Post-campaign Survey Research Articles

An Integrated mHealth Campaign to Reduce the Risk of Falling for Older Adults.

The number of falls among older adults is rising due to an aging population worldwide. An integrated communication campaign utilizing mHealth (mobile health) encouraged older adults to perform strength, balance, and flexibility exercises to reduce their risk of falling. Campaign development was guided by a mixed-method approach which incorporated expert interviews (N = 3), qualitative interviews (N = 22), and a quantitative baseline pre-campaign survey (N = 274) with older adults. We evaluated the campaign impact with a pre-post survey analysis (post n = 141). Impact was measured by knowledge, attitudes, self-efficacy, and behaviors as key Social Cognitive Theory factors to exercise adoption. Results showed that respondents with campaign exposure had a significant increase in all factor scores from pre- to post-campaign survey, which was significantly higher in the group with campaign exposure. The impact evaluation illustrated how digital mobile channels effectively provide means to reach older adults to reduce their risk of falling.

User-Centred Design of a Final Results Report for Participants in Multi-Sensor Personal Air Pollution Exposure Monitoring Campaigns.

Using low-cost portable air quality (AQ) monitoring devices is a growing trend in personal exposure studies, enabling a higher spatio-temporal resolution and identifying acute exposure to high concentrations. Comprehension of the results by participants is not guaranteed in exposure studies. However, information on personal exposure is multiplex, which calls for participant involvement in information design to maximise communication output and comprehension. This study describes and proposes a model of a user-centred design (UCD) approach for preparing a final report for participants involved in a multi-sensor personal exposure monitoring study performed in seven cities within the EU Horizon 2020 ICARUS project. Using a combination of human-centred design (HCD), human–information interaction (HII) and design thinking approaches, we iteratively included participants in the framing and design of the final report. User needs were mapped using a survey (n = 82), and feedback on the draft report was obtained from a focus group (n = 5). User requirements were assessed and validated using a post-campaign survey (n = 31). The UCD research was conducted amongst participants in Ljubljana, Slovenia, and the results report was distributed among the participating cities across Europe. The feedback made it clear that the final report was well-received and helped participants better understand the influence of individual behaviours on personal exposure to air pollution.

Leveraging Field-Campaign Networks to Identify Sexual Harassment in Atmospheric Science and Pilot Promising Interventions

AbstractSexual harassment in field settings brings unique challenges for prevention and response, as field research occurs outside “typical” workplaces, often in remote locations that create additional safety concerns and new team dynamics. We report on a project that has 1) trained field project participants to recognize, report, and confront sexual harassment, and 2) investigated the perceptions, attitudes, and experiences of field researchers regarding sexual harassment. Precampaign surveys from four major, multi-institutional, domestic, and international field projects indicate that the majority of sexual harassment reported prior to the field campaigns was hostile work environment harassment, and women were more likely to be the recipients, on average reporting two to three incidents each. The majority of those disclosing harassment indicated that they coped with past experiences by avoiding their harasser or downplaying incidents. Of the incidences reported (47) in postcampaign surveys of the four field teams, all fell under the category of hostile work environment and included incidents of verbal, visual, and physical harassment. Women’s harassment experiences were perpetrated by men 100% of the time, and the majority of the perpetrators were in more senior positions than the victims. Men’s harassment experiences were perpetrated by a mix of women and men, and the majority came from those at the same position of seniority. Postproject surveys indicate that the training programs (taking place before the field projects) helped participants come away with more positive than negative emotions and perceptions of the training, the leadership, and their overall experiences on the field campaign.

