Reduce Risk Behaviors Research Articles

The diffusion of dementia risk education

AbstractBackgroundThe Preventing Dementia Massive Open Online Course (PD‐MOOC) is one of several initiatives aiming to increase dementia risk knowledge and promote risk‐reducing behaviour. These initiatives primarily reach advantaged individuals, increasing health inequities. Previously, thematic analysis of PD‐MOOC participant feedback identified frequent reports of sharing dementia risk information with others. Interpersonal communication often introduces information to people from a broader demographic and may increase the impact of dementia risk education. This study investigated the diffusion of dementia risk reduction knowledge and behaviour beyond PD‐MOOC participants.MethodThe PD‐MOOC attracted over 99,000 enrolments from 2016 to 2019. Responses to surveys completed by participants before (demographics) and after (course feedback) the PD‐MOOC were analysed. Qualitative statements were characterised using key word filtering and subsequent thematic analysis. Chi‐squared tests of homogeneity with Bonferroni adjustments for multiple comparisons were used to determine significant information sharing patterns.ResultOlder people, females, health sector workers and people with a post‐secondary education were over‐represented among PD‐MOOC participants. Participants expressed an eagerness to share the MOOC with others, with 98.8% of respondents agreeing they “would recommend the MOOC to others”. 25% of responding participants discussed sharing PD‐MOOC information in their response to the question “If you have already applied your MOOC learning, please tell us how”. Among those who reported sharing information with specific people, family members were mentioned most frequently, followed by friends and colleagues. Significantly more responses discussed sharing information with males than females (p < 0.001) and with people outside the health sector than within (p < 0.001). Some participants reported sharing information about specific risk domains; physical activity was mentioned most frequently, followed by cognitive stimulation and diet. Additionally, some reported that the person with whom they shared information altered their behaviour; increased physical activity was most commonly reported, followed by a general improved lifestyle and a change in diet.ConclusionInformation sharing transmits dementia risk information to, and promotes behaviour change among, people who are demographically less represented in the PD‐MOOC, extending the reach and impact of this educational intervention. The PD‐MOOC enables dementia risk reduction beyond those educated.

Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda

BackgroundThere are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda.MethodsWe conducted a cross-sectional study. 815 women (aged 18–60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms.ResultsThe majority of participants (53%, n = 433) were young (18–29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3–9). Median knowledge score for symptoms recognition = 7 (IQR: 1–10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38–0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36–0.49 (95%CI: 0.26–0.84) were less likely to be knowledgeable of symptoms of cervical cancer.ConclusionA significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.

Parents Matter: Associations Between Parent Connectedness and Sexual Health Indicators Among Transgender and Gender-Diverse Adolescents.

Transgender and gender-diverse youth experience significant health disparities across numerous domains of health, including sexual health. Among general populations, parent connectedness has been strongly associated with youth sexual health. The relationships between parent connectedness and sexual health indicators were investigated among 2,168 transgender and gender-diverse youth who participated in the 2016 Minnesota Student Survey, a statewide population-based survey of ninth- and 11th-grade students. Multivariate logistic regression models, stratified by sex assigned at birth, tested associations between parent connectedness-youth's perceptions of parent caring and parent-youth communication-and eight sexual health indicators: ever having had sex, having multiple sexual partners in the past year, pregnancy involvement, substance use at last sex, partner communication about STI prevention, partner communication about pregnancy prevention, condom use at last sex and pregnancy prevention methods at last sex. The level of parent connectedness was inversely associated with ever having had sex, regardless of sex assigned at birth (odds ratios, 0.6-0.8). Although level of connectedness was inversely associated with having multiple sexual partners in the past year and pregnancy involvement among transgender and gender-diverse youth assigned male at birth (0.6-0.7), these relationships were nonsignificant among transgender and gender-diverse youthassigned female at birth. Further differences in associations between parent connectedness and four sexual risk-reduction behaviors were found between youth assigned male at birth and those assigned female. As with other populations, parent connectedness promotes sexual health among transgender and gender-diverse youth and may provide a point of intervention.

Women's Intentions to Engage in Risk-Reducing Behaviours after Receiving Personal Ovarian Cancer Risk Information: An Experimental Survey Study.

