Affective Traits Research Articles

Genetic and Depressive Traits Moderate the Reward-Enhancing Effects of Acute Nicotine in Young Light Smokers.

Rates of light smoking have increased in recent years and are associated with adverse health outcomes. Reducing light smoking is a challenge because it is unclear why some but not others, progress to heavier smoking. Nicotine has profound effects on brain reward systems and individual differences in nicotine's reward-enhancing effects may drive variability in smoking trajectories. Therefore, we examined whether a genetic risk factor and personality traits known to moderate reward processing, also moderate the reward-enhancing effects of nicotine. Light smokers (n = 116) performed a Probabilistic Reward Task to assess reward responsiveness after receiving nicotine or placebo (order counterbalanced). Individuals were classified as nicotine dependence 'risk' allele carriers (rs16969968 A-allele carriers) or non-carriers (non-A-allele carriers), and self-reported negative affective traits were also measured. Across the sample, reward responsiveness was greater following nicotine compared to placebo (p = 0.045). For Caucasian A-allele carriers but not non-A-allele carriers, nicotine enhanced reward responsiveness compared to placebo for those who received placebo first (p = 0.010). Furthermore, for A-allele carriers but not non-A-allele carriers who received nicotine first, the enhanced reward responsiveness in the nicotine condition carried over to the placebo condition (p < 0.001). Depressive traits also moderated the reward-enhancing effects of nicotine (p = 0.010) and were associated with blunted reward responsiveness following placebo but enhanced reward responsiveness following nicotine. These findings suggest that individual differences in a genetic risk factor and depressive traits alter nicotine's effect on reward responsiveness in light smokers and may be important factors underpinning variability in smoking trajectories in this growing population. Individuals carrying genetic risk factors associated with nicotine dependence(rs16969968 A-allele carriers) and those with higher levels of depressive personality traits, showmore pronounced increases in reward learning following acute nicotine exposure. These findingssuggest that genetic and personality factors may drive individual differences in smoking trajectoriesin young light smokers by altering the degree to which nicotine enhances reward processing. NCT02129387 (pre-registered hypothesis: www.clinicaltrials.gov).

Brain Basis of Psychopathy in Criminal Offenders and General Population.

Psychopathy is characterized by persistent antisocial behavior, impaired empathy, and egotistical traits. These traits vary also in normally functioning individuals. Here, we tested whether such antisocial personalities are associated with similar structural and neural alterations as those observed in criminal psychopathy. Subjects were 100 non-convicted well-functioning individuals, 19 violent male offenders, and 19 matched controls. Subjects underwent T1-weighted magnetic resonance imaging and viewed movie clips with varying violent content during functional magnetic resonance imaging. Psychopathic traits were evaluated with Levenson Self-Report Psychopathy Scale (controls) and Psychopathy Checklist-Revised (offenders). Psychopathic offenders had lower gray matter density (GMD) in orbitofrontal cortex and anterior insula. In the community sample, affective psychopathy traits were associated with lower GMD in the same areas. Viewing violence increased brain activity in periaqueductal grey matter, thalamus, somatosensory, premotor, and temporal cortices. Psychopathic offenders had increased responses to violence in thalamus and orbitofrontal, insular, and cingulate cortices. In the community sample, impulsivity-related psychopathy traits were positively associated with violence-elicited responses in similar areas. We conclude that brain characteristics underlying psychopathic spectrum in violent psychopathy are related to those observed in well-functioning individuals with asocial personality features.

