Odds Of Willingness Research Articles

Predictors of Willingness to Diffuse PrEP Information within Ego-Centric Networks of Women Who Inject Drugs.

Little is known about how social networks among women who inject drugs (WWID) can be leveraged to increase awareness about pre-exposure prophylaxis (PrEP). We tested the hypothesis that interpersonal characteristics influence willingness of WWID to communicate PrEP information with peers. Forty WWID ≥ 18years completed social network surveys. Participants named on average 9.3 (SD = 3.3) network members, resulting in 375 unique relationships. WWID were willing to share PrEP information with 83% of network members. Participants had higher odds of willingness to share information within relationships when the network member was female, homeless and perceived to be at risk for HIV. Among relationships with family members and transactional sex clients, stronger emotional closeness was associated with higher odds of willingness to share information. Peer interventions where WWID share PrEP information with peers may be an efficient approach to increase PrEP awareness among this vulnerable population.

COVID-19 vaccine acceptance among high-risk populations in Uganda.

Background:Immunization is an important strategy for controlling the COVID-19 pandemic. COVID-19 vaccination was recently launched in Uganda, with prioritization to healthcare workers and high-risk individuals. In this study, we aimed to determine the acceptability of COVID-19 vaccine among persons at high risk of COVID-19 morbidity and mortality in Uganda.Methods:Between 29 March and 14 April 2021, we conducted a cross-sectional survey consecutively recruiting persons at high risk of severe COVID-19 (diabetes mellitus, HIV and cardiovascular disease) attending Kiruddu National Referral Hospital outpatient clinics. A trained research nurse administered a semi-structured questionnaire assessing demographics, COVID-19 vaccine related attitudes and acceptability. Descriptive statistics, bivariate and multivariable analyses were performed using STATA 16.Results:A total of 317 participants with a mean age 51.5 ± 14.1 years were recruited. Of this, 184 (60.5%) were female. Overall, 216 (70.1%) participants were willing to accept the COVID-19 vaccine. The odds of willingness to accept COVID-19 vaccination were four times greater if a participant was male compared with if a participant was female [adjusted odds ratio (AOR): 4.1, 95% confidence interval (CI): 1.8–9.4, p = 0.00]. Participants who agreed (AOR: 0.04, 95% CI: 0.01–0.38, p = 0.003) or strongly agreed (AOR: 0.04, 95% CI: 0.01–0.59, p = 0.005) that they have some immunity against COVID-19 were also significantly less likely to accept the vaccine. Participants who had a history of vaccination hesitancy for their children were also significantly less likely to accept the COVID-19 vaccine (AOR: 0.1, 95% CI: 0.01–0.58, p = 0.016).Conclusion:The willingness to receive a COVID-19 vaccine in this group of high-risk individuals was comparable to the global COVID-19 vaccine acceptance rate. Increased sensitization, myth busting and utilization of opinion leaders to encourage vaccine acceptability is recommended.

Barriers to recruitment for research procedures in studies of Alzheimer’s disease and related disorders

AbstractBackgroundFemales and individuals of Latinx ethnicity have increased risk of developing Alzheimer’s Disease (AD) but are underrepresented in neurodegenerative research. It is critical to understand reasons for this underrepresentation so they can be addressed to ensure that findings are generalizable to the entire population. A potential barrier to AD research is willingness to participate in relatively invasive research procedures (e.g., lumbar puncture (LP), amyloid PET imaging). This willingness may vary by demographic/ethnicity factors thereby producing disparities in research participation. The purpose of this study is to investigate whether gender, education, age, and ethnicity are associated with willingness to participate in research procedures commonly used in observational studies and clinical trials of neurodegenerative disease.MethodA questionnaire that assessed demographics and willingness to participate (yes/no/maybe) in various research procedures [i.e., blood draw, magnetic resonance imaging (MRI), LP, amyloid PET imaging, brain autopsy, clinical trials] was administered in English or Spanish to 81 individuals (mean age=73.2+7.8; mean education=13.7+5.2) after they completed cognitive testing as part of community Memory Screening events. There were 32 Latinx and 49 non‐Latinx participants. There were 29 males and 50 females (gender unreported by two). Willingness to participate was reclassified into binary (yes/not yes) measures. Logistic regression models simultaneously controlling for age and education with gender and ethnicity as predictor variables were used.ResultOverall, a majority of participants were amenable to blood draw (84.5%‐yes), MRI (77.8%‐yes), Amyloid PET (56.8%‐yes), brain autopsy (61.7%‐yes), and observational study (68.8%‐yes). A smaller percentage were amenable to LP (34.6%‐yes) and clinical trials (41.8%‐yes). Women were less likely than men to express willingness to agree to amyloid PET imaging (Odds Ratio: 0.18; p‐value < 0.05). Higher education level was associated with higher odds of willingness to participate in a clinical trial (Odds Ratio: 1.28; p‐value < 0.01). Ethnicity and interaction effects between gender and ethnicity had no statistically significant effects on agreement to specific procedures.ConclusionThe findings reveal that gender and education are important in predicting attitudes toward participation in specific types of research procedures. These results could help inform recruitment strategies that maximize participation of underrepresented groups in research.