Simple SummaryRisk stratification using genetic testing to identify women at increased risk of ovarian cancer may increase the number of patients to whom risk-reducing surgery (e.g., salpingo-oophorectomy) may be offered. However, little is known about public acceptability of such approaches. Our online experimental survey aimed to explore whether women aged 45–75 in the general population are willing to undergo ovarian cancer risk assessment, including genetic testing, and whether women’s potential acceptance of risk-reducing surgery differs depending on their estimated risk. We looked at whether psychological and cognitive factors mediated women’s decision-making. The majority of participants would be interested in having genetic testing. In response to our hypothetical scenarios, a substantial proportion of participants were open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased from 2% to 5 or 10%.Risk stratification using genetic and/or other types of information could identify women at increased ovarian cancer risk. The aim of this study was to examine women’s potential reactions to ovarian cancer risk stratification. A total of 1017 women aged 45–75 years took part in an online experimental survey. Women were randomly assigned to one of three experimental conditions describing hypothetical personal results from ovarian cancer risk stratification, and asked to imagine they had received one of three results: (a) 5% lifetime risk due to single nucleotide polymorphisms (SNPs) and lifestyle factors; (b) 10% lifetime risk due to SNPs and lifestyle factors; (c) 10% lifetime risk due to a single rare mutation in a gene. Results: 83% of women indicated interest in having ovarian cancer risk assessment. After receiving their hypothetical risk estimates, 29% of women stated they would have risk-reducing surgery. Choosing risk-reducing surgery over other behavioural responses was associated with having higher surgery self-efficacy and perceived response-efficacy, but not with perceptions of disease threat, i.e., perceived risk or severity, or with experimental condition. A substantial proportion of women age 45–75 years may be open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased to as little as 5 or 10%.

Psychological drivers of risk-reducing behaviors to limit human-wildlife conflict.

Conflicts between people and wild animals are increasing globally, often with serious consequences for both. Local regulations or ordinances are frequently used to promote human behaviors that minimize these conflicts (risk-reducing behaviors), but compliance with ordinances can be highly variable. While efforts to increase compliance could be improved through applications of conservation psychology, little is known about the relative influence of different factors motivating compliance. Using concepts from psychology and risk theory, we conducted a longitudinal study pairing data from mail surveys with direct observations of compliance with a wildlife ordinance requiring residents to secure residential garbage from black bears (Ursus americanus). We assessed the relative influence of beliefs and attitudes toward bears and bear proofing, perceived behavioral control, perceived risks and benefits assigned to bears, norms, trust in management, previous experience with conflicts, and demographics on compliance behavior (i.e., bear proofing). Data on previous experience were obtained through direct observation and survey reports. We found that higher compliance rates were associated with more observed conflicts on a respondent's block. Counter to expectations, however, residents were less compliant when they were more trusting of the management agency and perceived more benefits from bears. We suggest that messages have the potential to increase compliance when they empower residents by linking successful management of conflicts to individual actions and emphasize how reducing conflicts could maintain benefits provided by wildlife. Modifying existing educational materials to account for these psychological considerations and evaluating their impact on compliance behavior over time are important next steps in changing human behaviors relevant to the globally important problem of human-wildlife conflict.

Drug use characteristics and correlates of multiple risk behaviors among synthetic drug users

ABSTRACT Objective: Understanding drug use characteristics can help inform preventive education and behavioral therapy. The aims of the current study are to describe drug use characteristics and examine factors associated with multiple risk behaviors among synthetic drug users in China. Method: Cross-sectional data were obtained in 2015 from 846 (457 men and 389 women) adult synthetic drug users in China. SAS 9.4 was used for all data analyses. Results: Multiple regression analyses showed that female participants were more likely to have engaged in a suicide attempt, while male participants were more likely to have engaged in group sex under the influence of drugs, gambling, vandalism, beating up others, motorcycle racing, and other criminal activities. Moreover, age, occupation, education level, household socioeconomic status, age of drug initiation, and drug use frequency were associated with multiple risk behaviors. Conclusions: Future health promotion efforts to reduce risk behaviors among synthetic drug users need to focus on reducing drug use frequency and helping them find possible ways to improve livelihoods. The gender differences in risk behaviors also suggest the needs of gender-specific prevention intervention strategies such as mental health services and reduction of partner influence among female users, and reduction of peer influence among male users.

