|| High Parity and Fetal Morbidity Outcomes
|| Methodologic Issues in Follow-up Studies of Cancer Incidence Among Occupational Groups in the United States
||A Longitudianl Analysis of Postpartum Depression Among Employed Women
||Role of Alcohol in Traffic Collisions Involving Older Drivers in Orange County, California
||Determining the Cellular Function of Cullin 5 Containing E3 Ubiquitin Ligase
||Short Birth Intervals and the Risk of School Unreadiness
||Impact of a Teen Theater Production on Attitudes Toward Alcohol and Tobacco Use Among Middle School Students
||Power and Community: Definitions and Implications for Gaining Entry
||Do You See What I See? An Application of Inter-Coder Reliability in Qualitative Analysis
||Effectiveness of a Computer-Based, Multimedia Cervical Cancer Risk Assessment Implemented Among African American Women
||Effects of Prior Exercise on Glucose Tolerance in African-American Women
||Alcohol Consumption and HIV-1 Vaginal Shedding
||Assessing Post-Abortion Contraceptive Use Among Women Receiving Surgical and Medical Abortion Services
||Trends in Secondhand Smoke Exposure in the Coronary Artery Risk Development in Young Adults Study (1985-2001)
||"She Calls Us Both 'Mama'": Shared Kinship Caregiving Among Low-Income, African-American Families
||How Traditional Beliefs About Pregnancy and Childbirth in Bali May Affect Maternal Mortality
||Rapid Response Vaccination Protects Against Lethal Human Outbreak Avian Influenza
High Parity and Fetal Morbidity Outcomes
Muktar Aliyu, MD, DrPH, University of Alabama at Birmingham School of Public Health
We investigated the association between high parity and fetal morbidity outcomes. We analyzed 22,463,141 singleton deliveries =20 weeks of gestation in the United States from 1989 through 2000. Adjusted odds ratios generated from logistic regression models were employed to approximate relative risk for neonatal morbidity in women with 2-4 (moderate parity or Type I; referent group), 5-9 (high parity or Type II), 10-14 (very high parity or Type III) and =15 (extremely high parity or Type IV) prior live births. Main outcome measures included low and very low birth weight, preterm and very preterm birth, and small- and large- for gestational age delivery.
The overall crude rates for low birth weight, very low birth weight, preterm birth, very preterm birth, small- and large- for gestational age were 55, 11, 97, 19, 83 and 129 per 1,000 live births respectively. The adjusted odds ratios for low birth weight, very low birth weight, preterm and very preterm delivery increased consistently and in a dose-effect fashion with ascending parity (p for trend <0.001). The findings with respect to small for gestational age were inconclusive. High parity is a risk factor for adverse fetal outcomes. However, the impact of heightened parity is more manifest as shortened gestation rather than physical size restriction. These findings could prove beneficial for counseling women of high parity.
Methodologic Issues in Follow-Up Studies of Cancer Incidence Among Occupational Groups in the United States
Thomas John Bender , University of Alabama at Birmingham
Incidence studies of occupational factors and cancer in the United States are problematic because the use of population-based registries to identify cases requires development of historical data on subjects' residences and often severely restricts the time period of follow-up. This paper describes procedures for addressing these challenges. We used data from studies of cancer incidence and mortality among microelectronics industry employees to assess various methods for developing residential histories and the relative informativeness of the two studies.
We developed residential histories for 98% of 99,229 mortality study subjects. Analyses making alternative assumptions about residential histories yielded standardized incidence ratios varying by at most 6%. Use of postemployment residential histories increased person-years by up to 62% and increased the observed number of cancers by up to 28%. The number of observed cancer cases in the incidence study was 60% higher than the number of observed cancer deaths in the mortality study. Assumptions about residential history had little impact on validity. Use of information sources with national coverage to develop residential histories increased the incidence study's precision. Despite geographic and temporal restrictions, incidence studies are more informative than mortality studies for cancers with good survival.
A Longitudinal Analysis of Postpartum Depression Among Employed Women
Rada K. Dagher, MPH, PhD Candidate, Health Services Research and Policy, University of Minnesota
This study adds to the literature on postpartum depression by longitudinally investigating the change in prevalence and predictors of maternal depression during the first 6 months postpartum, focusing on work-related stresses and supports. We utilize secondary data* on women 18 years or older; delivering a live, singleton infant at three Twin Cities hospitals in 2001. Telephone interviews were performed at 6 weeks, 3 months, and 6 months after delivery, yielding response rates of 88% (N=716), 81% (N=661), and 76% (N=625), respectively. Longitudinal analyses employed (1) baseline covariates, including demographics, pregnancy and delivery characteristics, and (2) time-dependent covariates including job characteristics, social support, health services used, and infant sleep problems. The impact on depression scores (on the Edinburgh Postnatal Depression Scale) was estimated using General Linear Models.
Women averaged 30 years old, 78% were married, 88% were white, and 46% were primiparas. Depression prevalence was 4.2% at 6 weeks, 4.9% at 12 weeks, and 3.9% at 6 months postpartum. Variables significantly predicting a higher depression score were: Being non-white, experiencing prenatal moods, higher job stress, less job flexibility, less social support, and infant sleep problems. Health care providers have an important role assessing and educating women about risk factors for depression and exploring the need for resources (counseling, parenting support groups, and primary health services). Employers can support postpartum women by implementing flexible work schedules. Given the positive association between increased job stress and postpartum depression, future research should investigate determinants of women's job stress.