Perceived Quality of Healthcare and Availability of Supplies Determine Household-Level Willingness to Join a Community-Based Health Insurance Scheme in Amhara Region, Ethiopia.

PurposeThe Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households’ willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia.Patients and MethodsUsing a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest.ResultsOut of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households’ occupation (AOR=2.26; 95% CI:=1.12–5.07), perceived good (AOR=2.21; 95% CI:=1.53−3.21), and medium (AOR=1.44; 95% CI=1.22–2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08–2.73) were associated with higher odds of willingness to join the scheme.ConclusionAs The study revealed that level of willingness to join is lower compared to other studies. Therefore, social protection activities for the low-income population and enhancement of the capacity of health facilities are crucial.

Physician and Nurse Practitioner Attitudes on Generic Prescribing of Oral Contraceptive Pills and Antidepressants.

As prescription drug costs rise, it is important to understand attitudes among primary care physicians and nurse practitioners (NPs) towards generic drugs. We aimed to examine the generic skepticism index (GSI) among primary care clinicians, and their willingness to discuss and prescribe generic antidepressants (ADs) and generic oral contraceptives (OCPs). We used a factorial vignette design survey to test 4 factors: message source, message, brand preference, and drug class. Participants were randomized to different combinations of factors. This was a cross-sectional study. Physicians registered with the American College of Physicians (ACP) and NPs registered with the American Association of Nurse Practitioners (AANP) participated in the study. The primary outcomes were generic skepticism as measured using the generic skepticism index (GSI), and clinician willingness to discuss and prescribe generics. Surveys were completed by 56% of physicians (n = 369/661) and 60% of NPs (n = 493/819). Compared with physicians, NPs were younger (p< 0.001), predominantly female (p< 0.001), and differed in the race (p< 0.001). According to the GSI, 16% (n = 138/862) were identified as generic skeptics (18.5% of NPs and 12.7% of physicians, p= 0.023). Generic skeptics had lower odds of willingness to discuss switching (OR 0.22, 95% CI (0.14-0.35), p < 0.001) or prescribe (OR 0.18, 95% CI (0.11-0.28), p < 0.001) generic OCPs. Participants had lower odds of willingness to prescribe generic drugs to patients with brand preference compared with brand-neutral patients (OR 0.64, 95% CI 0.50-0.82, p < 0.001). Generic skepticism was associated with lower willingness to discuss or prescribe generic drugs. Clinicians reported lower willingness to discuss switching or prescribe generics for OCPs than for ADs. Patient brand preference hindered generic prescribing. Message source and message type were not significantly associated with outcomes.

Investigating Bangladeshi Rural Women's Awareness and Knowledge of Cervical Cancer and Attitude Towards HPV Vaccination: a Community-Based Cross-Sectional Analysis.