The relationships of parent- and child-related psychiatric conditions with oppositional defiant disorder and conduct disorder symptoms in children with ADHD

ABSTRACT This cross-sectional study evaluated the impacts of maternal and paternal affective temperament traits, maternal and paternal ADHD, depression and anxiety symptoms, parenting styles, child’s depression and anxiety disorder symptoms, and child’s autistic traits on the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with attention-deficit/hyperactivity disorder (ADHD). Analysis showed a positive relation of maternal anxious and irritable temperament and child inattention, hyperactivity–impulsivity and obsessive-compulsive disorder (OCD) scores on ODD scores. However, there was a negative relationship between parental acceptance/involvement and ODD scores. Regarding CD scores, maternal irritable and paternal cyclothymic and hyperthymic temperament scores and child ODD and autistic trait scores showed a positive relationship, whereas maternal ADHD showed a negative relationship on CD scores. Certain parental affective temperaments, parenting styles, child’s OCD and autistic traits, and maternal ADHD may be important for the severity of disruptive behavioral disorder symptoms in children with ADHD.

The inner muses: How affective temperament traits, gender and age predict film genre preference

The aim of this study is to assess whether different affective temperaments, age and gender are associated with specific film genre preference.An online survey was administered to 689 adult subjects. We assessed the film genre preference on a Likert scale and affective temperament traits using the self-report questionnaire Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A) short-version scale.The scale showed acceptable psychometric properties. Results showed that cyclothymic temperament correlated positively with horror movie, depressive temperament correlated negatively with animation and positively with horror film, irritable temperament correlated negatively with animation and romance and positively with horror genre, hyperthymic trait correlated positively with comedy and musical genre, and anxious trait correlated negatively with documentary, thriller, action, and adult genres. Based on the population sampled, we concluded that stable, genetically conditioned styles of emotional reaction (temperaments) can predict film preference.

Feasibility Study on the Role of Personality, Emotion, and Engagement in Socially Assistive Robotics: A Cognitive Assessment Scenario

This study aims to investigate the role of several aspects that may influence human–robot interaction in assistive scenarios. Among all, we focused on semi-permanent qualities (i.e., personality and cognitive state) and temporal traits (i.e., emotion and engagement) of the user profile. To this end, we organized an experimental session with 11 elderly users who performed a cognitive assessment with the non-humanoid ASTRO robot. ASTRO robot administered the Mini Mental State Examination test in Wizard of Oz setup. Temporal and long-term qualities of each user profile were assessed by self-report questionnaires and by behavioral features extrapolated by the recorded videos. Results highlighted that the quality of the interaction did not depend on the cognitive state of the participants. On the contrary, the cognitive assessment with the robot significantly reduced the anxiety of the users, by enhancing the trust in the robotic entity. It suggests that the personality and the affect traits of the interacting user have a fundamental influence on the quality of the interaction, also in the socially assistive context.

Development and validation of a measure of instrumental practice–related affect

The article presents the development and validation of the instrumental practice–related affect measure (IPAM), based on the circumplex model of affect. This 16-item measure assesses four types of affect related to practicing a musical instrument: anxiety, comfort, depression, and enthusiasm. We conducted two studies. Confirmatory factor analysis supports the measure’s four-factor structure, allowing also for the distinction of two higher-order factors: positive and negative affect. The IPAM scales are highly reliable and correlate with affective traits, confirming the validity of the measure. The IPAM allows for capturing affective experiences in the musical learning context, in both basic and applied research.

Individual psychological peculiarities of the inconsistency between cognitive and socio-psychological development of students

