Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 30, Supplement - Infectious Diseases and Carceral Health

SUPPLEMENT ISSUE
Outbreaks and Investigations

Health Belief Model to Assess Mpox Knowledge, Attitudes, and Practices among Residents and Staff, Cook County Jail, Illinois, USA, July–August 2022

Rashida HassanComments to Author , Ashley A. Meehan, Sarah Hughes, Amy Beeson, Hillary Spencer, Jourdan Howard, Lauren Tietje, Morgan Richardson, Anne Schultz, Chad Zawitz, Isaac Ghinai, and Liesl M. Hagan
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. Hassan, A.A. Meehan, S. Hughes, A. Beeson, H. Spencer, L.M. Hagan); Chicago Department of Public Health, Chicago, Illinois, USA (H. Spencer, J. Howard, L. Tietje, M. Richardson, A. Schultz, I. Ghinai); Cermak Health Services of Cook County and Cook County Health, Chicago (C. Zawitz)

Main Article

Table 3

Summary of findings and illustrative quotes from study assessing mpox knowledge, attitudes, and practices among residents and staff, Cook County Jail, Illinois, USA, July–August 2022*

Construct Residents Staff
Perceived susceptibility to mpox Moderate to high. Residents perceived increased risk for infection due to structural factors of being in a correctional/detention setting. Moderate to low. Staff perceived trust in the effectiveness of PPE but acknowledged increased risk due to the nature of correctional/detention settings.
“I’m a clean freak type, constantly disinfecting and I stay away from a lot of people, but I’m not sure about things outside of my control.” (CCJ resident)
 “I think it’s unlikely that I will get monkeypox, but my concern is heightened because of the environment I work in.” (CCJ staff, nurse)
Perceived severity of potential mpox illness
 Uncertain. Residents and staff were not sure how severe mpox illness would or could be, or how severity might differ based on the presence of underlying conditions.
“I’m a diabetic…does it affect me? With COVID they said people with diabetes and older people need to be concerned…yeah, it may mess me up especially because I got diabetes.” (CCJ resident)
 “I’m not sure how sick I would get. I don’t know how severe this is.” (CCJ staff, custody officer)
Perceived benefits of behavior change to prevent mpox Some residents had previous knowledge about other vaccines and felt that receiving vaccination for mpox would protect their health. Residents also wanted to avoid bringing mpox home to their families once released from CCJ. Staff described wanting to engage in mpox prevention behaviors to protect themselves and to avoid bringing mpox home to their families after work.
“Is there any way to get tested [for mpox]? Cause it’s a lot of people in my cell and I just want to make sure…and I don’t want to take it back to my family.” (CCJ resident) “We have grandkids and kids at home we don't want to take it home to.” (CCJ staff, other role)
“The medical officers offered vaccine and I accepted. I was given no information, but I said let me get protected before anything gets out of hand…I just want to be safe.” (CCJ resident)
Perceived barriers to mpox preventive actions Residents described barriers to preventive actions related to lack of knowledge and information about mpox and mpox PEP. They also described rumors about mpox that could be a barrier for others.
Residents also perceived limited availability and insufficient quality of cleaning supplies and personal hygiene items (especially soap), which acted as a barrier for them.		 Staff described primarily knowledge and information barriers to mpox prevention. Staff also described rumors about mpox that could be a barrier for others.
“I don’t know how [the vaccine] works or what’s in it. If I were to take it, I would have to learn more about it.” (CCJ resident) “As long as I follow PPE protocol, I'll be ok.” (CCJ staff, nurse)
“I was told it’s from Boystown† and it’s a homosexual disease, I’m not sure if that info is true…Other inmates are pretty upset and homophobic, saying wild stuff.” (CCJ resident) “I’m not sure if this is real, but people say it’s largely among the homosexual community. I don't know that I agree.” (CCJ staff, custody officer)
“The facility doesn’t keep disinfectant on the deck [dormitory]. They're supposed to bring them every day, but it’s variable.” (CCJ resident)
Cues to action to engage in mpox preventive actions
 A confirmed mpox case within CCJ served as the cue to residents and staff to engage in preventive actions. Both residents and staff expressed the need for timely, clear communication to inform these actions.
“If I was in charge of telling people, I would tell them flat out the truth and not leave anything out.” (CCJ resident)
 “Let people know what’s going on in real time, not a day or two later. Rumors will start to spread.” (CCJ Staff, custody officer)
Self-efficacy to engage in mpox preventive actions Residents felt limited self-efficacy to protect themselves from mpox in the jail setting due to limited mpox knowledge, perceived limited access to healthcare and cleaning and hygiene supplies, perceived insufficient communication, and facility factors like communal housing. Healthcare staff had higher levels of self-efficacy because of their medical training, availability and knowledge of recommended PPE, and experience caring for patients with other infectious diseases. Staff in custody roles expressed more limited self-efficacy, due to a closer physical proximity to residents, limited knowledge of mpox and prevention methods, and perceived insufficient communication.
“There’s no way to protect yourself… ‘stay 6 feet from other people’ which is hard because the bunks are not 6 feet apart from each other.” (CCJ resident) “COVID-19 has opened our eyes and we’ve gotten used to taking care of these things as they come…The nurses here have been trained to handle this.” (CCJ staff, healthcare provider)
“I don’t know how likely it is that I would get [mpox], every now and again I have to go hands on with [a detainee]…Whenever they leave the tier, we always have to pat them down.” (CCJ staff, custody officer)

