Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.
The U.S. has the highest number of coronavirus disease (COVID-19) cases and deaths of any nation. Deaths due to COVID-19, especially among older adults and people of color, have created an urgency for advanced care planning (ACP). Despite benefits of ACP, only one-third of U.S. adults have completed advance directives, in part due to a lack of death education. We recommend four actions to increase death education and ACP completion: (1) integrate death education into teacher preparation programs, (2) incorporate death education in undergraduate curricula, (3) provide better education in death and dying to future health professionals, and (4) educate the public. Community transmission of the coronavirus disease (COVID-19) was first reported in the United States in February 2020 (Centers for Disease Control and Prevention (CDC), 2020a). As of August 2020, the United States has nearly doubled the number of cases and the highest number of deaths compared to any other nation in the world (Johns Hopkins University and Medicine, 2020a). The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system, has reported hospitalization and mortality rates based on data collected since March 1, 2020 (Centers for Disease Control and Prevention (CDC), 2020b). According to this network, as of August 15, 2020, the overall cumulative hospitalization rate in the U.S. was 151.7 per 100,000 (Centers for Disease Control and Prevention (CDC), 2020b). The rate of hospitalization was highest among adults aged 65 (412.9 per 100,000), followed by adults aged 50-64 years (228.1 per 100,000; Centers for Disease Control and Prevention (CDC), 2020b). Hospitalizations and deaths due to COVID-19 have disproportionately affected populations of color (Centers for Disease Control and Prevention (CDC), 2020b; Moore et al., 2020). Non-Hispanic American Indians or Alaska Natives have COVID-19 hospitalization rates more than five times greater than non-Hispanic Whites; rates among Hispanics or Latinos and non-Hispanic Blacks are just under five times greater than non-Hispanic Whites (Centers for Disease Control and Prevention (CDC), 2020b). Although Blacks (13%) and Hispanics (18%) make up a smaller segment of the U.S. population than non-Hispanic Whites (60%), they have experienced nearly 30 and 40% of COVID-19-related deaths, respectively, compared to non-Hispanic Whites at more than 20% when adjusting for age (Centers for Disease Control and Prevention (CDC), 2020c). Spikes of new infections, hospitalizations, and deaths are expected in the future, with predictions that the pandemic will continue into 2022 (Center of Infectious Disease Research and Policy [CIDRAP], 2020; Kissler et al., 2020). As the population of the U.S. awaits a vaccination or herd immunity, three outcomes are certain to occur in the near future: more adults will be infected, more will be hospitalized, and more will die from COVID-19 (Johns Hopkins University and Medicine, 2020b).
Purpose Assess the stage of readiness and barriers to ACP engagement among young adults in the United States utilizing the Precaution Adoption Process Model (PAPM). Methods A cross-sectional survey design was utilized to survey U.S. adults aged 18–35 through an online marketplace workforce (N = 414). Results Most (94.7%) had not engaged in comprehensive ACP. Young adults aged 18–29 reported higher perceived barriers scores to complete ACP than those aged 30–35. The perceived barriers score was significantly associated with stage of readiness for ACP ( p = .004); those who were unaware (stage 1) or did not want to engage in ACP (stage 4) reported more barriers to ACP engagement. Conclusion The PAPM is a useful framework for assessing barriers and tailoring programs for ACP engagement. Future research should further assess barriers for young adults to engage in ACP, particularly relating to stages of readiness.
Background Vector borne diseases are responsible for almost one fifth of global infectious disease burden. International travelers are at risk for potentially life-threatening conditions when visiting areas with endemic vector borne disease, but this risk can be mitigated when proper insect precautions are taken. This study sought to evaluate the prevalence of insect precaution use and subsequent insect bites among Utah travelers who have attended pre-travel consultations. Methods A cross-sectional study at the University of Utah and Salt Lake County travel clinics was analyzed. Descriptive statistics and multivariable logistic regression were used to explore factors associated with insect repellant use, and reporting bug bites despite insect repellant use. Results A total of 463 individuals completed the survey and were included in our analytic sample. The majority of respondents (80%) reported using insect repellent, and close to half (45%) reported bug bites. Insect repellent use was positively associated with visiting rural/countryside (OR 2.78, 95% CI 1.50 – 5.15), and traveling to South East Asia (OR 3.16, 95% CI 1.40 – 7.26), or Americas regions (OR 3.34, 95% CI 1.45 – 7.92). Being of male gender (OR 0.37, 95% CI 0.21 – 0.64) or traveling to high altitude locations (OR 0.37, 95% CI 0.18 – 0.74) was negatively associated with using insect repellent. Longer trip duration (OR 1.01, 95% CI 1.00 – 1.02) was positively associated with reporting insect bites, while male gender (OR 0.51, 95% CI 0.33 – 0.80), older age (OR 0.96, 95% CI 0.95 – 0.98), and having an advanced degree (OR 0.47, 95% CI 0.22 – 0.99) were negatively associated. Estimated Risk Factors of Insect Bites and Insect Repellent Use Characteristics of international travelers were self-reported in a cross-sectional study. Use of insect repellent and reporting bug bites despite repellant use was examined through multivariate logistic regression and used to calculate odds ratios and 95% confidence intervals. Due to multicollinearity and data skewness, the following variables were omitted from the insect repellent model: Accommodation: Hotel/other enclosed structure, Location: European, Location: and Western Pacific. Reference categories are Gender: Female, Education: High school diploma/GED or less, Group size: 1 (Traveled alone), Location type: Urban, and Malaria region: No. All other categories are not mutually exclusive and evaluated as separate binary variables. Conclusion We show that gender, age, trip duration, and education level were associated with self-reported bug bites during travel abroad. Given the number of vector-borne diseases affecting health of travelers, our findings will contribute towards strategies to advise travelers for disease prevention. Disclosures All Authors: No reported disclosures
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