Cervical cancer remains a significant disease burden and contributes to prominent cancer-related mortality among women. This study aimed to assess awareness and knowledge of cervical cancer and attitude towards HPV vaccination among rural women in Bangladesh. A cross-sectional study was carried outfrom September 2019 to January 2020 involving 600 women selected using multi-stage sampling from six rural areas of Bangladesh. Face-to-face interviews were conducted using a semi-structured questionnaire consisting of socio-demographic information, knowledge (20-items) and, attitudes (5-items). Most of the participants (71.8%) were aware of cervical cancer. Women's awareness was significantly associated with marital status, education level, employment status, and internet/social media use (p < 0.05). Mass media was the main source of information and 2.3% of the women had previously undergone cervical cancer screening. Knowledge regarding symptoms, risk factors, and preventive measures was limited with a mean knowledge score of 8.73 (SD: 2.68). Only 5.3% of women had vaccinated against HPV, but the willingness to receive the HPV vaccine was high (76.6%) among those who were not vaccinated. The cost of the HPV vaccine (40.1%) and lack of adequate knowledge (34.3%) were the main reasons behind women's unwillingness to receive the vaccine. Higher odds of willingness to receive the HPV vaccine were found among women aged 15-29years (aOR: 1.92, CI = 1.21-3.04, p = 0.006), had high education (aOR: 1.93, CI = 1.25-4.42, p = 0.005), and internet/social media users (aOR: 2.32, CI: 1.51-3.56, p < 0.001). These results highlight the urgent need for educational intervention on cervical cancer and the institution of national policies providing HPV vaccination coverage.

Disaster Risk Perception, Sense of Pace, Evacuation Willingness, and Relocation Willingness of Rural Households in Earthquake-Stricken Areas: Evidence from Sichuan Province, China.

Based on survey data from 327 rural households in the areas affected by the Wenchuan Earthquake and Lushan Earthquake in Sichuan Province, this study systematically analyzed disaster risk perception, sense of place, evacuation willingness, and relocation willingness among residents in these earthquake-stricken areas. Further, this study constructed an ordinal logistic regression analysis to probe the correlations between residents’ disaster risk perception or sense of place and evacuation willingness and relocation willingness, respectively. The results showed that (1) faced with the threat of earthquake disasters, residents have a strong willingness to evacuate and relocate. Specifically, 93% and 78% of the residents in the Wenchuan Earthquake and Lushan Earthquake areas were willing to evacuate and relocate, respectively, whereas 4% and 17% of the residents were unwilling to evacuate and relocate, respectively. (2) Place dependence and the severity of disaster occurrence were significantly positively correlated with residents’ evacuation willingness, while the interaction term between place dependence and the severity of disaster occurrence was negatively related to residents’ evacuation willingness. Specifically, when everything else remains constant, every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to evacuate by factors of 0.042 and 0.051, respectively; every one-unit increase in place dependence × severity corresponds to a decrease in the odds of willingness to evacuation by a factor of 0.004. (3) Place identity was significantly negatively correlated with residents’ relocation willingness, while place dependence and severity of disaster occurrence were positively related to residents’ relocation willingness. The interaction term between place dependence and the severity of disaster occurrence as well as the interaction term between place identity and severity of disaster occurrence were significantly negatively correlated with residents’ relocation willingness. Specifically, every one-unit increase in place identity corresponds to a decrease in the odds of willingness to relocate by a factor of 0.034, while every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to relocate by factors of 0.041 and 0.028, respectively, and every one-unit increase in place dependence × severity and place identity × severity corresponds to decreases in the odds of willingness to relocate by factors of 0.003 and 0.003, respectively.

US oral health students' willingness to train and administer the HPV vaccine in dental practices.

HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14–3.35) and administration (OR = 3.79, 95% CI = 1.63–8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14–17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27–15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.

Attitudes and experiences regarding genetic research among persons of African descent.

Minorities are underrepresented in genetic research. This study examined the attitudes, experiences, and willingness of persons of African descent related to participation in genetic research. A total of 272 persons of African descent completed a questionnaire about attitudes and experiences associated with genetic research. Descriptive, Chi-square, and logistic regression were used to examine the impact of attitudes and experiences in predicting the odds of willingness to participate in genetic research. A majority of participants (97%) indicated that they have never participated in genetic research; however, a majority also reported that they would be willing to participate in a genetic study specifically for the detection of risk factors for cancer (87%), diabetes (89%), alcohol use disorder (73%), and Alzheimer's disease (88%). Participants who disagreed that "results from genetic research can explain why some diseases are found more often in some ethnic groups than others" were less likely to be willing to participate in studies related to cancer (OR = 0.16), diabetes (OR = .16), alcohol use disorder (OR = 0.27), and Alzheimer's disease (OR = 0.27). Participants reported limited experiences engaging in genetic research; yet, they overwhelmingly acknowledged the importance of genetic research and expressed willingness to participate in multifactorial genetic studies despite concerns about genetic discrimination, stigma, and/or a potentially poor prognosis. Further research on the underlying reasons why persons of African descent choose to participate in genetic research should be explored and addressed to make research more inclusive and ethically sound.

