A Global Study of COVID-19 Vaccination Intentions: The Role of Personal Experiences and Risk Perceptions

Background The COVID-19 pandemic presents an opportunity to assess the impact of personal experiences on vaccine decision-making. The aim of this study was to examine the associations between experiences with COVID-19 and intention to vaccinate against COVID-19. Methods We administered 28 repeated cross-sectional, online surveys between June 2020 and June 2021 in the US and Asia. The main exposures were three types of experiences: COVID-19 diagnosis, knowing a friend/family member with COVID-19, and exposures to media containing COVID-19 patients. A series of logistic regression models estimated the association between each experience and acceptance of a hypothetical COVID-19 vaccine. We also explored perceived susceptibility as a potential mediator. Results Intent to vaccinate was lowest in the US and Taiwan, and highest in India, Indonesia, and China. Personal diagnosis with COVID-19 had the greatest impact on intentions to vaccinate across country sites compared to those who experienced a friend or family member diagnosed with COVID-19 or exposures to personal stories reported through media. In India participants that reported a personal diagnosis with COVID-19 had 12.95 times the odds (95% CI: 4.89, 34.28) of accepting a COVID-19 vaccine compared to those with no diagnosis. Higher risk perceptions were associated with higher intention to vaccinate against COVID-19. Conclusions Proximity and seriousness of experiences are influential factors for intention to vaccinate against COVID-19. This study highlights the numerous ways in which pandemic experiences may influence intention to vaccinate against COVID-19 across geographies and cultures, where the course of the pandemic differed.

Black American Fathers Employed in Higher-Risk Contexts for Contracting COVID-19: Implications for Individual Wellbeing and Work-Family Spillover

Black Americans remain disproportionately affected by the COVID-19 pandemic. Emerging data suggests that employment in certain occupations (e.g., essential; frontline) may place individuals at higher-risk for contracting COVID-19. The current investigation examined how Black American fathers’ COVID-19 perceived work risk was associated with their individual well-being (COVID-19 diagnosis; depressive and anxiety symptoms; sleep disturbance; sleep quality) as well as spillover into family contexts. Participants were 466 Black American fathers ( M = 36.63; SD = 11.00) who completed online surveys in June–July 2020. Adjusted binomial logistic and multiple regressions were estimated to examine how fathers’ work context was associated with COVID-19 health outcomes, psychological functioning, sleep health, and family stress. Descriptive analyses revealed that 32% of fathers reported a personal diagnosis of COVID-19 and 21% indicated that an immediate family member had been diagnosed. Adjusted binomial logistic regression analyses revealed that fathers working in higher-risk contexts for contracting COVID-19 had a greater odds ratio for both a personal (OR: 1.68, 95% CI: 1.05, 2.68) and an immediate family member diagnosis (OR: 2.58, 95% CI: 1.52, 4.36). Working in a higher-risk context for contracting COVID-19 was associated with poorer psychological functioning, greater sleep disturbance, and higher levels of family discord. Findings suggest that Black fathers working in higher risk contexts may be at risk for COVID-19 exposure and infection. Further, this study indicates that these effects extend to their own well-being, including mental and sleep health as well as increased family stress.

Impact of family history risk assessment on surgical decisions and imaging surveillance at breast cancer diagnosis

Introduction In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. Methods The practice in our breast unit was compared with the NICE guidance with regard to arranging appropriate FUI and referral to the genetics team for women diagnosed with BC with a FH of BC. Data were obtained retrospectively on 200 women with BC, identified from the breast multidisciplinary team meetings from January to March 2014. Initial audit showed poor compliance with recording of FH. A standardised history taking proforma was produced for clinic use. A re‐audit was conducted on a further 200 women between May and July 2016. Results In the initial audit, FH was taken in 151 women (76%) compared with 174 women (87%) in the re‐audit. Thirty-seven women (25%) were thought to be of moderate risk (MR) or high risk (HR) based on FH in the first audit. Re‐audit identified 35 women (20%) with MR or HR FH. Under half (43%) of the women of HR were referred to the genetics team initially; this increased to 70% in the second audit. While almost half (46%) of the women with MR or HR had inappropriate FUI in the initial audit, this fell to 11% in the re‐audit. Conclusions A proportion of women diagnosed with BC would fall into the MR or HR categories as defined in the NICE FH guidance. Inadequate recording of FH could result in inadequate FUI surveillance and in some cases missing the opportunity for a genetic referral to assess suitability for gene testing.

