H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?
Identifieur interne : 000801 ( Pmc/Checkpoint ); précédent : 000800; suivant : 000802H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?
Auteurs : Ramona Ludolph ; Marta Nobile ; Uwe Hartung ; Silvana Castaldi ; Peter J. SchulzSource :
- Journal of Public Health Research [ 2279-9028 ] ; 2015.
Abstract
The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians’ willingness to get vaccinated in case of a novel influenza pandemic.
We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012.
Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one’s life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance.
The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter.
Whereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people’s willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public’s concerns when having to communicate during the next outbreak of pandemic influenza.
Url:
DOI: 10.4081/jphr.2015.559
PubMed: 26425501
PubMed Central: 4568430
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?</title>
<author><name sortKey="Ludolph, Ramona" sort="Ludolph, Ramona" uniqKey="Ludolph R" first="Ramona" last="Ludolph">Ramona Ludolph</name>
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<author><name sortKey="Nobile, Marta" sort="Nobile, Marta" uniqKey="Nobile M" first="Marta" last="Nobile">Marta Nobile</name>
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<affiliation><nlm:aff id="aff002">Phd Program in Public Health,<institution>University of Milan</institution>
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<author><name sortKey="Hartung, Uwe" sort="Hartung, Uwe" uniqKey="Hartung U" first="Uwe" last="Hartung">Uwe Hartung</name>
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<author><name sortKey="Castaldi, Silvana" sort="Castaldi, Silvana" uniqKey="Castaldi S" first="Silvana" last="Castaldi">Silvana Castaldi</name>
<affiliation><nlm:aff id="aff003">IRCC Foundation Ca’ Cranda Major Hospital of Milan, Department of Biomedical Sciences for Health,<institution>University of Milan</institution>
,<addr-line>Italy</addr-line>
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<author><name sortKey="Schulz, Peter J" sort="Schulz, Peter J" uniqKey="Schulz P" first="Peter J." last="Schulz">Peter J. Schulz</name>
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<series><title level="j">Journal of Public Health Research</title>
<idno type="ISSN">2279-9028</idno>
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<imprint><date when="2015">2015</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians’ willingness to get vaccinated in case of a novel influenza pandemic.</p>
</sec>
<sec><title>Design and Methods</title>
<p>We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012.</p>
</sec>
<sec><title>Results</title>
<p>Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one’s life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance.</p>
</sec>
<sec><title>Conclusions</title>
<p>The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter.</p>
<p><boxed-text position="float" orientation="portrait"><caption><title>Significance for public health</title>
</caption>
<p>Whereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people’s willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public’s concerns when having to communicate during the next outbreak of pandemic influenza.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Public Health Res</journal-id>
<journal-id journal-id-type="iso-abbrev">J Public Health Res</journal-id>
<journal-id journal-id-type="publisher-id">JPHR</journal-id>
<journal-title-group><journal-title>Journal of Public Health Research</journal-title>
</journal-title-group>
<issn pub-type="ppub">2279-9028</issn>
<issn pub-type="epub">2279-9036</issn>
<publisher><publisher-name>PAGEPress Publications, Pavia, Italy</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26425501</article-id>
<article-id pub-id-type="pmc">4568430</article-id>
<article-id pub-id-type="doi">10.4081/jphr.2015.559</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Ludolph</surname>
<given-names>Ramona</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nobile</surname>
<given-names>Marta</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hartung</surname>
<given-names>Uwe</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Castaldi</surname>
<given-names>Silvana</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Schulz</surname>
<given-names>Peter J.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<institution>Institute of Communication and Health, University of Lugano</institution>
,<addr-line>Switzerland</addr-line>
</aff>
<aff id="aff002"><label>2</label>
Phd Program in Public Health,<institution>University of Milan</institution>
,<addr-line>Italy</addr-line>
</aff>
<aff id="aff003"><label>3</label>
IRCC Foundation Ca’ Cranda Major Hospital of Milan, Department of Biomedical Sciences for Health,<institution>University of Milan</institution>
,<addr-line>Italy</addr-line>
</aff>
<author-notes><corresp id="cor1">Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Via G. Buffi 6, CH 6904 Lugano, Switzerland. <phone>+41.058.666.4821</phone>