WILLINGNESS TO FORMALIZE: A CASE STUDY OF THE INFORMAL MICRO AND SMALL-SCALE ENTERPRISES IN ZIMBABWE

The rapidly growing informal micro and small-scale enterprise sector in Zimbabwe is an issue of concern because the government is still struggling to revive the economy from the effects of economic meltdown. Of main concern is the lost revenue through tax evasion. The growing informal sector is believed to be a result of the poor quality of certain institutions, high corruption levels in the country and lack of incentives to formalize. The objective of this study was to analyze the impact of growth constraints on the willingness to formalize by informal MSEs. Twenty internal and external growth inhibiting factors were analyzed using Principal Component Analysis (PCA) and a logistic model was estimated on a dichotomous variable of willing/not willing to formalize. The results show that willingness/unwillingness to formalize by informal entrepreneurs in Zimbabwe is significantly related to institutional imperfections and asymmetry of bureaucracy associated with the registration process, lack of access to technology, market and financial constraints and lack of entrepreneurial and management skills. Improving the bureaucracy of the registration process and access to technology may possibly increase the odds of the informal operators formalizing their businesses. However, improvement in market and financial constraints and entrepreneurial and managerial skills will decrease the odds of willingness to formalize.

Assessment of willingness to uptake male circumcision and associated factors among male students, south west Ethiopia

Background: Male circumcision has been shown to reduce the risk of transmission of HIV. As there was low level of circumcision and high prevalence of HIV/AIDS in Gambella, this study intends to identify predictors of willingness to uptake circumcision among indigenous male college students. Methods: A cross-sectional study was conducted among randomly selected 314 male college students who were selected using simple random sampling technique with self-administered questionnaire from March 27-30, 2014. The data were entered in to computer and analyzed using SPSS for windows version 16.0. Finally, logistic regressions analyses were used to identify independent predictors of willingness to uptake circumcision. To determine any association between the variables; we computed confidence interval of 95% at P. value &lt;0.05. Result: Three hundred fourteen [94%] of them completely filled and return the questionnaire; 99[31.6%] of them didn’t get circumcise and 130[41.4%] of male students believed that they could suffer rejection from their community if they would uptake circumcision. After multivariate logistic regression was employed, the result showed that; students who believed that they get rejected from society if circumcised were less likely to uptake circumcision 0.03 [AOR=.03, 95% CI: 0.01-0.12]. The other result showed that, as age of students increases by one year the odd of willingness to uptake circumcision also increases by 0.84 and the result was statistically significant [AOR=0.84, 95% CI: 0.71-0.99]. Perceived threat was also significantly associated and students who perceived HIV/AIDS as a high threat to them were about 1.28 times more likely willing to uptake circumcision [AOR=1.28, 95% CI: 1.10-1.53]. The other predictor variable was knowledge of students; per a unit increases in total score of knowledge the odds of willingness to uptake circumcision was increased by 1.5 folds [AOR=1.5, 95% CI: 1.13-2.08]. Conclusion: High perceived threat, knowledge, age and fear of rejection by society were the main predictors of willingness to uptake circumcision among male students. Therefore, designing communication strategies that directly address these factors should be implemented. Men who were willing to uptake circumcision should be provided access to high-quality male circumcision surgical services. It is also highly recommended providing accurate information that would increase the perceived threat of adolescents; reinforcement of messages regarding the importance of HIV risk-reduction strategies. Finally addressing these issues of adolescents at school or different institutional levels might be crucial and easier than shifting population-level norms around male circumcision in future strategies.

Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use

BackgroundTake-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia.MethodsThe sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison.ResultsMost participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03–4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32–4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14–5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73–11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18–0.77) was associated with decreased odds of willingness to participate in a prison THN training.ConclusionOur findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period.

Human Papillomavirus Vaccine Acceptability among Parents of Adolescent Girls in a Rural Area, Mysore, India.