Improving awareness of energy conservation: Rocky Mountain City

Purpose The purpose of this research project was to improve public awareness to improve public awareness of the importance of energy conservation and to improve the use of simple conservation strategies. A thorough evaluation of the net gain from the numerous energy campaigns rolled out to the public every year is lacking. This study conducted pre- and post-campaign surveys and focus groups to evaluate one campaign’s impact on self-reported energy behaviors. Design/methodology/approach The campaign used television public service announcements and a website to improve awareness of the city’s efforts to conserve energy and to increase individual energy conservation practices. Focus groups (n = 40) were used to identify common barriers to conservation, and pre- and post-surveys (n = 533, 479) were conducted to evaluate the campaign’s effectiveness. Findings Results indicated that the campaign increased positive changes in changing light bulbs and confidence in taking action to turn down thermostats, unplug devices and turn off lights. While follow-up research is needed on the precise mechanism of the psychological process at work, the findings are consistent with the concepts of self and response efficacy as needed components of any behavior change. The authors advocate the adoption of research-informed message design to maximize communication campaign effects. Originality/value This paper demonstrates how the combination of three prominent persuasion theories can be used to develop behavior change campaigns. Also, it is one of the few studies to evaluate the effectiveness of the Energy Star campaign.

Experimental Investigation of Technical and Human Factors Related to Phishing Susceptibility

This article reports on a simulated phishing experiment targeting 6,938 faculty and staff at George Mason University. The three-week phishing campaign employed three types of phishing exploits and examined demographic, linked workstation/network monitoring audit data, and a variety of behavioral and psychological factors measured via pre- and post-campaign surveys. While earlier research studies have reported disparate effects of gender and age, the present results suggest that these effects are not significant or are of limited strength and that other underlying factors may be more important. Specifically, significant differences in phishing susceptibility were obtained for different email contexts and based on whether individuals have been successfully phished before (these people were more likely to succumb to subsequent phishing emails in our study). Further, participants who responded to phishing exploits scored higher on impulsivity than the non-clickers. Also, participants whose survey responses indicated that they had more appropriate online “security hygiene habits,” such as checking the legitimacy of links, were less likely to be successfully phished in our campaign. Participants whose post-campaign survey responses indicated that they were suspicious of a phishing email message in our campaign were far less likely to click on the phishing link than those who were not suspicious. Similar results were obtained for judgments of pertinence of the email. Participants who indicated that they thought about the negative consequences of clicking the link were less likely to do so than participants who did not think about the negative consequences. Implications for effective training and awareness are discussed.

Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up

BackgroundThe global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. MethodsWe documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. ResultsAll the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. ConclusionPolio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources.This approach may have resulted in better MVC outcomes and contributed to Nigeria’s efforts in measles control and elimination.

Measles outbreak in complex emergency: estimating vaccine effectiveness and evaluation of the vaccination campaign in Borno State, Nigeria, 2019

BackgroundFrom January to May 2019, large measles outbreaks affected Nigeria. Borno state was the most affected, recording 15,237 suspected cases with the state capital of Maiduguri having 1125 cases investigated and line-listed by March 2019. In Borno state, 22 of the 27 Local Government Areas (LGAs or Districts), including 37 internally displaced persons (IDPs) camps were affected. In response to the situation, an outbreak response immunization (ORI) campaign was conducted in the 13 most affected LGAs. In addition to conventional vaccination teams, special teams were deployed in security compromised areas, areas with migrants, and for nomadic and IDPs. Here we describe the outbreak and the ORI campaign. We also assess the measles-containing vaccine (MCV) coverage and vaccine effectiveness (VE) in order to quantify the population-level impact.MethodsWe reviewed the ORI activities, and conducted an analysis of the surveillance and the outbreak investigation reports. We assessed VE of MCV by applying the screening-method. Sensitivity analyses were also conducted to assess the effect of final classification of cases on the VE of MCV. The MCV coverage was assessed by a post-campaign coverage survey after completion of the ORI through a quantitative survey in the 12 LGAs that were accessible.ResultsOf the total 15,237 reported measles cases, 2002 cases were line-listed and investigated, and 737 were confirmed for measles by week 9 of 2019. Of the investigated cases 67.3% (n = 1348) were between 9 and 59 months of age. Among the 737 confirmed cases, only 9% (n = 64) stated being vaccinated with at least 1 dose of MCV. The overall VE for MCV was 98.4% (95%CI: 97.8–98.8). No significant differences were observed in the VE estimates of lab-confirmed and epi-linked cases when compared to the original estimates. The aggregated weighted vaccination coverage was 85.7% (95% CI: 79.6–90.1).ConclusionThe experience in Borno demonstrates that adequate VE can be obtained in conflict-affected areas. In complex emergencies affected by measles outbreaks, health authorities may consider integration with other health strategies and the engagement of security personnel as part of the ORI activities.