*Categories are organized according to the health belief model construct (21,22). CCJ, Cook County Jail; PEP, postexposure prophylaxis; PPE, personal protective equipment. †Boystown, also known as Northalsted, is a historical LGBTQ+ neighborhood in Chicago, Illinois.

Main Article

References
  1. Hennessee  I, Shelus  V, McArdle  CE, Wolf  M, Schatzman  S, Carpenter  A, et al.; California Department of Public Health Monkeypox Pediatric Working Group; CDC Monkeypox Pediatric Working Group. CDC Monkeypox Pediatric Working Group. Epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox—United States, May 17–September 24, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1407–11. DOIPubMedGoogle Scholar
  2. Pfeiffer  JA, Collingwood  A, Rider  LE, Minhaj  FS, Matheny  AM, Kling  C, et al. High-contact object and surface contamination in a household of persons with monkeypox virus infection—Utah, June 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1092–4. DOIPubMedGoogle Scholar
  3. Spicknall  IH, Pollock  ED, Clay  PA, Oster  AM, Charniga  K, Masters  N, et al. Modeling the impact of sexual networks in the transmission of monkeypox virus among gay, bisexual, and other men who have sex with men—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1131–5. DOIPubMedGoogle Scholar
  4. Kyaw  NTT, Kipperman  N, Alroy  KA, Baumgartner  J, Crawley  A, Peterson  E, et al. Notes from the field: clinical and epidemiologic characteristics of mpox cases from the initial phase of the outbreak—New York City, May 19–July 15, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1631–3. DOIPubMedGoogle Scholar
  5. Centers for Disease Control and Prevention. Science brief: detection and transmission of mpox (formerly monkeypox) virus during the 2022 clade IIb outbreak [cited 2023 Apr 25]. https://www.cdc.gov/poxvirus/mpox/about/science-behind-transmission.html
  6. Kriss  JL, Boersma  PM, Martin  E, Reed  K, Adjemian  J, Smith  N, et al. Receipt of first and second doses of JYNNEOS vaccine for prevention of monkeypox—United States, May 22–October 10, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1374–8. DOIPubMedGoogle Scholar
  7. Rao  AK, Petersen  BW, Whitehill  F, Razeq  JH, Isaacs  SN, Merchlinsky  MJ, et al. Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:734–42. DOIPubMedGoogle Scholar
  8. Nolen  LD, Osadebe  L, Katomba  J, Likofata  J, Mukadi  D, Monroe  B, et al. Introduction of monkeypox into a community and household: risk factors and zoonotic reservoirs in the Democratic Republic of the Congo. Am J Trop Med Hyg. 2015;93:410–5. DOIPubMedGoogle Scholar
  9. Turabelidze  G, Lin  M, Wolkoff  B, Dodson  D, Gladbach  S, Zhu  BP. Personal hygiene and methicillin-resistant Staphylococcus aureus infection. Emerg Infect Dis. 2006;12:422–7. DOIPubMedGoogle Scholar
  10. Pembi  E, Omoleke  S, Paul  H, Augustine  T, Cuevas  LE. Monkeypox outbreak in a correctional center in North Eastern Nigeria. J Infect. 2022;85:702–69. DOIPubMedGoogle Scholar
  11. Yinka-Ogunleye  A, Aruna  O, Dalhat  M, Ogoina  D, McCollum  A, Disu  Y, et al.; CDC Monkeypox Outbreak Team. Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis. 2019;19:872–9. DOIPubMedGoogle Scholar
  12. Hagan  LM, Beeson  A, Hughes  S, Hassan  R, Tietje  L, Meehan  AA, et al. Monkeypox Case Investigation - Cook County Jail, Chicago, Illinois, July-August 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1271–7. DOIPubMedGoogle Scholar
  13. US Department of Health and Human Services. Protection of human subjects. 45 CFR §46. Revised 2018 Jul 19 [cited 2023 Apr 25]. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/revised-common-rule-regulatory-text/index.html
  14. Food and Drug Administration. 21 CFR part 56: Institutional review boards [cited 2023 Apr 25]. https://www.ecfr.gov/on/2018-07-19/title-21/chapter-I/subchapter-A/part-56