The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India. Cross-sectional. Mysore, India. Parents of school-going adolescent girls. Parents completed a validated self-administered questionnaire. Parental willingness to vaccinate their daughters with HPV vaccine. Of the 831 parents who participated in this study, 664 (79.9%) were willing to vaccinate their daughter with HPV vaccine sometime soon if they were invited to receive it. Higher odds of parental willingness to vaccinate their daughters with HPV vaccine was observed among those who believed that HPV vaccine is safe (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.01-4.45); their daughter might become sexually active (aOR, 1.84; 95% CI, 1.08-3.13); they have support of other family members to vaccinate their daughter (aOR, 2.86; 95% CI, 1.47-5.57); and that HPV infection causes severe health problems (aOR, 1.64; 95% CI, 1.04-2.57). In contrast, parents who believed that there is low risk that their daughter will get cervical cancer (aOR, 0.52; 95% CI, 0.29-0.95); that the family will disapprove of getting their daughter vaccinated (aOR, 0.45; 95% CI, 0.22-0.76); that the injection might cause pain (aOR, 0.53; 95% CI, 0.31-0.89), and were older-age parents (aOR, 0.96; 95% CI, 0.93-0.99) had lower odds of willingness to vaccinate daughters with HPV vaccine. Acceptance of HPV vaccination for daughters was high among rural parents in Mysore, India. However, health education to reduce the belief that injection is painful and that daughters are at low risk to get cervical cancer is important to further improve parental HPV vaccine acceptability in Mysore. Public health education should target older-aged parents and extended family members.

Rural Households' Livelihood Capital, Risk Perception, and Willingness to Purchase Earthquake Disaster Insurance: Evidence from Southwestern China.

Earthquake disaster insurance can effectively reduce the impact of earthquake disasters on rural households. Exploring rural households’ willingness to purchase earthquake disaster insurance in earthquake disaster areas provides an understanding of the motivations underlying the implementation of an insurance policy. However, few studies have examined the perspectives of rural households, in order to explore the correlations between the rural households’ livelihood capital, their disaster risk perception, and their willingness to purchase earthquake disaster insurance. A cross-sectional survey data including 241 rural households from the most severe disaster counties (cities) during the 5 • 12 Wenchuan earthquake was examined with regard to rural households’ livelihood and disaster risk perception, and ordinal logistic regression models were constructed to explore rural households’ willingness to purchase earthquake disaster insurance, as well as the driving mechanism behind this willingness. The results showed that 34.44% of rural households were very willing to purchase earthquake disaster insurance, and 7.05% of rural households were very reluctant to purchase earthquake insurance. Rural households’ livelihood capital and risk perceptions were the most important factors affecting their willingness to purchase earthquake disaster insurance. Rural households with higher scores on natural capital, physical capital, possibility, and worry were more likely to purchase earthquake disaster insurance. Specifically, keeping all other variables constant, every one unit increase in nature capital and physical capital corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.14 and 0.06, respectively; every one unit increase in possibility and worry corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.03 and 0.04, respectively. This study contributes to the current literature by increasing the understanding of the relationships between Chinese rural households’ livelihood capital and risk perceptions, and their willingness to purchase earthquake disaster insurance.

Caregiver and expecting caregiver support for early peanut introduction guidelines

BackgroundRecent guidelines recommend early peanut introduction (EPI) beginning around 4 to 6 months of age in infants with severe eczema and/or egg allergy and around 6 months for all other infants. Caregiver preferences for such practices are unknown. ObjectiveTo determine levels of support for early allergenic solid food recommendations among new and expecting caregivers of infants at risk for peanut allergy. MethodsWe explored preferences for EPI and in-office allergy risk assessment (IRA) through a nationally representative survey of expecting (n = 1,000) and new caregivers of infants younger than 1 year (n = 1,000). ResultsAmong a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no or vague awareness of the new guidelines, 61% had no or minimal concern for their child developing food allergy, but 54% felt timing of food introduction has moderate to strong importance for developing food allergy. Only 31% expressed willingness for EPI before or around 6 months of age, with 40% reporting willingness to introduce peanut after 11 months of age, similar to tree nuts and seafood. However, 60% reported willingness to introduce egg before 8 months of age. A total of 51% and 56.8% were unwilling to allow IRA methods, such as skin testing and oral challenge, before 11 months of age, respectively. Odds of willingness to delay peanut introduction (odds ratio, 0.79; 95% confidence interval, 0.65–0.96) and undergo challenge (odds ratio, 0.67; 95% confidence interval, 0.54–0.82) after 6 months of age were lower among expecting caregivers. ConclusionAmong new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including IRA before introduction. Willingness was better among expecting vs current caregivers. These trends underscore a need for broader formal implementation planning to facilitate early allergen introduction and maximize its preventive benefits.