Application of the Geographic Information System (GIS) in immunisation service delivery; its use in the 2017/2018 measles vaccination campaign in Nigeria

BackgroundAs global effort is made towards measles elimination, the use of innovative technology to enhance planning for the campaign has become critical. GIS technology has been applied to track polio vaccination activities in Nigeria with encouraging outcomes. Despite numerous measles vaccination campaigns after the first catch up campaign in 2005, sub-optimal outcomes of previous measles supplemental immunization activities necessitated the use of innovative ideas to achieve better outcomes especially when planning for the 2017/2018 measles vaccination campaign. This led to the application of the use of the GIS technology for the Northern states in 2017/2018 campaign. This study is a report of what was achieved with the use of the GIS in the 2017/2018 measles vaccination campaign in Nigeria. MethodsGIS generated ward maps were used for the microplanning processes for the 2017/2018 measles vaccination campaign. These ward maps had estimates of the target population by settlements, the number and location of vaccination posts ensuring that a vaccination post is sited within one-kilometer radius of a settlement, and the number of teams needed to support the vaccination campaign as well as the catchment area and daily implementation plans. The ward microplans were verified by checking for accuracy and consistency of the target population, settlements, number of teams, vaccination posts and daily implementation work plans using a standard checklist. The ward maps were deployed into use for the measles vaccination campaign after the state team driven validation and verification by the National team (Government and Partners) ResultsThe Northern states that applied the GIS technology had a closer operational target population to that on the verified microplan than those of the non-GIS technology states. Greater than 90% of the ward maps had all that is expected in the maps - i.e settlements, target populations, and vaccination posts captured, except Kaduna, Katsina and Adamawa states. Of all enumeration areas sampled during the post-campaign survey in states with GIS ward maps, none had a zero-vaccination coverage of the surveyed children, with the exception of one in Borno state that had security issues. In the post campaign coverage survey, the percentage of responses that gave vaccination post being too far as a reason for non-vaccination of children in the Northern zones that used GIS generated ward maps was less than half the rate seen in the southern zones where the GIS microplanning was not used. ConclusionThe use of GIS-generated wards maps improved the quality of ward micro plans and optimized the placement of vaccination posts, resulting in a significant reduction in zero-dose clusters found during the post campaign coverage survey.

Using data to improve outcomes of supplemental immunisation activities: 2017/2018 Nigeria measles vaccination campaign

BackgroundDespite the enormous resources committed to the implementation of supplemental immunisation activities in Nigeria, achieving the required coverage (post-campaign survey) to halt the transmission of vaccine-preventable diseases has continued to seem like an impossibility. A vast volume of data is generated and transmitted during mass vaccination campaigns, but this administrative data does not always culminate into improved coverage. The absence of data-informed guidance from stakeholders with long years of experience in planning and implementing mass vaccination campaigns has impeded achieving 95% coverage in measles campaigns in Nigeria. This study reviews the use of data to guide the implementation of the 2017/2018 measles vaccination campaign in Nigeria. MethodsA central coordinating body was formed at the national level with the same replicated in every state. Tools were developed to measure the performance of the different phases and activities required for the implementation of a mass vaccination campaign as recommended in the international guidelines. Stakeholders were engaged to help ensure that feedback provided by the national measles technical coordinating committee was implemented at the lower level. ResultsMonitoring and analysis of daily data submission caused a proper spread of senior supervisors, vaccination posts location during the campaign and helped identify areas targeted for mop-up. Although the verification of states’ microplan increased the operational target population by 11.2%, the process aided the distribution of resources as appropriate.Maps showing the likely areas that needed additional effort to achieve required coverage with recommendation on the necessary approach to be deployed were transmitted to the states implementing the campaign. ConclusionThe improvement in the use of data to guide implementation of the Nigeria 2017/2018 measles vaccination campaign caused an increase in the number of states that achieved higher coverage in the post-campaign coverage survey.