Do genetic testing criteria identify individuals with Lynch syndrome prior to cancer diagnoses?

e13158 Background: Screening colonoscopies every 1-2 years are estimated to decrease the risk for colorectal cancer (CRC) development in individuals with Lynch syndrome (LS) by 62-72%. However, in order for risk reduction to be effective, genetic testing guidelines must identify individuals with LS before they develop CRC. Current NCCN indications for LS evaluation focus on individuals who have already developed cancer. This study aims to identify the effectiveness of NCCN criteria in identifying LS patients before a cancer develops. Methods: A retrospective chart review was performed for 173 patients with a personal history of a LS-associated cancer seen at UT Southwestern and affiliate hospitals between 2009-2018. All patients tested positive (pathogenic or likely pathogenic) for a LS-associated mutation. Review determined if patients met NCCN (v1.2018) criteria for the evaluation of LS before and after their personal diagnosis of cancer. The study controlled for known mutations in families, past iterations of NCCN guidelines and instances of limited family history. Results: Of patients with LS, 31.8% (55/173) met NCCN testing criteria only after their personal diagnosis of cancer. Data per gene reveals 13.3% (8/60) MLH1, 25.4% (16/63) MSH2, 44.8% (13/29) MSH6 and 85.7% (18/21) PMS2 mutation carriers in the cohort were missed by current guidelines . Conclusions: 31.8% of patients with LS mutations would not have met NCCN LS evaluation criteria prior to their diagnosis of cancer. Criteria disproportionately missed individuals with lower penetrant MSH6/PMS2 mutations. These findings highlight a need for the field to develop criteria that support the detection of LS in individuals with and without cancer. As the field debates the merits of population based testing, this study suggests the current criteria for LS germline testing are not sufficient for identification of LS prior to cancer diagnosis for many patients with LS.

A survey of Canadian and Australian pharmacists’ stigma of suicide

Background: There is limited information available regarding community pharmacists’ stigma of suicide. Pharmacists regularly interact with people at risk of suicide and stigmatizing attitudes may impact care. Objective: To measure community pharmacists’ stigma of suicide. Method: Pharmacists in Canada and Australia completed an online survey with the Stigma of Suicide Scale–Short Form. Data were analysed descriptively and with univariate and multivariate analyses. Results: Three hundred and ninety-six pharmacists returned completed surveys (Canada n = 235; Australia n = 161; female 70%; mean age = 38.6 ± 12.7 years). The rate of endorsement of stigmatizing terms was low overall. Canadian and Australian pharmacists differed (p < 0.05) for several variables (e.g. age, friend or relative with a mental illness, training in mental health crisis). Pharmacists without someone close to them living with a mental illness were more likely to strongly agree/agree with words describing those who die by suicide as pathetic, stupid, irresponsible, and cowardly. Those without a personal diagnosis of mental illness strongly agreed/agreed with the terms immoral, irresponsible, vengeful, and cowardly. More Australian pharmacists strongly agreed/agreed that people who die by suicide are irresponsible, cowardly, and disconnected. Independent variables associated with a higher stigma were male sex, Australian, and negative perceptions about suicide preventability. Conclusion: Community pharmacists frequently interact with people at risk of suicide and generally have low agreement of stigmatizing terms for people who die by suicide. Research should focus on whether approaches such as contact-based education can minimize existing stigma.

Multi-gene hereditary cancer testing among men with breast cancer.