The subject of this article is the search for individual psychological peculiarities of the inconsistency between cognitive and socio-psychological development of students. The relevance of this topic is substantiated by the theoretical diversity of research on the inconsistency in psychology and the need for the development of socio-cultural and cognitive skills in the educational process. A hypothesis is advanced that the inconsistency between the processes of cognitive and socio-personal development would be variable, determining the individual psychological methods of its resolution. The goal of this research lies in conjoint analysis of cognitive and personal characteristics for assessing the inconsistency of students&amp;rsquo; development. The author applies the correlational research design, which is defined by the goal of research and specificity of the sampling. The survey involved 34 students (18 boys and 16 girls) of the Institute of Mathematics and Computer Science of the Ural Federal University aged 18-22 (M=18.3 3 SD=0.79). The article employs the psychodiagnostic questionnaires: Aizenka EPI test; short version of the &amp;ldquo;Dark Triad of Personality&amp;rdquo; scale adapted by M. S. Egorova and others; characterological questionnaire by G. Schmishek, &amp;ldquo;Rational-experiential&amp;rdquo; questionnaire by S. Epstein adapted by T. V. Kornilova, A. Y. Razvalyaeva; Mann-Whitney U-test, Spearman's rank correlation coefficient. The following gender differences are revealed: for the female students, cognitive and personal characteristics are generally more interrelated, while the pronounced affective personality traits testify to the possible tension in social communication; male students demonstrated greater proneness to rational processing of information and formation of engineering skills, while weakness of integration of the inner and outer Self, which may increase narcissistic traits, reduce self-criticism, and cause difficulties in establishment and maintenance of social contacts. The acquired results empirically&amp;nbsp; prove the importance of socio-psychological competence, and allow differentiating the technologies of its formation in the educational process.

A RESEARCH ON THE RELATIONSHIP BETWEEN ACADEMIC SELF PERCEPTION AND ACADEMIC SUCCESS

Bu araştırmanın temel amacı ortaokul yedinci sınıf düzeyindeki öğrencilerin akademik benlik algıları ile akademik başarıları arasındaki ilişkiyi belirlemektir. Akademik başarı; somut ve nesnesi olan bir kavramken, akademik benlik algısı soyut ve duyuşsal bir kişilik özelliğidir. Bu iki değişkenin birbirini hangi koşullar altında ne şekilde etkilediği ise birçok araştırmanın konusu olmuştur. Çalışmamız bu bağlamda insanın yaşam boyu geliştirip olgunlaştırmaya çalıştığı benlik bütünlüğü ve bunun parçalarına değinerek, akademik benlik algısı oluşturmanın başarıya giden yolda temel basamak olduğunu vurgulamaktadır. İnsanın kendi ile ilgili düşüncelerini içeren benlik kavramını ve bu kavramın akademik hayatla bağdaştığı akademik benlik algısını inceleyip öğrencilerimizin içsel süreçlerine ışık tutması açısından bu araştırma önemlidir. İlişkisel tarama modelinde desenlenen araştırmanın çalışma evrenini Bursa İlinin Mudanya İlçesine bağlı Hatice-İsmail Hakkı Kayan Ortaokulu yedinci sınıf öğrencileri oluşturmaktadır (N=90). Araştırmaya ilişkin verilerin toplanmasında Akademik Öz-yeterlik Ölçeği (Kandemir, 2010) kullanılmıştır. Veriler analiz edilirken IBM SPSS 22.00 istatistik paket programı üzerinden korelasyon ve t-testi analizi istatistiksel çözümlemesi uygulanmıştır. Korelasyon analizinde; öğrencilerin ölçek puanları ile mihver derslerindeki başarı notları veri olarak girilerek bu değişkenler arasında anlamlı bir ilişki olup olmadığına bakılmış ve cinsiyet değişkeninin, notları ve akademik benlik algıları ile ilişkisine de t-testi sonuçları ile karar verilmiştir. Araştırmanın bulguları genel olarak özetlendiğinde akademik benlik algısı puanları ile ders notlarının pozitif yönlü korelasyon gösterdiği tespit edilmiş ve cinsiyet değişkeninin öğrencilerin ders başarı notları ya da akademik benlik algılarıyla ilişkili olmadığı görülmüştür.

Caring ahead: Mixed methods development of a questionnaire to measure caregiver preparedness for end-of-life with dementia

Background: Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. Aim: To develop a multi-dimensional questionnaire titled ‘Caring Ahead’ to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. Design: A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. Setting/population: Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. Results: Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the ‘Caring Ahead’ preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. Conclusions: Family caregivers’ feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.