Using social media influencers to increase knowledge and positive attitudes toward the flu vaccine.

Seasonal influenza affects millions of people across the United States each year. African Americans and Hispanics have significantly lower vaccination rates, and large-scale campaigns have had difficulty increasing vaccination among these two groups. This study assessed the feasibility of delivering a flu vaccination promotion campaign using influencers, and examined shifts in social norms regarding flu vaccine acceptability after a social media micro influencer campaign. Influencers were asked to choose from vetted messages and create their own original content promoting flu vaccination, which was posted to their social media pages. Content was intentionally unbranded to ensure that it aligned with the look and feel of their pages. Cross-sectional pre- and post-campaign surveys were conducted within regions that received the campaign and control regions to examine potential campaign impact. Digital metrics assessed campaign exposure. Overall, 117 influencers generated 69,495 engagements. Results from the region that received the campaign showed significant increases in positive beliefs about the flu vaccine, and significant decreases in negative community attitudes toward the vaccine. This study suggests that flu campaigns using a ground-up rather than top-down approach can feasibly reach at-risk groups with lower vaccination rates, and shows the potentials of using an influencer-based model to communicate information about flu vaccination on a large scale.

How much does it cost to measure immunity? A costing analysis of a measles and rubella serosurvey in southern Zambia.

Serosurveys are a valuable surveillance tool because they provide a more direct measure of population immunity to infectious diseases, such as measles and rubella, than vaccination coverage estimates. However, there is concern that serological surveys are costly. We adapted a framework to capture the costs associated with conducting a serosurvey in Zambia. We costed a nested serosurvey in Southern Province, Zambia that collected dried blood spots from household residents in a post-campaign vaccine coverage survey. The financial costs were estimated using an ingredients-based costing approach. Inputs included personnel, transportation, field consumable items, social mobilization, laboratory supplies, and capital items, and were classified by serosurvey function (survey preparation, data collection, biospecimen collection, laboratory testing, and coordination). Inputs were stratified by whether they were applicable to surveys in general or attributable specifically to serosurveys. Finally, we calculated the average cost per cluster and participant. We estimated the total nested serosurvey cost was US $68,558 to collect dried blood spots from 658 participants in one province in Zambia. A breakdown of the cost by serosurvey phase showed data collection accounted for almost one third of the total serosurvey cost (32%), followed by survey preparation (25%) and biospecimen collection (20%). Analysis by input categories indicated personnel costs were the largest contributing input to overall serosurvey costs (51%), transportation was second (23%), and field consumables were third (9%). By combining the serosurvey with a vaccination coverage survey, there was a savings of $43,957. We estimated it cost $4,285 per average cluster and $104 per average participant sampled. Adding serological specimen collection to a planned vaccination coverage survey provided a more direct measurement of population immunity among a wide age group but increased the cost by approximately one-third. Future serosurveys could consider ways to leverage existing surveys conducted for other purposes to minimize costs.

Association of a Public Health Campaign About Coronavirus Disease 2019 Promoted by News Media and a Social Influencer With Self-reported Personal Hygiene and Physical Distancing in the Netherlands