- <fax>+41.058.666.4647</fax>
. <email>ludolr@usi.ch</email>
</corresp>
<fn fn-type="con"><p>Contributions: RL, data analysis and interpretation, first draft of the article, design and approval of the final version; MN, conception of the study, data acquisition, revision of the first draft, approval of the final version of the work; UH, data analysis and interpretation, addition of insightful content to the early version, approval of the final version. SC, conception of the study, data acquisition, revision of the first draft of the study, approval of the final version, PJS, design and conception of the study, interpretation of the data, revision of the first draft of the article, addition of important intellectual content, approval of the final version of the work.</p>
</fn>
<fn fn-type="conflict"><p>Conflict of interest: the authors declare no potential conflict of interest.</p>
</fn>
</author-notes>
<pub-date pub-type="epub"><day>04</day>
<month>9</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><day>16</day>
<month>7</month>
<year>2015</year>
</pub-date>
<volume>4</volume>
<issue>2</issue>
<elocation-id>559</elocation-id>
<history><date date-type="received"><day>23</day>
<month>3</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>03</day>
<month>6</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>©Copyright R. Ludolph et al.</copyright-statement>
<copyright-year>2015</copyright-year>
<copyright-holder>Licensee PAGEPress, Italy</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians’ willingness to get vaccinated in case of a novel influenza pandemic.</p>
</sec>
<sec><title>Design and Methods</title>
<p>We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012.</p>
</sec>
<sec><title>Results</title>
<p>Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one’s life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance.</p>
</sec>
<sec><title>Conclusions</title>
<p>The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter.</p>
<p><boxed-text position="float" orientation="portrait"><caption><title>Significance for public health</title>
</caption>
<p>Whereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people’s willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public’s concerns when having to communicate during the next outbreak of pandemic influenza.</p>
</boxed-text>
</p>
</sec>
</abstract>
<kwd-group><title>Key words</title>
<kwd>H1N1 pandemic</kwd>
<kwd>Italy</kwd>
<kwd>vaccination</kwd>
</kwd-group>
<counts><fig-count count="1"></fig-count>
<table-count count="2"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="38"></ref-count>
<page-count count="6"></page-count>
</counts>
</article-meta>
</front>
<floats-group><fig id="fig001" orientation="portrait" position="float"><label>Figure 1.</label>
<caption><p>Self-reported future behaviour in case of a future influenza pandemic. Question wording: <italic>If there were news stories again on a coming influenza pandemic, what would you do?</italic>
(Check all that applies.), N=139. Black: recommended behaviours, Grey: behaviours not recommended.</p>
</caption>
<graphic xlink:href="jphr-2015-2-559-g001"></graphic>
</fig>
<table-wrap id="table001" orientation="portrait" position="float"><label>Table 1.</label>
<caption><p>Comparison of study sample with the Italian population regarding socio-demographic characteristics.</p>
</caption>
<table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="2" colspan="1">Socio-demographic</th>
<th align="center" valign="top" colspan="2" rowspan="1">Study sample<xref ref-type="table-fn" rid="tfn001">*</xref>
</th>
<th align="center" valign="top" colspan="2" rowspan="1">Italian population</th>
</tr>
<tr><th align="center" valign="top" rowspan="1" colspan="1">Total</th>
<th align="center" valign="top" rowspan="1" colspan="1">%</th>
<th align="center" valign="top" rowspan="1" colspan="1">Total</th>
<th align="center" valign="top" rowspan="1" colspan="1">%</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" colspan="5" rowspan="1">Age</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 18-24</td>
<td align="center" valign="top" rowspan="1" colspan="1">14</td>
<td align="center" valign="top" rowspan="1" colspan="1">10.0</td>
<td align="center" valign="top" rowspan="1" colspan="1">4,246,496</td>
<td align="center" valign="top" rowspan="1" colspan="1">8.6</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 25-34</td>
<td align="center" valign="top" rowspan="1" colspan="1">39</td>
<td align="center" valign="top" rowspan="1" colspan="1">27.9</td>
<td align="center" valign="top" rowspan="1" colspan="1">7,093,190</td>
<td align="center" valign="top" rowspan="1" colspan="1">14.4</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 35-44</td>
<td align="center" valign="top" rowspan="1" colspan="1">31</td>
<td align="center" valign="top" rowspan="1" colspan="1">22.1</td>
<td align="center" valign="top" rowspan="1" colspan="1">9,338,057</td>
<td align="center" valign="top" rowspan="1" colspan="1">18.9</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 45-54</td>
<td align="center" valign="top" rowspan="1" colspan="1">23</td>
<td align="center" valign="top" rowspan="1" colspan="1">16.4</td>
<td align="center" valign="top" rowspan="1" colspan="1">8,924,249</td>