How Ethical Leadership Impacts Deviant Normative Conduct? The Role of Trait Affect, Voice Behaviour, and Social Support

ABSTRACT Objective: This study developed and validated ethical leadership and deviant normative conduct model through mediating variables of trait affect as a psychological process and subordinate voice behavior. In addition, we also tested the moderating influence of social support in the association between subordinate voice behavior and deviant normative conduct. Method: The sample of the study was comprised of 258 pairs of employees and their direct leaders from six different organizations in China. We performed a structural equation model and hierarchical linear tests to check the hypothesized relationships. Results: The results indicated that ethical leadership has a positive impact on positive affect and negative impact on negative affect. Positive affect and negative affect have a differential positive and negative influence on subordinate voice behavior that, as a result, has a positive impact on organizational citizenship behavior and negative influence on counterproductive work behavior. This study also confirmed the role of social support as an enhancer and suppressor of deviant normative conduct when social support interacts with subordinate voice behavior. Conclusion: Our study uniquely applied social learning and conservation of resource theories to ethical leadership and normatively (un)desirable conduct at work, which have important implications for theory and practice. KEY POINTS What is already known about this topic: (1) Ethical leadership has a positively direct effect on employee normatively desirable conduct. (2) Ethical leadership has a negatively direct effect on employee normatively undesirable conduct. (3) A single mediating mechanism exists until now in the relationship between ethical leadership and normative conduct, which are explored individually. What this topic adds: (1) Distinctively integrates and empirically validates ethical leadership and deviant normatively (un)desirable conduct of subordinates at work relationships, simultaneously. (2) Synthesized psychological processes (operationalized as trait affect) and challenging behaviour (operationalized as voice behaviour) as underlying serial mechanisms. (3) Recognized the role of social support as a crucial enhancer and suppressor simultaneously.

CCopeY: A Mixed-Methods Coproduced Study on the Mental Health Status and Coping Strategies of Young People During COVID-19 UK Lockdown

PurposeExploring the impact of the COVID-19 pandemic on young people’s mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning, and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using coproduction methodology. MethodsThe mental health status of young people (aged 16–24) in April 2020 was established utilizing a sequential explanatory coproduced mixed methods design. Factors associated with poor mental health status, including coping strategies, were also examined using an online survey and semi-structured interviews. ResultsSince the lockdown, 30.3% had poor mental health, and 10.8% had self-harmed. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI .54–25.40). Behavioral disengagement (OR 1.462, 95% CI 1.22–1.76), self-blame (OR 1.307 95% CI 1.10–1.55), and substance use (OR 1.211 95% CI 1.02–1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07–1.15), sleep problems (OR .915 95% CI .88–.95) and conscientiousness personality trait (OR .819 95% CI .69–.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened, and (3) mental health and nonmental health support needed during and after lockdown. ConclusionPoor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.

Generalizability of Psychopathy Network Analysis Findings to Scores Assigned to Individuals Convicted of a Sex Offense

Despite being well-researched, the conceptualization of psychopathy incites much debate within the field. Results from network analysis can inform these debates by graphically and quantitatively depicting the core characteristics of the construct of psychopathy. Existing network studies with Psychopathy Checklist—Revised (PCL-R) scores suggest the affective traits are most central to the construct of psychopathy, but more studies are needed. The current study examined network models developed using data from risk assessments of individuals convicted of a sex offense ( N = 615). Findings corroborate some aspects of previous network studies in that affective features were most central to the construct and antisocial traits were least central, but there were instances of traits with notably higher centrality (e.g., Pathological Lying, Need for Stimulation, and Impulsivity) or lower centrality (e.g., Shallow Affect) than in prior research, suggesting that trait centrality may vary depending on the sample and evaluation context.