In the absence of a vaccine and therapeutic agent, personal hygiene and physical distancing are essential measures to contain the coronavirus disease 2019 pandemic. To determine whether a social media campaign, targeted at the gaps in behavior on personal hygiene and physical distancing and distributed nationwide via digital news media, may be an effective method to improve behavior and help to inhibit person-to-person transmission of severe acute respiratory syndrome coronavirus 2. This survey study was designed to uncover self-reported gaps in behavior regarding personal hygiene and physical distancing in the Netherlands. A diagnostic survey was distributed by a large national newspaper (De Telegraaf) and a popular social influencer (Govert Sweep) on March 17, 2020, and was completed by 16 072 participants. Analysis of these outcomes showed that coughing and sneezing in the elbow was done well, but that handwashing, face touching, and physical distancing showed serious gaps compared with advised behavior. This diagnostic information was used to design infographics and a video targeted at repairing these gaps in behavior. The video and infographics were distributed on a national level on March 21, 2020, followed by a postcampaign survey to measure the results on March 24, 2020. Data analysis was performed from March to April 2020. Exposed participants were those who viewed the infographics and/or video. Improvement on the extent of handwashing in all areas, handwashing duration of 20 seconds or longer, awareness on face touching, and physical distancing were measured according to responses on the postcampaign survey. A total of 17 189 participants (mean [SD] age, 47.61 [13.57] years; 9100 women [52.9%]) responded to the postcampaign survey. The news article in De Telegraaf was read more than 2 million times, and the influencer video was watched more than 80 000 times. Cross-sectional analysis of the postcampaign survey using logistic regression correcting for age, gender, and educational level showed that exposure to the video plus infographics (827 participants) (adjusted odds ratio [OR], 2.14; 95% CI, 1.83-2.50; P < .001) and to the infographics alone (11 348 participants) (adjusted OR, 1.31; 95% CI, 1.22-1.40; P < .001) were positively associated with washing hands in all areas compared with the unexposed group (4751 participants). In addition, exposure to the video plus infographics (adjusted OR, 1.86; 95% CI, 1.59-2.16; P < .001) and to the infographics alone (adjusted OR, 1.27; 95% CI, 1.19-1.36; P < .001) were positively associated with washing hands long enough compared with the unexposed group. Exposure to the video alone was not associated with improved handwashing. Compared with the unexposed group, exposure to the infographics alone and video plus infographics were associated with improvements in physical distancing when the participant had COVID-19 syptoms (infographics alone, adjusted OR, 1.10; 95% CI, 1.03-1.17; P = .006; video plus infographics, adjusted OR, 0.79; 95% CI, 0.69-0.91; P = .001) and face touching (infographics alone, adjusted OR, 1.29; 95% CI, 1.22-1.38; P < .001; infographics and video, adjusted OR, 1.49, 95% CI, 1.30-1.71; P < .001). These findings suggest that a targeted behavioral change campaign, promoted by a news platform and social media, was associated with self-reported improvement in personal hygiene with the aim to prevent person-to-person transmission of severe acute respiratory syndrome coronavirus 2. This method of evidence-based campaigning may be an effective way to improve critical public health issues, such as the coronavirus disease 2019 pandemic.

Geospatial variation in measles vaccine coverage through routine and campaign strategies in Nigeria: Analysis of recent household surveys

Measles vaccination campaigns are conducted regularly in many low- and middle-income countries to boost measles control efforts and accelerate progress towards elimination. National and sometimes first-level administrative division campaign coverage may be estimated through post-campaign coverage surveys (PCCS). However, these large-area estimates mask significant geographic inequities in coverage at more granular levels. Here, we undertake a geospatial analysis of the Nigeria 2017–18 PCCS data to produce coverage estimates at 1 × 1 km resolution and the district level using binomial spatial regression models built on a suite of geospatial covariates and implemented in a Bayesian framework via the INLA-SPDE approach. We investigate the individual and combined performance of the campaign and routine immunization (RI) by mapping various indicators of coverage for children aged 9–59 months. Additionally, we compare estimated coverage before the campaign at 1 × 1 km and the district level with predicted coverage maps produced using other surveys conducted in 2013 and 2016–17. Coverage during the campaign was generally higher and more homogeneous than RI coverage but geospatial differences in the campaign’s reach of previously unvaccinated children are shown. Persistent areas of low coverage highlight the need for improved RI performance. The results can help to guide the conduct of future campaigns, improve vaccination monitoring and measles elimination efforts. Moreover, the approaches used here can be readily extended to other countries.