(En)gendering risk: gender dynamics, trust and risk negotiations among drug-using couples

Although intimate partnerships where both partners inject drugs have emerged as the focus of research and interventions, the gender dynamics characterising risk behaviours in injecting partnerships have largely been neglected. This study explored qualitative interview accounts focusing on the ways gender dynamics that reflect power differences between male and female injecting partners influenced risk perception and management. It drew upon a qualitative study of risk negotiation practices of injecting partners (n = 16) in Uyo, Nigeria. Analysis highlighted three key themes: ‘caring and drug-using partnerships’; ‘risk reduction and production’, and ‘male dominance and gendered violence’. Although the intimate partnerships of PWID provided emotional and social support in a high-risk environment, factors operating within these partnerships, including affection, trust, and gendered violence, undermined agency and risk-reducing behaviours, creating conditions that increased vulnerability to HIV particularly for women. The findings support calls to move beyond individual risk factors and privilege a relationship orientation in HIV prevention work. In particular, the analysis highlights a need for intervention models that build and maintain trust among drug-using partners, while improving communication skills, preventing violence and promoting HIV prevention through the adoption of risk-reducing measures.

Effects of kratom (Mitragyna speciosa Korth.) in reducing risk-behaviors among a small sample of HIV positive opiate users in Malaysia

Out-of-treatment HIV positive opiate users often engage in risky injecting and sexual behaviors. We sought the self-reported experiences on whether or not kratom (Mitragyna speciosa Korth.) use was associated with a reduction in HIV risk behaviors among them. A convenience sample consisting of thirty-two HIV positive opiate users participated in the study. Of this, three-fifths (n = 20/32) used kratom to suppress opiate withdrawal, increase energy, as a heroin substitute, to reduce heroin dependence and self-treat psychological problems. More than one-third (38%) in the sample claimed that kratom use reduced their risky injecting and sexual behaviors. Given the small sample size, the perceived association between kratom use and the reduction in HIV risk behaviors could not be established more convincingly. However, the findings provide the basis for a broader-based study to evaluate the potential of kratom in curtailing HIV risk behaviors among HIV positive opiate users.

Risk Perception & Risk-Reduction Behavior Model for Blue-Collar Workers: Adapted From the Health Promotion Model.

This study examined the health promotion model (HPM) as a framework for assessing perceptions and health-related behaviors related to cardiovascular disease (CVD) risk among blue-collar workers. This was done with the aim of providing time-sensitive educational and training materials for workers while on the job or functioning in their communities. The revised HPM was evaluated in the above context using specific criteria developed by Chinn and Kramer (2008) and scoping literature review. Specifically, we assessed the model based on five criteria such as its clarity, simplicity, generality, accessibility, and importance. The revised HPM showed strengths in both accessibility and generality. That is, it applied to all populations and chronic illnesses through clearly defined and specified major concepts. However, there were several weaknesses in areas of clarity and consistency; the model included three new concepts (i.e., activity-related affect, commitment to a plan of action, and immediate competing demands and preference) that actually decreased these elements. In this context, situational influences require adequately reflected external variables. Nevertheless, the revised HPM showed predictive power among this study’s target population. The HPM was modified to address deficiencies in regard to the concept of risk perception. Work-related situational influences were also restructured based on individual and environmental characteristics. The modified framework can be used to clarify health-related behaviors among blue-collar workers.

The Association Between African American Father-Child Relationships and HIV Testing.

