Explore the vast range of titles available.

The urgency to develop a vaccine against the 2019 coronavirus (COVID-19) has waxed stronger in speed, scale, and scope. However, wisdom dictates that we take a vantage position and start to examine the demographic predictors of COVID-19 vaccine hesitancy. The objective of this study was to examine the role of health locus of control (HLOC) in the relationship between religiosity and COVID-19 vaccination intention. In a cross-sectional survey (N = 501), we found a significantly negative association between religiosity and COVID-19 vaccination intention. This relationship was partially mediated by external HLOC. Collaborative efforts with religious institutions may influence COVID-19 vaccine uptake.

AI-enabled chatbots are increasingly positioned as a remedy for breastfeeding support gaps in rural maternal health, offering private, immediate assistance amid persistent shortages of lactation specialists and limited access to care. However, their clinical promise remains constrained by the probabilistic nature of large language models, which can generate hallucinations that undermine maternal–infant safety. This article argues that safely integrating AI into breastfeeding support requires treating hallucination not as a singular technical flaw but as a systems-level risk shaped by design, governance, and use context. We identified key risks of AI systems that could result in hallucination such as, false citations, transcription errors, prompt injection and jailbreaking, and incorrect generalization or personalization, and analyze how each error introduces distinct safety vulnerabilities. Drawing from systems thinking, we outline mitigation strategies including retrieval-augmented generation grounded in authoritative breastfeeding sources, layered guardrails, adversarial testing, uncertainty-aware messaging, and domain-specific fine-tuning. By linking AI system design choices to downstream health consequences in resource-constrained settings, this paper reframes AI-assisted breastfeeding support as a governance challenge central to equitable, safe maternal health innovation.

The U.S. Surgeon General and others have emphasized a critical need to address COVID-19 misinformation to protect public health. In St. Louis, MO, we created iHeard STL, a community-level misinformation surveillance and response system. This paper reports methods and findings from its first year of operation. We assembled a panel of over 200 community members who answered brief, weekly mobile phone surveys to share information they heard in the last seven days. Based on their responses, we prioritized misinformation threats. Weekly surveillance data, misinformation priorities, and accurate responses to each misinformation threat were shared on a public dashboard and sent to community organizations in weekly alerts. We used logistic regression to estimate odds ratios (ORs) for associations between panel member characteristics and misinformation exposure and belief. In the first year, 214 panel members were enrolled. Weekly survey response rates were high (mean = 88.3% ± 6%). Exposure to a sample of COVID-19 misinformation items did not differ significantly by panel member age category or gender; however, African American panel members had significantly higher reported odds of exposure and belief/uncertain belief in some misinformation items (ORs from 3.4 to 17.1) compared to white panel members. Our first-year experience suggests that this systematic, community-based approach to assessing and addressing misinformation is feasible, sustainable, and a promising strategy for responding to the threat of health misinformation. In addition, further studies are needed to understand whether structural factors such as medical mistrust underly the observed racial differences in exposure and belief.

Background Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners’ education attainment and early ANC, and 2) determine whether partners’ level of education modified the relationship between mothers’ education, mothers’ age, planned pregnancy, employment status and early ANC. Methods Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners’ level of education modified the relationship between mothers’ education, mothers’ age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals. Results Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners’ education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18–19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57). Conclusions Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC.

Religion is a complex and sociocultural driver of human papillomavirus (HPV) vaccination decisions, but its exact role has been mixed/unclear. We used a cross-sectional study of 342 Christian parents to examine the associations between the three domains of religiosity (organizational, non-organizational, and intrinsic) and the intention to (i) seek HPV information and (ii) receive the HPV vaccine. Organizational religiosity was the only domain that was positively associated with information-seeking intention regardless of the type of covariates included. Mixed findings in the association between religiosity and HPV vaccination decisions may depend on the religiosity domain being assessed.

The main objective of this study was to examine the association between COVID-19 information search activities and vaccination intention. Cross-sectional data were collected using online surveys. Independent variables included COVID-19 information search on the (1) science of viral effects of COVID-19 on the body, (2) origin of COVID-19, (3) symptoms and outcomes, (4) transmission and prevention, (5) future outbreak, and (6) policies/procedures to follow. The outcome variable was vaccination intention. A multivariable regression analysis was conducted. Participants (N = 501) had a mean age of 32.44 ± 11.94 years, were 55.3% female, and 67.9% were white. Most COVID-19 information searches were on symptoms and outcomes (77.7%) and policies/procedures to follow (69.9%). Intention to vaccinate against COVID-19 was higher among participants who searched for information on the science of viral effects of COVID-19 on the body ( = 0.23, 95% CI: 0.03-0.43; = 0.03) and policies/procedures to follow ( = 0.24, 95% CI: 0.03-0.41; = 0.02). People who searched for information about (1) the science of viral effects of COVID-19 and (2) policies/procedures recommendations also reported higher vaccination intention. Risk communication seeking to increase vaccination should meet the consumers' information demand by prioritizing the scientific rationale for COVID-19 vaccination and by clarifying what policies/procedures are recommended.