Antibiotic use and resistance in Belgium: the impact of two decades of multi-faceted campaigning

ABSTRACT Objective: To present an overview of almost two decades of multi-faceted campaigning by the Belgian Antibiotic Policy Coordination Committee (BAPCOC) and partners, and its impact on public and prescribers’ awareness, outpatient antibiotic use, its cost and antimicrobial resistance in Belgium.Methods: Awareness of both public and prescribers was assessed through pre- and post-campaign interviews and surveys. Outpatient antibiotic use was evaluated using national reimbursement data expressed in number of defined daily doses and packages (a good proxy for treatments) per 1000 inhabitants per day (DID and PID, respectively) from July 1997 to June 2018. Its cost was studied using the same data expressed in number of euros per 1000 inhabitants per day. Antimicrobial resistance was evaluated between 1986 and 2017 using national data on the proportion of Streptococcus pneumoniae isolates not susceptible to penicillins, macrolides and tetracyclines.Results: Antibiotic awareness improved significantly, with general practitioners preferred by 87.5% of respondents as source of information. The Belgian outpatient antibiotic use has decreased by 12.8% in DID and by 42.8% in PID in the 2017-2018 winter compared to the winter before the start of its public awareness campaigns (1999-2000). This evolution coincided with decreasing costs for antibiotics and decreasing antimicrobial resistance. Despite multi-faceted campaigning, outpatient antibiotic use and use of broad-spectrum antibiotics, especially fluoroquinolones and amoxicillin with clavulanic acid, are still high in Belgium.Conclusion: Almost two decades of multi-faceted campaigning coincide with improvements in antibiotic awareness among the public and prescribers, outpatient antibiotic use and resistance. Nevertheless, additional efforts are needed to reach the targets set in BAPCOC’s national action plan 2014-2019. Therefore, a new national action plan was developed for 2020-2024 using a One Health approach.

‘Break the Chains 2015’ community-based HIV prevention campaign for men who have sex with men in Switzerland: non-randomised evaluation and cost analysis

ObjectivesTo study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May...

Impact of The Real Cost Media Campaign on Youth Smoking Initiation

The purpose of this study was to assess the relationship between youth exposure to the U.S. Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in smoking initiation. From November 2013 to November 2016, a longitudinal study of youth was conducted with a baseline and 4 post-campaign follow-up surveys. The sample consisted of nonsmoking youths from 75 U.S. media markets (n=5,103) who completed a baseline and at least 1 follow-up survey. Exposure was measured by media market-level target rating points and self-reported ad exposure frequency. Smoking initiation was examined among youths who had never smoked at baseline and defined as first trial of a cigarette. Discrete-time survival models using logistic regression and controlling for confounding influences were estimated. Analyses were conducted in 2018. The odds of reporting smoking initiation at follow-up was lower among youths in media markets with higher levels of campaign advertisements than among those with less. Both between-wave and cumulative target rating points were associated with decreased risk of smoking initiation (AOR=0.69 [p<0.01] and AOR=0.89 [p<0.05], respectively); for every 3,500 between-wave target rating points on air, there was an associated 30% reduction in the hazard of smoking initiation among youths. Results from self-reported recall of the campaign advertisements found similar dose-response effects. The campaign is associated with an estimated 380,000-587,000 youths aged 11-19 years being prevented from initiating smoking nationwide. Sustained national tobacco public education campaigns like The Real Cost can change population-level smoking initiation among youths, preventing future generations from tobacco-related harms.

Socio-spatial heterogeneity in participation in mass dog rabies vaccination campaigns, Arequipa, Peru.