<td align="center" valign="top" rowspan="1" colspan="1">18.1</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 55-64</td>
<td align="center" valign="top" rowspan="1" colspan="1">17</td>
<td align="center" valign="top" rowspan="1" colspan="1">12.1</td>
<td align="center" valign="top" rowspan="1" colspan="1">7,423,621</td>
<td align="center" valign="top" rowspan="1" colspan="1">15.0</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> 65 and above</td>
<td align="center" valign="top" rowspan="1" colspan="1">16</td>
<td align="center" valign="top" rowspan="1" colspan="1">11.4</td>
<td align="center" valign="top" rowspan="1" colspan="1">12,370,822</td>
<td align="center" valign="top" rowspan="1" colspan="1">25.0</td>
</tr>
<tr><td align="left" valign="top" colspan="5" rowspan="1">Gender</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Female</td>
<td align="center" valign="top" rowspan="1" colspan="1">76</td>
<td align="center" valign="top" rowspan="1" colspan="1">54.3</td>
<td align="center" valign="top" rowspan="1" colspan="1">25,805,833</td>
<td align="center" valign="top" rowspan="1" colspan="1">52.2</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Male</td>
<td align="center" valign="top" rowspan="1" colspan="1">64</td>
<td align="center" valign="top" rowspan="1" colspan="1">45.7</td>
<td align="center" valign="top" rowspan="1" colspan="1">23,590,602</td>
<td align="center" valign="top" rowspan="1" colspan="1">47.8</td>
</tr>
<tr><td align="left" valign="top" colspan="5" rowspan="1">Education</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No degree/primary school</td>
<td align="center" valign="top" rowspan="1" colspan="1">2</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.4</td>
<td align="center" valign="top" rowspan="1" colspan="1">11,206,689</td>
<td align="center" valign="top" rowspan="1" colspan="1">21.8</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Secondary school</td>
<td align="center" valign="top" rowspan="1" colspan="1">13</td>
<td align="center" valign="top" rowspan="1" colspan="1">9.3</td>
<td align="center" valign="top" rowspan="1" colspan="1">19,303,454</td>
<td align="center" valign="top" rowspan="1" colspan="1">37.5</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> High school/vocational training</td>
<td align="center" valign="top" rowspan="1" colspan="1">48</td>
<td align="center" valign="top" rowspan="1" colspan="1">34.3</td>
<td align="center" valign="top" rowspan="1" colspan="1">14,873,768</td>
<td align="center" valign="top" rowspan="1" colspan="1">28.9</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> University/Polytechnic</td>
<td align="center" valign="top" rowspan="1" colspan="1">66</td>
<td align="center" valign="top" rowspan="1" colspan="1">47.1</td>
<td align="center" valign="top" rowspan="1" colspan="1">6,073,358</td>
<td align="center" valign="top" rowspan="1" colspan="1">11.8</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Others</td>
<td align="center" valign="top" rowspan="1" colspan="1">11</td>
<td align="center" valign="top" rowspan="1" colspan="1">7.9</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Total</td>
<td align="center" valign="top" rowspan="1" colspan="1">140</td>
<td align="center" valign="top" rowspan="1" colspan="1">100</td>
<td align="center" valign="top" rowspan="1" colspan="1">51,457,269</td>
<td align="center" valign="top" rowspan="1" colspan="1">100</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn001"><p>*Study sample (N=140). Statistical information on age and gender refers to the Italian population aged ≥18 years on 1<sup>st</sup>
January 2012; Statistical information on the educational level refers to the Italian population aged ≥15 years in 2012.<sup><xref rid="ref36" ref-type="bibr">36</xref>
,<xref rid="ref37" ref-type="bibr">37</xref>
</sup>
</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="table002" orientation="portrait" position="float"><label>Table 2.</label>
<caption><p>Predictors of willingness to get vaccinated in case of a future influenza pandemic.</p>
</caption>
<table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="2" colspan="1"></th>
<th align="center" valign="top" rowspan="2" colspan="1">B</th>
<th align="center" valign="top" rowspan="2" colspan="1">df</th>
<th align="center" valign="top" rowspan="2" colspan="1">Sig.</th>
<th align="center" valign="top" rowspan="2" colspan="1">Exp(B)</th>
<th align="center" valign="top" colspan="2" rowspan="1">95%CI for Exp(B)</th>
</tr>
<tr><th align="center" valign="top" rowspan="1" colspan="1">Lower</th>
<th align="center" valign="top" rowspan="1" colspan="1">Upper</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Got vaccinated against H1N1</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.644</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.289</td>
<td align="center" valign="top" rowspan="1" colspan="1">5.174</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.303</td>
<td align="center" valign="top" rowspan="1" colspan="1">88.363</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Get usually/sometimes vaccinated against seasonal flu</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.644</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.014</td>