Affective Temperament Traits Measured by TEMPS-A and Their Associations with Cognitive Functions among Offspring of Parents with Bipolar Disorder with and without Subthreshold Symptoms

BackgroundTo our knowledge, there have been no studies that have examined affective temperament traits in offspring of parents with bipolar disorder (BD). The aim of this study was to identify affective temperamental characteristics and their relationships with cognitive functions in BD offspring. MethodsA group of BD offspring were enrolled in this study. Subthreshold symptoms were used to categorize participants as either symptomatic offspring (SO) (n=60) or asymptomatic offspring (AO) (n=52). Healthy controls (HCs; n=48) were also enrolled for comparison. We used the Chinese Short Version of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire (TEMPS-A) to measure temperament traits, and MATRICS Consensus Cognitive Battery (MCCB) to measure cognitive functions. ResultsWe observed higher cyclothymic, irritable, depressive and anxious temperament scores in SO than AO when compared to HCs. In BD offspring (SO and AO), cyclothymic individuals performed better in processing speed and verbal learning than depressive individuals and better in attention/vigilance than irritable and anxious individuals; hyperthymic individuals performed better in processing speed than depressive individuals. We also observed that a higher cyclothymic score was associated with better verbal learning and verbal fluency, a higher hyperthymic score was associated with better processing speed and verbal learning; while a higher depressive score was associated with worse processing speed, verbal learning and verbal fluency and a higher irritable score was associated with worse attention/vigilance. ConclusionsThe relationships between cognitive functions and measures of temperament suggest that these features may share neurobiological substrates and appear to be heritable.

Subtle nuances in personality differences between gifted children as perceived by parents and teachers

This study, using a phenomenological research design, was conducted with 10 gifted children, 7 parents, and 2 teachers. The data, which were analyzed via content analysis method, revealed that there were subtle nuances in personality differences between gifted children. Moreover, while the Science and Arts Center (SAC) teachers were more aware of the gifted children’s cognitive traits, while parents were more aware of their children’s affective and personality traits and needs. Furthermore, the results of the study seem to indicate that gifted children are leaders and intelligent, rational, hardworking, knowledgeable, very careful, calm, amusing, funny, curious, and highly observant individuals who like reading books and have a well-developed strong memory. On an average day in their lives, these students allocate spare time for academic success-focused behaviors, their hobbies, and socialization. Among these, the time spent on activities related to academic success and hobbies constitutes the highest amount of ratio.

Marginal relationship between affective dispositions and neurocognitive function in patients with schizophrenia spectrum disorders

Purpose Neurocognitive outcomes are frequently used as indicators of real-world functioning in schizophrenia spectrum disorders (SSD). These test results may be influenced by individual differences, such as affective dispositions. Here we investigate the relationship between positive and negative affect and neuropsychological test scores in a large, mixed-gender, population based group of participants without co-morbid substance abuse. Materials and methods We assessed 129 male and female SSD patients with the Positive and Negative Affect Schedule (PANAS) and a comprehensive neuropsychological test battery. Results and conclusions The neuropsychological test scores were mainly predicted by age and gender, with small contributions from negative psychosis symptoms. There was a statistically significant relationship between Positive Affect and processing speed and between Negative Affect and verbal memory and executive function. However, the level of neurocognitive function variance explained by these affects was only 5%. Thus, the neurocognitive test results were not associated with trait affect in any clinically significant manner. This adds to previous findings of no relationship between affective dispositions and psychosis symptom variables in our participants. We suggest that affective traits constitute an independent dimension that may influence well-being, coping, and real-life outcome in SSD patients directly, and not through neurocognitive function.

Managers’ trait affectivity and cognitive ability as drivers of business practices

An under-researched question is to what extent managers’ trait affectivity and cognitive ability play a role in driving business practices. As such, we carry out a survey with 623 textile and garme...