To control and prevent rabies in Latin America, mass dog vaccination campaigns (MDVC) are implemented mainly through fixed-location vaccination points: owners have to bring their dogs to the vaccination points where they receive the vaccination free of charge. Dog rabies is still endemic in some Latin-American countries and high overall dog vaccination coverage and even distribution of vaccinated dogs are desired attributes of MDVC to halt rabies virus transmission. In Arequipa, Peru, we conducted a door-to-door post-campaign survey on >6,000 houses to assess the placement of vaccination points on these two attributes. We found that the odds of participating in the campaign decreased by 16% for every 100 m from the owner’s house to the nearest vaccination point (p = 0.041) after controlling for potential covariates. We found social determinants associated with participating in the MDVC: for each child under 5 in the household, the odds of participating in the MDVC decreased by 13% (p = 0.032), and for each decade less lived in the area, the odds of participating in the MDVC decreased by 8% (p<0.001), after controlling for distance and other covariates. We also found significant spatial clustering of unvaccinated dogs over 500 m from the vaccination points, which created pockets of unvaccinated dogs that may sustain rabies virus transmission. Understanding the barriers to dog owners’ participation in community-based dog-vaccination programs will be crucial to implementing effective zoonotic disease preventive activities. Spatial and social elements of urbanization play an important role in coverage of MDVC and should be considered during their planning and evaluation.

Unplanned purchasing of tobacco products: Beyond point of sale display

Tobacco products remain widely available and unplanned purchasing of tobacco has been implicated in cessation relapse. Little is known however about the frequency of consumers' unplanned tobacco purchases or the type of retail outlets where this is more likely to occur. Questions on cigarette purchasing were added to a post-campaign telephone survey for the Make Smoking History Campaign in Western Australia. Respondents (n=200) were aged 25 to 54 years and were either current smokers or had quit in the last 4-5 weeks. Two-thirds of respondents had tried to quit in the past 2 years. Survey responses were analysed to look at place of purchase (the usual and after cessation relapse) and frequency and reasons for unplanned purchases. Supermarkets were the "usual" purchase location for the majority of respondents overall (78%), but the proportion who reported buying cigarettes from a supermarket after taking up smoking again declined substantially (52%), while purchases from convenience stores and service stations increased. Nearly a third (30%) of respondents indicated that they sometimes bought cigarettes unplanned or on impulse, and for 16%, this was at least once a week. Among smokers who have tried to quit but not succeeded, unplanned cigarette purchases are common. There is evidence to suggest that when people resume smoking after a cessation attempt, the cigarette purchase is not necessarily made at their "usual" type of retail outlet. SO WHAT?: The banning of point of sale tobacco display has not eliminated the pervasive availability and retail presence of tobacco, and unplanned purchasing of cigarettes is an impediment to successful smoking cessation. This study adds weight to growing momentum internationally and in Australia to reduce the widespread availability of tobacco products and decrease the barriers to quitting use of a product that kills over half of its consumers.

Can a mass media campaign raise awareness of alcohol as a risk factor for cancer and public support for alcohol related policies?

Alcohol consumption increases the risk of several cancers, but public awareness of alcohol as a risk factor for cancer is low. Research indicates that public opinion about alcohol related policies can be influenced by mass media campaigns and awareness of alcohol as a carcinogen. The objective of this study was to test whether a mass media campaign intended to raise awareness of the relation between alcohol and cancer is associated with higher public awareness of alcohol as a risk factor for cancer, and higher levels of support for alcohol related policies. Cross-sectional surveys of a nationally representative sample of N = 6000 Danish adults were conducted pre- (n = 3000) and post campaign (n = 3000) in 2017–2018.Awareness of alcohol as a cancer risk factor significantly increased between the pre and post campaign survey (approximately 5 percentage points). The proportion of respondents who supported minimum unit pricing, a ban on alcohol advertising, and mandatory nutrition labelling was significantly higher post campaign than pre campaign, while support for limited number of retail outlets and limited sale hours were unchanged. For males, but not females, higher support for an 18 year age limit for purchasing alcohol, age limits for buying alcohol at secondary education school parties, and increased enforcement of age limits was found after the campaign than prior to it. Conclusively, the results show that a mass media campaign was associated with an increase in awareness of alcohol as a risk factor for cancer as well as alcohol policy support at a population level.

Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey

BackgroundSerological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. MethodsDried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). ResultsOverall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). ConclusionSeroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.