To increase community conversations about COVID-19 vaccine hesitancy, we distributed vaccine cardholders and conversation cards to 6000 newly vaccinated adults at vaccination sites and encouraged them to talk with unvaccinated friends and family members. In 257 onsite exit interviews, we found that cardholders and conversation cards were well liked, and most recipients expected to use them. Follow-up surveys two weeks later showed that 51% of respondents used a card to start a conversation and 41% gave a card to an unvaccinated friend or family member. (Am J Public Health. 2024;114(S1):S87–S91. https://doi.org/10.2105/AJPH.2023.307481 )

Rural communities face persistent challenges in accessing timely, culturally relevant, and trustworthy health information due to inadequate communication infrastructures, workforce shortages, and infrastructural constraints. As generative artificial intelligence (GenAI) tools become increasingly accessible, rural serving organizations are often pushed to explore their use to expand communication reach and reduce staff burden through funding incentives, vendor offerings, and policy signals, even when adoption is misaligned with local capacity or priorities. However, guidance is lacking on how rural systems should approach GenAI adoption in ways that strengthen, rather than undermine, trust and equity. This Opinion offers a systems-oriented and community-centered perspective on rural GenAI readiness by distinguishing between non-agentic applications that support human communicators and agentic systems that introduce varying degrees of autonomy. We propose a staged maturity framework tailored to rural health communication ecosystems, outlining opportunities, risks, and governance needs at each stage of adoption. By centering on rural context, communication trust, and system readiness, this Opinion aims to support the intentional, ethical, and sustainable integration of GenAI into rural health communication systems.

This dissertation clarified the roles that religiosity play in human papillomavirus (HPV) vaccination among Christian parents of unvaccinated adolescents. Although religiosity has been cited as a potent driver of vaccine decisions, its exact role has been unclear, making it hard to intervene effectively. Existing studies suggest that the uncertainty in the role of religiosity in HPV vaccination may be due to the non-monolithic nature of religiosity and variation in the psychosocial factors (threat appraisal, coping appraisal, and attitudes) emphasized in HPV messages. Understanding the role of religiosity is necessary to guide the development of interventions to increase HPV vaccination among religious parents. I administered a survey first to explore the association between three dimensions of religiosity (i.e., organizational, non-organizational, and intrinsic religiosity) and the intention to seek HPV information. Second, I examined the interdependent roles of the psychosocial factors to identify what factor may be more important to address when designing an HPV messaging intervention. Third, I created and tested an attitude-based religiously framed HPV message that addressed anti-vaccination religious beliefs using a randomized controlled trial. My findings showed no association between the three domains of religiosity and information-seeking intention. It also identified attitude towards vaccination as a mediator of the association between coping appraisal and vaccination intention. Finally, the religiously framed message targeted at parent's anti-vaccination attitudes effectively increased parents' vaccination intention compared to a secular HPV vaccination message from the Centers for Disease Control and prevention. In summary, this dissertation suggests that religiosity may not play a role in HPV information-seeking intention unless there is a deliberate effort to leverage religiosity to influence vaccination decisions. However, religiosity may play a positive role in increasing HPV vaccination intention through a scripture-embedded HPV vaccination message (merging scriptural references and scientific facts) that targets anti-vaccination religious beliefs. Therefore, future faith-based interventions can increase HPV vaccination among religious parents by identifying their most practiced religiosity domains, their anti-vaccination religious beliefs, and designing scripture-embedded messaging interventions to address their barrier beliefs. This approach may promote health equity in HPV vaccination by ensuring equitable messaging for religious parents.

Community-based public health advocacy efforts are crucial to sustaining the low-cost/free breast cancer services that support underserved populations. We introduce two ways in which narrative theory may be a useful tool for developing advocacy materials and provide an example, using a community-academic partnership to promote Latina breast health in Chicago, Illinois. Community and academic partners 1) engaged 25 Spanish-speaking Latinas in an advocacy workshop, 2) leveraged narrative theory to develop multi-media advocacy materials, and 3) disseminated materials to policymakers. Our project highlights 1) that narrative theory may be useful to describe how Latinas engage policy-makers in relation to their needs and cultural norms, 2) the importance of flexibility and offering community members multiple options to engage policymakers, and 3) the importance of leveraging partners' complementary strengths. Narrative theory may be a useful tool for developing advocacy materials in community-academic partnerships.