The existing literature identifies parent communication as a protective mechanism in the reduction of sexual risk behaviors among youth; however, not much is known about father–child communication and bonding and its association with HIV testing. Therefore, this study examines the link between the relationship, bonding, and communication shared by African American (AA) fathers and their children and HIV testing over time. This secondary data analysis included data from Waves 1 and 3 of the National Longitudinal Study of Adolescent to Adult Health on the health of adolescents to adults in a sample of AA males and females (N = 509), with a mean age of 16 years. The independent variables included fathers’ communication, bonding, and relationships, and the dependent variables included HIV testing. A multinomial analysis assessed the factors that contributed to or prevented HIV testing. It was found that the overall model was statistically significant; F(24, 55) = 8.95; p < .001. The results suggest that father–adolescent communication was statistically significant and positively associated with HIV testing (B = 23.88; p < .05). AA adolescents who reported going to the doctor or making a nursing visit were more likely to get tested multiple times (B = 13.91; p < .001). Our findings indicate that father–child relationships are essential to adolescent sexual development and serve as a protective factor against threats to sexual health. Future studies should be designed to investigate the cognitive mechanisms through which the father–child bonding and communication may impact HIV testing.

Relationship Between Impulsivity, Sensation-Seeking, and Drug Use in Aggressors and Victims of Violence.

Introduction: The impulsivity, sensation-seeking, and drug use variables, in addition to being closely related, have repercussions on peer conflict and violence in schools.Objective: The purpose of this study was to analyze the relationship between impulsivity, sensation-seeking, and drug use in aggressors and victims of violence.Methods: The study design was cross-sectional and observational. The study sample was made up of 822 students aged 13–18 who had completed an ad hoc questionnaire, the State Impulsivity Scale and the Sensation-Seeking Scale.Results: The results showed that the aggressors had high levels of gratification, automatism, attentional factor, disinhibition, and susceptibility to boredom and used alcohol and/or tobacco.Conclusion: The design of an effective education intervention for reducing risk behaviors related to violence must focus on these variables.

Association between state stay-at-home orders and risk reduction behaviors and mental distress amid the COVID-19 pandemic

The 2019 Coronavirus Disease (COVID-19) pandemic has triggered stay-at-home orders in 43 states since March 19, 2020. Evidence is limited on how these orders affect peoples' behaviors and mental distress. We used a nationally representative survey of 1094 American adults collected between March 19 and March 31, 2020 to compare risk-reduction behaviors and mental distress in states with and without orders.Risk reduction behaviors included hand washing, wearing face mask and social distancing, and the mental distress was assessed by the four-item version of the Patient Health Questionnaire (PHQ-4). We predicted the probability of a person adopting risk reduction behaviors and the mental distress status using the number of days since their state issued the order relative to those in the non-order states, controlling for COVID-19 prevalence in the state, self-reported symptoms and demographic characteristics. The analysis was conducted in April 2020.Results show that the probability of adopting risk reduction behaviors increased between 8 (avoidance of people with high risk, 87% to 95%) and 27 (use of face mask, 18% to 45%) percentage points in the response period. Mental distress increased by 1.0 point on the PHQ-4 score (from 2.4 to 3.5 point) in the first week and started to drop afterwards.In summary, stay-at-home orders were associated with a differential increase in risk-reduction behaviors. People's mental distress rose in the first week under order and dropped afterwards. While in need for confirmation in longitudinal data, these results suggest that residents are responsive to orders.

Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach

ObjectiveSince the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related...

Exposure to Natural Vegetation in relation to Mammographic Density

Background: Exposure to natural vegetation or “greenness” promotes breast cancer risk-reduction behaviors (e.g. greater physical activity and lower BMI) and three epidemiologic studies reported inverse associations with breast cancer risk; however, it remains unknown whether this is due to direct biological effects on breast tissue or indirect impacts on lifestyle. We examined the association between greenness and mammographic density—a strong risk factor for breast cancer—to determine whether greenness directly influences breast tissue composition. Methods: We included 2,323 women without a history of breast cancer who underwent mammographic screening at the Brigham and Women’s Hospital from 2007-2014. Normalized Difference Vegetation Index (NDVI) satellite data at 1 km2 scale at participants’ residential address was used to estimate 5-, 3- and 1-year cumulative average annual and summer greenness prior to the mammogram. We used multivariable linear regression to estimate differences in log transformed volumetric percent density for a 0.1 unit increase in NDVI adjusted for breast density predictors and stratified by menopausal status. Results: Overall, associations were null for NDVI measures and mammographic density. Among 1,108 premenopausal women, 5-year annual average NDVI was non-significantly inversely associated with percent mammographic density (β=-0.01 95% CI -0.03, 0.02; p-value=0.52) after adjustment for age, BMI, race/ethnicity, parity, family history of breast cancer, and benign breast disease; results were similar for other NDVI measures. Among 1,215 postmenopausal women, 5-year annual average NDVI was non-significantly inversely associated with percent mammographic density (β=-0.02 95% CI -0.04, 0.01; p-value=0.18) after adjustment for aforementioned variables and hormonal therapy use; results were similar for other NDVI measures.Conclusions: While in the expected direction, findings suggest that greenness does not have a direct role on breast tissue composition. Future work will explore if the potential benefit of greenness is more relevant to subgroups of women based on race/ethnicity, BMI, and physical activity.

