis of pre- and post-intervention survey results showed a substantial increase in average scores (p < 0.05). Conclusions: Nursing students initially exhibited limited knowledge in managing dental trauma but demonstrated a positive attitude toward learning this new skill. The targeted educational intervention significantly enhanced their understanding, underscoring the need to incorporate such training into nursing curricula. By improving nursing students’ competence in managing dental injuries, this training can help better preserve dental structures and improve the prognosis for dental trauma cases.

This study evaluated the impact of an educational intervention on knowledge and counseling on metered-dose inhalers (MDIs) and nebulisers among community pharmacists in Ibadan, Nigeria. A validated semi-structured questionnaire was utilised for data collection on study participants’ baseline knowledge and counseling on the selected asthma medication devices. The community pharmacists were randomised into control and intervention groups. An online educational intervention was carried out among pharmacists in the intervention group. The intervention comprised updates on basic information vis-à-vis knowledge and patient counseling on MDIs and nebulisers. A post-intervention assessment was carried out a month later to evaluate the impact of the intervention. Data was summarised using descriptive and inferential statistics, with level of significance set as p &lt; 0.05. Response rate was 77.2% (112/145). Study findings showed significant improvement on knowledge and counseling among the community pharmacists in the intervention group, postintervention. Pharmacists’ knowledge of MDIs and nebulisers (control versus intervention) was comparable at baseline (5.83 ± 2.46 versus 6.34 ± 2.16) but significantly different postintervention (5.87 ± 2.34 versus 7.10 ± 2.21). Similarly, pharmacists’ counselling on asthma medication devices was comparable at baseline (3.59 ± 2.54 versus 3.63 ± 1.83) but significantly different postintervention (3.35 ± 3.13 versus 7.93 ± 2.58). Work experience as community pharmacists did not influence participants’ knowledge and counseling on MDIs and nebulisers. The educational intervention significantly improved knowledge and counseling on MDIs and nebulisers among community pharmacists in Ibadan, Nigeria. There is need for regular educational updates to improve the quality of care offered by community pharmacists.

We determined the effectiveness of a community-based breast cancer education intervention among understudied populations in the New York State (NYS) Capital Region by assessing and comparing baseline and post-education breast cancer knowledge. Participants included 417 students recruited from five colleges/universities and 67 women from four community group organizations. Baseline and post-education knowledge was assessed via self-administered mostly multiple-choice questionnaires. An open-ended question soliciting opinions about public health prevention strategies against breast cancer was included on college/university students' questionnaires. Effectiveness of education intervention was estimated through a paired t test. Stratified analysis was done using demographic and descriptive variables. Answers to the open-ended questions were analyzed qualitatively. The mean percentage of correct answers increased from 39.9% at baseline to 80.8% post-education (P < 0.0001) among college/university students and from 43.5% to 77.8% (P < 0.0001) among community group members. Effectiveness remained statistically significant in all stratified analyses with similarly high percentage of correct answers achieved post-education irrespective of knowledge level at baseline. Stratified analysis also revealed similar patterns of improvement in overall knowledge and narrowing of the gap in post-education knowledge. Primary prevention emerged as the dominant theme post-education in students' responses to the open-ended question, signifying the effectiveness of our education in raising awareness about modifiable risk factors and inspiring proactive thinking about public health prevention strategies. This community-based education intervention was effective in increasing breast cancer knowledge among demographically diverse groups with low levels of baseline knowledge in the NYS Capital Region. Our findings provide leads for future public health prevention strategies.