Depression Symptoms are Linked to Music Use

People across cultures often use music to evoke positive emotions and moods. Yet, some people tend to employ maladaptive strategies such as rumination, avoidant coping, or social isolation when they listen to music. The present research investigated how strongly maladaptive musical engagement is linked with depression and trait affect in a sample of 1415 Indians (17–65 years) across four cities and two countries. Participants completed a battery of assessments on trait affect, depression, adaptive and maladaptive musical engagement strategies, music preferences, and music skills. 1329 participants were included for analysis. All nine symptoms ( r = .16, to .30) and the sum score of depression ( r = .39), as well as trait negative affect ( r = .36) were correlated with maladaptive music engagement. Six of the symptoms of depression were significant predictors of maladaptive music engagement. Among those, suicidal ideation, worthlessness, and fatigue were the most important. Maladaptive music engagement increased the odds of experiencing all the depression symptoms ( OR = 1.04 to 1.14). Trait positive affect ( r = .29) and having music as a hobby ( r = .22) correlated with adaptive music engagement. Musicians who had been playing an instrument for six years and above had lower levels of maladaptive music engagement ( d = .84). Furthermore, the results show that depression symptoms might have a bidirectional relationship with maladaptive music engagement, with suicidal thoughts being the most important symptom. The current study also validated the Healthy-Unhealthy Music Scale (HUMS; Saarikallio et al., 2015 ) in India and provides a cut-off score based on the sensitivity (.86) and specificity (.66) in identifying people at risk for depression. Overall, the results reveal that socio-demographic factors (age, gender, relationship status, occupation status, geographical location), psychological factors (trait affect, depressive symptoms), and music skills play an important role in engaging with music.

The effect of affective temperament traits on emotion regulation difficulties (tur)

The effect of affective temperament traits on emotion regulation difficulties (tur)

Affective temperament, depressive symptoms and interleukins in patients with psoriasis.

IntroductionPsoriasis is a chronic inflammatory skin disease, in which psychological factors play an important role. In the studies of common markers of psoriasis and depression, the abnormal function of the stress axis in both diseases is highlighted, whereas interleukin-6 (IL-6) and interleukin-1 are indicated as particularly important.AimTo evaluate the relationship between the affective temperament traits and the intensity of depressive symptoms in patients with psoriasis in the context of immunoenzymatic markers.Material and methodsThe study included 208 subjects. Severity of psoriasis was assessed by PASI. TEMPS-A was applied for the evaluation of affective temperament and BDI was used for the assessment of the intensity of depressive symptoms. The level of cytokines was determined by means of the immunoenzymatic method.ResultsPatients presented a specific profile of affective temperament, with higher scores on depressive, anxious and irritable dimensions. The severity of depressive symptoms correlated positively with the severity of psoriasis. A significant correlation was found between IL-6 and the severity of psoriasis in patients with depressive disorders and psoriasis. No similar correlation was found in patients without depressive disorder.ConclusionsResults of the present study show common mechanisms for psoriasis and depression. Specific traits of affective temperament may play an important role in the clinical picture of both diseases. Higher levels of IL-6 in patients with psoriasis predispose to more frequent occurrence of depressive disorders and the depressive dimension of affective temperament.

Personality Characteristics Associated with Attitudes towards the COVID-19 Virus

Background: We examined the presence of five maladaptive personality trait domains and 14 personality disorder traits from DSM-5 with regard to attitudes towards the COVID-19 virus, i.e., whether viewed as a serious threat (COVID-19 Group) or not (Denier/Minimizer Group). Method: 146 undergraduate and graduate students in India participated online to answer the questionnaire. Ages ranged from 18 to 33 years old (100 men, 46 women). Results: Consistent with hypotheses, the COVID-19 Group (n = 66) scored significantly higher on the negative affectivity and detachment trait domains and higher on the avoidant and depressive personality disorder traits than the Denier/Minimizer Group (n = 77). Contrary to hypotheses, the COVID-19 Group scored significantly higher on the disinhibition trait domain and Borderline personality disorder scale. Importantly, 20.3% of the COVID-19 Group endorsed the current suicidal ideation item compared to only 11.7% of the Denier/Minimizer Group. While a greater percentage of the COVID-19 Group adhered to the pandemic precautions, a majority of participants in both groups were compliant with social distancing, handwashing/sanitizing, and face-masking. Conclusion: Gaining an understanding of these personality variations might assist in establishing efficient public health actions to mitigate health threats.