Differences in the Knowledge of Cardiovascular Risk Reduction Behaviors in Young and Older Populations: Using 2018 Hints Survey Data

Differences in the Knowledge of Cardiovascular Risk Reduction Behaviors in Young and Older Populations: Using 2018 Hints Survey Data

Patient perspectives of pharmacists prescribing HIV pre-exposure prophylaxis: A survey of patients receiving antiretroviral therapy

BackgroundGroundbreaking new laws granting community pharmacists the authority to prescribe human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) medications have the potential to substantially expand PrEP access in high-risk communities. However, whether patients will be accepting of pharmacists as PrEP providers is underexplored within the literature. ObjectivesTo assess patient perspectives of pharmacist PrEP prescribing and identify potential barriers to acceptance of pharmacist-prescribed PrEP. MethodsAdult patients currently receiving antiretroviral therapy for HIV prophylaxis or treatment at a specialty pharmacy were surveyed telephonically from January 2020-April 2020. A 4-point Likert scale was used to measure perceptions in addition to open-ended questions. ResultsThe participation rate was 87.5%. Of the 49 included patients, 100% agreed/strongly agreed that pharmacists were knowledgeable about medications, but they were less likely to strongly agree that pharmacists were knowledgeable about HIV drugs (14.3% vs. 75.5% for other drugs, P < 0.001). Most (93.9%) of the patients agreed/strongly agreed that they would feel comfortable seeking a pharmacist for PrEP information or HIV testing. With respect to PrEP prescribing, 16.3% disagreed that they would feel comfortable having a pharmacist prescribe their first fill of PrEP, preferring to speak to their physician or expressing concerns that pharmacists have inadequate training. All patients expressed a desire for additional HIV/PrEP training requirements for pharmacists before allowing them to prescribe PrEP. A portion of the respondents (18.4%) expressed concerns that the increased availability of PrEP would lead to persons becoming lax about barrier protection. However, 100% of the patients agreed/strongly agreed that having pharmacist-prescribed PrEP would benefit their community. ConclusionPatients receiving antiretroviral therapy reported overall favorable perceptions of pharmacist PrEP prescribing; however, some concerns relating to pharmacists’ level of training in HIV exist. This may be ameliorated through increased pharmacist education, including how to counsel patients seeking PrEP on behavioral risk reduction.

The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

BackgroundWidespread viral and serological testing for SARS-CoV-2 may present a unique opportunity to also test for HIV infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on HIV incidence and the cost-effectiveness of this strategy in six US cities.MethodsUsing a previously-calibrated dynamic HIV transmission model, we constructed three sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviours at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to scenario (2). We estimated cumulative HIV infections between 2020-2025 and incremental cost-effectiveness ratios of linked HIV testing over 20 years.ResultsIn the absence of linked, opt-out HIV testing, we estimated a total of 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviours and no service disruptions), and 9.0% increase in the worst-case scenario (no behavioural change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7,225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health care costs in each city.ConclusionsA campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce HIV incidence and reduce direct and indirect health care costs attributable to HIV.

Toward Community Empowerment: The Puerto Rican Ganchero.