  15. United States Code. 42 USC §241: Research and investigations generally [cited 2023 Apr 25]. https://www.govinfo.gov/content/pkg/USCODE-2010-title42/html/USCODE-2010-title42-chap6A.htm
  16. United States Code. 5 USC section §552a. Records maintained on individuals. [cited 2023 Apr 25]. https://www.govinfo.gov/content/pkg/USCODE-2022-title5/pdf/USCODE-2022-title5-partI-chap5-subchapII-sec552a.pdf
  17. United States Code. 44 USC section 3501: Public printing and documents [cited 2023 Apr 25]. https://www.govinfo.gov/content/pkg/USCODE-2021-title44/pdf/USCODE-2021-title44.pdf
  18. Gale  RC, Wu  J, Erhardt  T, Bounthavong  M, Reardon  CM, Damschroder  LJ, et al. Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci. 2019;14:11. DOIPubMedGoogle Scholar
  19. Keniston  A, McBeth  L, Astik  G, Auerbach  A, Busch  J, Kangelaris  KN, et al. Practical applications of rapid qualitative analysis for operations, quality improvement, and research in dynamically changing hospital environments. Jt Comm J Qual Patient Saf. 2023;49:98–104. DOIPubMedGoogle Scholar
  20. Watkins  DC. Rapid and rigorous qualitative data analysis: the “RADaR” technique for applied research. Int J Qual Methods. 2017;16:1609406917712131. DOIGoogle Scholar
  21. Abraham  C, Sheeran  P. The health belief model. In: Conner M, Norman P, editors. Predicting health behaviour: research and practice with social cognition models, 3rd ed. Berkshire (UK): Open University Press; 2015. p. 30–55.
  22. Champion  VL, Skinner  CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice, 4th edition. Hoboken (NJ): Jossey-Bass; 2008. p. 45–65.
  23. Vixama  G, Hughes  SE, Afanuh  S; National Institute for Occupational Safety and Health (NIOSH). Safe and proper use of disinfectants to reduce viral surface contamination in correctional facilities (poster). Publication no. 2023–127. Cincinnati: The Institute; 2023.
  24. Centers for Disease Control and Prevention. Considerations for reducing mpox transmission in congregate living settings [cited 2023 Nov 17]. https://www.cdc.gov/poxvirus/mpox/community/congregate.html
  25. Centers for Disease Control and Prevention. Mpox informational poster for correctional and detention facilities [cited 2023 Nov 17]. https://archive.cdc.gov/#/details?url=https://www.cdc.gov/poxvirus/mpox/pdf/Mpox-Corrections-toolkit.pdf
  26. Devilly  GJ, Sorbello  L, Eccleston  L, Ward  T. Prison-based peer-education schemes. Aggress Violent Behav. 2005;10:219–40. DOIGoogle Scholar
  27. Erfani  P, Sandoval  RS, Rich  KM, Ojo  A, Walker  L, White-Hammond  G, et al. Ask Me Anything": Lessons learned in implementing a COVID-19 vaccine information initiative in Massachusetts jails. Vaccine. 2022;40:2981–3. DOIPubMedGoogle Scholar
  28. Haynie  DL, Whichard  C, Kreager  DA, Schaefer  DR, Wakefield  S. Social networks and health in a prison unit. J Health Soc Behav. 2018;59:318–34. DOIPubMedGoogle Scholar
  29. Andrews  ME, Mattan  BD, Richards  K, Moore-Berg  SL, Falk  EB. Using first-person narratives about healthcare workers and people who are incarcerated to motivate helping behaviors during the COVID-19 pandemic. Soc Sci Med. 2022;299:114870. DOIPubMedGoogle Scholar
  30. Kramer  C, Song  M, Sufrin  CB, Eber  GB, Rubenstein  LS, Saloner  B. COVID-19 vaccination hesitancy and uptake: Perspectives from people released from the Federal Bureau of Prisons. Vaccine. 2023;41:1408–17. DOIPubMedGoogle Scholar
  31. Ortiz-Paredes  D, Varsaneux  O, Worthington  J, Park  H, MacDonald  SE, Basta  NE, et al. Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons. PLoS One. 2022;17:e0264145. DOIPubMedGoogle Scholar

Main Article

Page created: January 03, 2024
Page updated: March 31, 2024
Page reviewed: March 31, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external