Hepatitis B virus (HBV) remains a challenging public-health issue in China. Hepatitis B carriers and patients suffer not only physically but also experience strong discrimination and stigma. China's rural population is 629 million. Thus, there is a great need to understand the situation surrounding HBV-related discrimination in everyday life in rural China. We studied 6,538 participants (18 y old) from 42 villages across 7 provinces (districts). Many studies have addressed discrimination against those with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). However, few studies have addressed HBV-related discrimination. We found that the fear of HBV infection, not lack of knowledge about it, predominantly leads to HBV-related discrimination (although limited knowledge is also a cause). Notably, receiving the HBV vaccination contributes to reduced discrimination. In addition, the existence of fewer misunderstandings about false HBV transmission routes plays a more important role in discrimination than does understanding of true HBV transmission routes. Therefore, to reduce HBV-related discrimination, policy makers should consider eliminating HBV-related fear, strengthening adult HBV immunization programs, developing large-scale education dissemination about HBV transmission routes and non-transmission routes, and paying greater attention to target populations.
Background: In China, the hepatitis B virus (HBV) is a particularly challenging public health issue, with an estimated 90 million chronic hepatitis B carriers accounting for almost 7% of the population. Healthrelated discrimination can serve as a barrier to prevention and care for infectious diseases, such as HBV, degrade the HBV sufferers' quality of life and limit HBV patients' employment opportunities. While rural migrants account for up to 40% of the total urban population in the developed cities in China, there has been no study of the discrimination behavior of rural migrant workers toward HBV carriers.Objective: This study evaluates the discrimination behavior of rural migrant workers toward HBV carriers and patients and proposes public policy recommendations to address discrimination and stigma.Methods: The sample comprised 903 rural adults, aged over 18 years old, who migrated to Beijing. Using a face-to-face interview, we surveyed rural migrants' demographic characteristics, knowledge of HBV and discrimination against HBV carriers. Descriptive statistics were used to characterize the study population, HBV stigma and knowledge of HBV. Three discrimination levels (no-mild, medium and severe discrimination) were modeled using multiple logistic regression.Results: Rural migrants to Beijing had a mean age of 36 years, were overwhelmingly married (91.58%), mostly with a junior high school or lower education (78.05%) and mainly engaged as temporary workers (42.52%) or self-employed (33.78%). Only 30.56% reported that they had been vaccinated against HBV. On the 0-10 discrimination scale, rural migrants rated 6.24, with only 4.54% displaying no sign of HBV-related discrimination. The high discrimination score occurred alongside a low mean knowledge of HBV (7.61 on the 1-22 ranking of HBV knowledge). Multiple logistic regression results suggest an inverse relationship between discrimination levels and HBV knowledge, especially knowledge about treatment and transmission routes. The "fear of being infected with HBV" and being HBV vaccinated was positively associated with HBV-related discrimination. Unemployed rural migrants were more likely to exhibit severe HBV-related discrimination than other occupational groups. Personal attributes, such as gender, age, marital status and education level were not associated with the level of discrimination.Conclusions: Knowledge of HBV, its transmission and treatment, and the fear of HBV infection were key features in understanding HBV discrimination by rural migrant workers. To reduce discrimination, HBV public health education campaigns need to focus on both knowledge about HBV and the fear of HBV infection. Such campaigns should target rural migrant subgroups, such as unemployed rural migrant workers.
Introduction: With China's accelerating urbanization, migrant workers comprise up to 40% of the urban population of China's largest cities. More mobile than non-migrant urban dwellers, migrants are more likely to contract and spread hepatitis B (HB) than non-migrants. Due to the mandatory system of household registration (hukou), migrants are less likely to be covered by national HB immunization programs and also to have more limited access to public health services where they work than nonmigrants. Migrants form a significant sub-group in all Chinese cities posing unique public policy vaccination challenges. Objective: Using protection motivation theory (PMT), we developed and measured HB cognitive variables and analyze the factors affecting HB vaccination behavior and willingness to vaccinate by migrant workers. We propose public policy interventions to increase HB vaccination rates of migrant workers. Methods: We developed a questionnaire to collect information on the HB vaccination characteristics of 1684 respondents from 6 provinces and Beijing. Exploratory factor analysis was used to create PMT variables and a binary logistic regression model was used to analyze the factors affecting migrant workers' HB vaccination behavior and willingness to vaccinate. Results: Vulnerability and response-efficacy were significant PMT cognition factors determining HB vaccination behavior. The HB vaccination rate for migrants decreased with increasing age and was smaller for the primary education than the high education group. The vaccination rate of the medical insurance group was significantly greater than the non-insured group, and the vaccination probability was significantly higher for the self-rated good health compared to the self-rated poor health group. Geographical birth location mattered: the vaccination rate for Beijing city and Ningxia province migrants were higher than for Hebei province and the vaccination rate was lower for migrants born far from health facilities compared to those located middle-near distances from health facilities. We also studied vaccination willingness for the unvaccinated group. For this group, vulnerability and selfefficacy cognition factors were significant factors determining HB vaccination willingness. The probability of willingness to vaccinate for the 46C age group was significantly smaller than the 16-25 age group and the willingness to vaccinate was lower in Jiangsu and Hainan province than in Hebei province. Conclusion: Increased knowledge of HB cognition is an effective way for improving HB vaccination behavior and HB vaccination willingness of migrant workers. We also found that health intervention policies should focus on older migrants (age 46C), without medical insurance, with poorer self-reported health status and poor health services accessibility.
This study examines heterogeneity in nonindustrial private forest owners' timber supply by using a large panel data set of Norwegian landowners. The full sample is divided into more homogenous subsamples. We apply four econometric panel data specifications. Three of the specifications have seldom or never been applied previously in such a supply analysis. Interpretations and results for estimated slope parameters vary substantially between estimators. Supply responses differ considerably with respect to property size and across regions. Changes in roundwood prices and interest rates are the main determinants explaining the decrease in supply during the period 1989-1997. Future roundwood supply analysis should preferably account for heterogeneity in order to avoid inconsistent estimators that could mislead decision makers.
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