People who inject drugs (PWID) who migrate from Puerto Rico (PR) to New York City (NYC) are at elevated risk for hepatitis C (HCV), HIV and drug overdose. There is an urgent need to identify a sustainable path toward improving the health outcomes of this population. Peer-driven HIV/HCV prevention interventions for PWID are effective in reducing risk behaviors. Additionally, the concept of intravention-naturally occurring disease prevention activities among PWID (Friedman, 2004)-is a suitable theoretical framework to cast and bolster PWID-indigenous risk reduction norms and practices to achieve positive health outcomes. From 2017-2019, we conducted an ethnographic study in the Bronx, NYC to identify the injection risks of migrant Puerto Rican PWID, institutional barriers to risk reduction and solutions to these barriers. Study components included a longitudinal ethnography with 40 migrant PWID (e.g., baseline and exit interviews and monthly face-to-face follow-ups for 12 months), two institutional ethnographies (IEs) with 10 migrants and six service providers, and three focus groups (FGs) with another 15 migrant PWID. Data were analyzed using a grounded theory approach. In this article, we present findings from the IEs and FGs, specifically regarding a promising intravention pathway to promote health empowerment among these migrants that leverages an existing social role within their networks: the PR-indigenous ganchero. A ganchero is a vein-finding expert who is paid with drugs or cash for providing injection services. Ethnographic evidence from this study suggests that gancheros can occupy harm reduction leadership roles among migrant Puerto Rican PWID, adapting standard overdose and HIV/HCV prevention education to the specific experiences of their community. We conclude by noting the culturally appropriate risk reduction service delivery improvements needed to mitigate the health vulnerabilities of migrants and provide a roadmap for improving service delivery and identifying future research avenues.

Municipality-Level Checklist to Promote Parental Behaviors Related to Prevention of Unintentional Injury in Young Children: A Multilevel Analysis of National Data.

BackgroundUnintentional injury is a major cause of morbidity and mortality among young children in developed countries. In this national study, we examined the role of municipality-level safety checklist implementation for reducing risky child-safety-related parental behaviors.MethodsNationwide data were collected to evaluate the impact of the Healthy Parents and Children 21 initiative of the Japanese government. Questionnaires related to safety checklist implementation were administered to a random sample of municipal offices and to parents at the child’s routine 1.5-year health exam on parental behaviors related to child safety. Adjusting for municipality and individual-level variables, multilevel analysis was used to examine the relationship between municipality checklist implementation (4-month health exam) and six child-safety-related parental behaviors at the 1.5-year health exam.ResultsFamilies (n = 23,394) across 371 municipalities in Japan were included in this study; 5.6% of municipalities implemented a child safety intervention. Living in a municipality with a checklist intervention was associated with reduction in certain risk behaviors (not keeping tobacco/ashtray and candy out of the reach of infants, not using a car seat, not having a lock on bathing room door). However, after additionally taking into account municipality-level residual effects, only the “tobacco” behavior showed association with municipality of residence (Interval odds ratio, 0.25–0.94) and others were weak in the context of other potential municipality-level influences.ConclusionsA municipality-level intervention taking a checklist-based approach at the 4-month health exam in Japan appears to promote certain child safety behaviors in parents with children around 1.5 years of age.

Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic

ObjectiveBetter understand knowledge, attitudes and practices of pregnant women and mothers of infants around coronavirus disease 2019 (COVID-19). MethodsA 58-item electronic survey was distributed to pregnant and postpartum women (infants <12 months) who were >15 years, English-speaking and enrolled in prenatal programs. Data is summarized using central tendency, frequencies and nonparametric statistics. ResultsOf 114 (51 % response rate) participants, 82.5 % reported negative changes in mental status measures (e.g. stress, anxious thoughts, changes in sleep patterns). All reported risk-reduction behavior changes (e.g. handwashing/use of sanitizer, social distancing). Significant changes were reported in employment and financial status due to the pandemic. Increases in alcohol consumption among postpartum women were also reported. Few reported changes in prenatal, infant or postpartum healthcare access. ConclusionThis study provides initial insight into the knowledge, attitudes and practices of pregnant and postpartum women during the COVID-19 pandemic. This study is limited as participants represent a single Midwest community and social desirability response bias may have impacted responses. However, results may inform future interventions to support pregnant women and mothers of infants during pandemics. Practice implicationsProviders should consider the impact of such events on mental status, access to resources and changes in behaviors.