1532 Background: All men with a personal diagnosis of breast cancer (BC) are candidates for BRCA1/2 genetic testing, as pathogenic variants (PVs) in these genes have a known association with BC risk in both men and women. As additional genes with known BC risk in women are now routinely included in multi-gene panel testing, we evaluated the outcomes of multi-gene panel testing in a large cohort of men with BC. Methods: This analysis includes the results of commercial genetic testing for 1,358 men with BC usinga multi-gene pan-cancer panel between September 2013 and January 2017. Clinical information was obtained from provider-completed test request forms. Age at diagnosis, personal, and family history were compared for men with PVs in BRCA1/2 versus non- BRCA1/2 genes. Results: Overall, 207 (15.2%) men with BC were found to carry a PV, where 147 (10.8%) men had a PV in BRCA1/2 ( BRCA1, 0.7%; BRCA2, 10.2%) and 60 (4.4%) men had a PV in a non- BRCA1/2 gene ( CHEK2, 2.0%; ATM, 1.0%; PALB2, 1.0%; BARD1, 0.2%; NBN, 0.2%; MSH6, 0.1%; BRIP1, 0.1%; CDH1, 0.1%; CDKN2A, 0.1%; MLH1, 0.1%, TP53, 0.1%). There were no substantial differences in the median age-at-diagnosis for men without a PV (65) compared to those with a BRCA1/2 PV (66) or a non- BRCA1/2 PV (63). Prostate cancer was the most common additional malignancy among all men with BC (9.0%), with a similar incidence among men with a BRCA1/2 PV (9.2%) and a non- BRCA1/2 PV (8.3%). In addition, 1.4% of men with a BRCA1/2 PV and 3.3% of men with a non- BRCA1/2 PV had a second BC. A family history of breast and/or ovarian cancer was present in 44.4% of the testing cohort, 66.7% of men with a BRCA1/2 PV, and 48.3% of men with a non- BRCA1/2 PV. This is consistent with the relative penetrance of BRCA1/2 and other genes included here. There were no other substantial differences in family history among BRCA1/2 PV carriers versus non- BRCA1/2 PV carriers. Conclusions: Close to a third of all PVs identified here in men with BC were in a gene other than BRCA1/2. There were no obvious differences in the clinical presentation of men with a BRCA1/2 PV compared to men with a PV in another gene or no PV at all. Collectively, this suggests that multi-gene panel testing is appropriate for all men with BC, regardless of other personal or family history.

Using Twitter to mine sleep related information from people who declare a diagnosis of a psychotic disorder

ABSTRACT ObjectivesOur group has investigated the occurrence of psychotic(-like) experiences (PLEs) in Twitter posts, namely auditory hallucinations. Tweets classified as potentially related to auditory hallucinations were proportionately higher between 23:00 and 5:00 in comparison to tweets not classified. This may indicate a clinically significant relationship between sleep and PLEs in the general population, a notion supported by the literature. Based on our previous investigation, the current study aimed to explore whether this methodology could be amended to generate datasets regarding sleep experiences in people who self-report a diagnosis of a psychotic disorder. ApproachThe current investigation seeks to establish if it is feasible to generate anonymised datasets regarding sleep by extracting information from the timelines of people who self-report a psychotic diagnosis. A text mining method was implemented that utilised rule-based semantic filters that aimed to identify self-reported diagnoses. This focused on occurrences of personal and possessive pronouns to detect the subjectivity of tweets, as well as potential diagnostic verb indicators and any mentions of other related factors. For each diagnostic tweet, we collected information from user timelines. A sleep-related classifier was then implemented, which used lexical features (e.g. bag-of-words, part-of-speech tags) to predict whether a given tweet refers to sleep-related experience. ResultsAfter training the classifier on the bag-of-words model, the most informative words which contributed to the performance of the classifier were: ‘sleep’, ‘can’t awake’, ‘never’, ‘stress’. Part-of-speech tags (e.g. verbs, adverbs) were also important features. The classification accuracy of the ‘bag-of-words’ model was better than the ‘part-of-speech’ model. Through the method outlined herein, we were able to improve the quality of the generated datasets in comparison to the previous investigation. This methodology also facilitated the mining of individual Twitter users timelines who stated a personal diagnosis. To this end, an additional filter was implemented to identify tweets regarding sleep experience. The potential relationship between sentiment and temporality expressed in diagnosis and sleep experiences are also discussed. ConclusionsThe results from this study have implications for mental health research on Twitter. Specifically, the refinements in the methodology enabled retrieval of two high quality datasets regarding psychosis and sleep. Therefore it is feasible other psychosis-related phenomena (e.g. visual hallucinations, delusions, medication) could also be applied as separate filters to create one dataset of psychosis-related experiences within individuals diagnosed with psychosis.