<td align="center" valign="top" rowspan="1" colspan="1">5.177</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.401</td>
<td align="center" valign="top" rowspan="1" colspan="1">19.133</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Assessment of H1N1 infection as life threatening</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.410</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.002</td>
<td align="center" valign="top" rowspan="1" colspan="1">4.094</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.681</td>
<td align="center" valign="top" rowspan="1" colspan="1">9.974</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Assessment of institutional performance</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">2</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.335</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Institutional performance was adequate<xref ref-type="table-fn" rid="tfn002"><sup>a</sup>
</xref>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.992</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.181</td>
<td align="center" valign="top" rowspan="1" colspan="1">2.696</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.631</td>
<td align="center" valign="top" rowspan="1" colspan="1">11.525</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Performance of some institutions was adequate and of some not</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.123</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.146</td>
<td align="center" valign="top" rowspan="1" colspan="1">3.073</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.677</td>
<td align="center" valign="top" rowspan="1" colspan="1">13.947</td>
</tr>
<tr><td align="left" valign="top" colspan="7" rowspan="1">Socio-demographics</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Highest level of education</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">2</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.973</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Secondary school or below<xref ref-type="table-fn" rid="tfn003"><sup>b</sup>
</xref>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.105</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.896</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.110</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.230</td>
<td align="center" valign="top" rowspan="1" colspan="1">5.369</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> High School or other<xref ref-type="table-fn" rid="tfn003"><sup>b</sup>
</xref>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.100</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.826</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.105</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.454</td>
<td align="center" valign="top" rowspan="1" colspan="1">2.689</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Male gender</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.048</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.915</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.049</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.434</td>
<td align="center" valign="top" rowspan="1" colspan="1">2.538</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Age in years</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.009</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.566</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.009</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.979</td>
<td align="center" valign="top" rowspan="1" colspan="1">1.039</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Constant</td>
<td align="center" valign="top" rowspan="1" colspan="1">-2.702</td>
<td align="center" valign="top" rowspan="1" colspan="1">1</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.008</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.067</td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn002"><p><sup>a</sup>
Reference category: Institutional performance was inadequate.</p>
</fn>
<fn id="tfn003"><p><sup>b</sup>
Reference category: University or Polytechnic. Variables were entered block wise; coefficients are from the final step with all blocks included; N=124. R<sup><xref rid="ref2" ref-type="bibr">2</xref>
</sup>
=0.08 (Hosmer & Lemeshow) 0.20 (Cox & Snell) 0.28 (Nagelkerke). Model Chi<sup><xref rid="ref2" ref-type="bibr">2</xref>
</sup>
(1)=28.505, P<0.001</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Castaldi, Silvana" sort="Castaldi, Silvana" uniqKey="Castaldi S" first="Silvana" last="Castaldi">Silvana Castaldi</name>
<name sortKey="Hartung, Uwe" sort="Hartung, Uwe" uniqKey="Hartung U" first="Uwe" last="Hartung">Uwe Hartung</name>
<name sortKey="Ludolph, Ramona" sort="Ludolph, Ramona" uniqKey="Ludolph R" first="Ramona" last="Ludolph">Ramona Ludolph</name>
<name sortKey="Nobile, Marta" sort="Nobile, Marta" uniqKey="Nobile M" first="Marta" last="Nobile">Marta Nobile</name>
<name sortKey="Schulz, Peter J" sort="Schulz, Peter J" uniqKey="Schulz P" first="Peter J." last="Schulz">Peter J. Schulz</name>
</noCountry>
</tree>
</affiliations>
</record>
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