Primary care providers' willingness to continue gender-affirming hormone therapy for transgender patients.

Most transgender individuals either use or are interested in using gender-affirming hormone therapy (HT). Making gender-affirming HT available in primary care is critical for quality care to this vulnerable population. The barriers that transgender patients experience to accessing this treatment may be exacerbated if primary care providers (PCPs) will not provide it. Little is known about PCPs' willingness to administer HT to transgender patients. To examine whether PCPs are willing to continue prescribing HT for transgender patients and the factors that predict such willingness. An online survey of internal and family medicine physicians and residents practising in a large integrated Midwest health system (n = 308); 158 responded to the relevant questions (51.3%). Approximately 50% of respondents were willing to continue HT for transgender patients. Most participants had previously met a transgender person (77%), and approximately half of them had cared for a transgender patient in the past 5 years. Multivariate logistic regression results indicate that attending physicians had lower odds of willingness to continue HT compared with medical residents, and those who reported perceived capability of providing routine care to transgender patients had higher odds of willingness. Only about half of PCPs surveyed were willing to continue HT for transgender patients. Our study indicates that both personal and clinical factors play a role. Future research should address ways to increase PCPs' willingness and comfort related to continuing HT for transgender patients.

Willingness and influencing factors of using pre-exposure prophylaxis among 301 men have sex with men in Wuhan city, 2015

Objective: To understand willingness and influencing factors of using pre-exposure prophylaxis (Pr-EP) among men who have sex with men (MSM). Methods: Snow ball sampling was employed to recruit MSM in the social spaces (like bars and bathrooms) with focused activities by MSM and internet (QQ and Wechat) in Wuhan between August and November, 2015. 304 MSM were considered eligible when they were self-identified MSM and has had sex with men in the previous 12 months, over the age of 18 and have full civil liability. On-site and online questionnaire surveys were conducted by self-designed questionnaires to collect information including demographic characteristics, sexual risks and practices, awareness of PrEP, and willingness to use PrEP. A total of 301 qualified questionnaires were obtained. Multivariate logistic regression models were constructed to identify factors associated with willingness to use Pr-EP. Results: The mean age of surveyed MSM were (27.51±8.31) years, between18-61. 149 on-site survey, online were152; 131 MSM have regular homosexual partners, 170 MSM have not regular homosexual partners. Only 17.28% (52/301) had heard of Pr-EP before this survey, 18.32% (24/130) had heard of Pr-EP among those who had regular homosexual partners and those who had not accounted for 16.47% (28/170). 74.42% (224/301) had willingness to use Pr-EP after they knew Pr-EP was safe and effective through the survey. The proportion among those who had regular homosexual partners was 74.05%(74), and the proportion among those who had not was 74.71% (127); Among those who had regular homosexual partners, results suggested that those who were married/cohabiting were more likely to report a willingness to use PrEP compared to unmarried/divorced or widowed (OR=5.60), compared with homosexual, heterosexuality was associated with decreased odds of willingness to use Pr-EP (OR= 0.22), compared with HIV status of sexual partner was negative or uncertain, positive infection status was associated with increased odds of willingness to use (OR=7.52). Compared with MSM who have not regular homosexual partners, those who were married/cohabiting were more likely to report a willingness to use PrEP compared to unmarried/divorced or widowed (OR=9.09), compared with those who think they have risk of infection, those who do not think they have risk of infection was associated with decreased odds of willingness to use Pr-EP (OR= 0.30), compared with those with a high frequency to seek sexual partners, those not often to seek was associated with decreased odds of willingness to use Pr-EP (OR= 0.27). All above P values were<0.05. Conclusion: The awareness rate of Pr-EP among MSM in Wuhan is low in 2015, but the willingness to use Pr-EP could get a considerable increase after introduction. It is considered that promotion of Pr-EP is feasible in China, and there are different influencing factors for the willingness between two MSM subgroups (having regular homosexual partners and having no regular homosexual partners).

Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters.

To determine if severity of osteoarthritis-related knee pain is associated with a willingness to undergo total knee replacement (TKR) and whether this association is confounded or modified by components of socioeconomic status and health care coverage. Cross-sectional analysis was conducted among 3,530 Osteoarthritis Initiative study participants. Logistic regression models were used to assess the effect of knee pain severity (where 0 = none, 1-3 = mild, 4-7 = moderate, and 8-10 = severe) on willingness to undergo TKR. Stratified analyses were conducted to evaluate whether socioeconomic status and health care coverage modify the effect of knee pain severity on willingness. Participants with severe knee pain, compared to participants without pain, were less willing to undergo TKR (odds ratio [OR] 0.73, 95% confidence interval [95% CI] 0.57-0.93). This association was attenuated when adjusted for age, sex, comorbidity, depression, health insurance coverage, prescription medicine coverage, health care source, education, income, employment, race, and marital status (adjusted OR 0.92, 95% CI 0.68-1.24). The odds of willingness to undergo TKR were significantly lower in those with the highest level of pain, compared to those without pain, among participants without health insurance (adjusted OR 0.08, 95% CI 0.01-0.56), but not among those with health insurance (adjusted OR 1.03, 95% CI 0.73-1.38), when adjusted for demographic, clinical, health care access, and socioeconomic factors (P = 0.015). However, <5% of participants were without health insurance. Among participants without health insurance, severe knee pain was paradoxically associated with less willingness to undergo TKR. Policies that improve access to quality health care may affect patient preferences and increase utilization of TKR surgery among vulnerable populations.

Patient Attitudes Toward Telemedicine for Diabetic Retinopathy.

Diabetic retinopathy (DR) is the leading cause of new-onset blindness in adults. Telemedicine is a validated, cost-effective method to improve monitoring. However, little is known of patients' attitudes toward telemedicine for DR. Our study explores factors that influence patients' attitudes toward participating in telemedicine. Ninety seven participants in a university and the Veterans Administration setting completed a survey. Only people with diabetes mellitus (DM) were included. The main outcome was willingness to participate in telemedicine. The other outcomes were perceived convenience and impact on the patient-physician relationship. Participants reported demographic information, comorbidities, and access to healthcare. Analysis was performed with t-tests and multivariable logistic regression. Demographic factors were not associated with the outcomes (all p > 0.05). Patients had decreased odds of willingness if they valued the patient-physician relationship (adjusted odds ratio [OR] = 0.08, confidence interval [CI] = 0.02-0.35, p = 0.001) or had a longer duration of diabetes (adjusted OR = 0.93, CI = 0.88-0.99, p = 0.02). Patients had increased odds of willingness if they perceived increased convenience (adjusted OR = 8.10, CI = 1.77-36.97, p = 0.01) or had more systemic comorbidities (adjusted OR = 1.85, CI = 1.10-3.11, p = 0.02). It is critical to understand the attitudes of people with DM where telemedicine shows promise for disease management and end-organ damage prevention. Patients' attitudes are influenced by their health and perceptions, but not by their demographics. Receptive patients focus on convenience, whereas unreceptive patients strongly value their patient-physician relationships or have long-standing DM. Telemedicine monitoring should be designed for people who are in need and receptive to telemedicine.

Factors Associated with Willingness to Use Mental Health Services in Korean Immigrants

Responding to the concern about underutilization of mental health services in immigrant populations, the present study explored the factors associated with Korean immigrants' willingness to use mental health services. Guided by Andersen's behavioral model, consideration was given to the role of predisposing (age, gender, marital status, education, and years in the United States), need (depressive symptoms), and enabling (health insurance, acculturation, and personal beliefs about depression) variables. The study estimated, using data from a sample of 205 Korean immigrants (ages 18–45), a logistic regression model of willingness to use mental health services. Although participants experiencing more depressive symptoms tend to be less willing to use these services (odds ratio [OR] = .89, p < .05), an increase in the odds of willingness to use them are found among women (OR = 2.52, p < .01), highly acculturated individuals (OR = 1.09, p < .05), and individuals who believe that depression is a medical condition (OR = 4.71, p < .01). Educational interventions focused on increasing mental health literacy may be beneficial in promoting mental health services for Korean immigrants.