Role of Alcohol in Traffic Collisions Involving Older Drivers in Orange County, California
Shahram Loftipour, University of California School of Public Health
The older adult driving population (over 65) is increasing at a rapid pace. As drivers age, confidence in driving as well as confidence in driving while intoxicated has been found to increase. This study was conducted to determine the effects of alcohol on older drivers involved in motor vehicle collisions. Orange County collision data of 23,239 older drivers from Statewide Integrated Traffic Reporting Systems (SWITRS, 1998-2002) was evaluated based on five categories of inebriation: Had Not Been Drinking- 21,967 collisions (94.5%), Driving Under the Influence (DUI)- 259 (1.1%), Had Been Drinking not DUI- 111 (0.5 %), Not Known- 441 (1.9%), and Not Specified- 403 (1.7%).
Older DUI drivers account for 1.1 percent of collisions, moreover, the percentage decreases as age increases. Additionally, collision frequency of older DUI drivers seems to increase during weekends and between the hours of 11:00 pm and 4:00 am. Furthermore, older drivers who had consumed legal amounts of alcohol are at fault 79% of the time, while those who had not consumed alcohol are at fault only 51% of the time. DUI drivers are found at fault 93 % of the time. Collisions of older drivers under the influence of alcohol make up an insignificant percentage of collisions. Furthermore, collision trends of older DUI drivers seem to indicate a higher number of collisions during weekends. Lastly, as alcohol levels increase, the likelihood that older drivers will be determined at fault in collisions also increases.
Determining the Cellular Function of Cullin 5 Containing E3 Ubiquitin Ligase
Elana Ehrlich, Johns Hopkins Bloomberg School of Public Health
Short Birth Intervals and the Risk of School Unreadiness
Holly Gilmore, MSPH, University of South Carolina Arnold School of Public Health
Many communities across the nation have become involved in enhancing school readiness. South Carolina has low rankings regarding educational achievement and has made minimal progress in the past decade. Many predictors of school readiness relate to conditions following birth, including a child's birth weight. Shortened birth intervals are related to a variety of health and social consequences that affect child development, yet no formal research has examined the association between birth intervals and school readiness. This study was a secondary data analysis of de-identified pregnancy-related vital record information, matched to selected items from the Department of Social Services Medicaid records on mothers and children and to the Cognitive Skills Assessment Battery (CSAB) score in South Carolina for the year 2000 for the child of interest (N=6,915). Analysis of covariance and logistic regression were used to determine if there was a statistically significant relationship between birth interval and school readiness.
Results showed that birth interval is a significant predictor of school readiness with a p-value < 0.001 even after controlling for various socio-demographic factors. Children born with inadequate birth intervals (less than 24 months) are more likely to fail the CSAB compared to those with adequate birth intervals. This research is significant in the realms of public health and education by focusing on one contributing factor to a child's readiness for school. Potential implications of this research include promoting optimal birth spacing to improve the likelihood that future first graders will come to school ready to learn.
Impact of a Teen Theater Production on Attitudes Toward Alcohol and Tobacco Use Among Middle School Students
Bethany Bell Ellison, College of Public Health, University of South Florida
We investigated the impact of an evidence-based, theory-driven theater-as-education program on attitudes toward alcohol and tobacco use among middle school students. The production, The End of Summer, was based on research with, and performed by, youth and was aimed at helping students recognize and respond to peer pressure as they witness consequences of life decisions. Using a case study, youth attitudes and perceptions of norms regarding alcohol and tobacco use were assessed via surveys and unstructured youth-written letters to the play's cast. Content analysis of over 800 surveys and 350 letters by multiple independent coders identified major themes via template analysis (survey data) and editing analysis (letters). RESULTS: Responses reflected the production's reinforcement that it is unnecessary to drink and smoke to be liked. Students also wrote about the risk of being caught drinking or smoking and/or disappointing parents and the importance of confidence and self esteem in youth's ability to make healthy choices.
Results underscore the role that constructs central to social learning theory -- reciprocal determinism, expectations, reinforcement, and self-efficacy -- play in the health behavior of middle school students. Although theater-as-education is not widely used in prevention education, the results of this study emphasize its promise as a supporting and reinforcing mechanism for prevention of adolescent risk behaviors, particularly when community, theory, and evidence-based elements are involved. d drugs. Conclusions: HIV-prevention strategies should be tailored to address the specific needs and characteristics of rural stimulant users.
Power and Community: Definitions and Implications for Gaining Entry
Corrina Moucheraud, MPH, University of North Carolina at Chapel Hill School of Public Health, Department of Health Behavior and Health Education
Other Authors: Rebecca Matthew, MPH; Lisa A. Wald, MPH; and Claire K.M. Townsend, MPH
CBPR is unique in its consciousness of power dynamics to establish equitable research relationships with communities. The current state of knowledge and methods for navigating power, however, is still in its infancy. The purpose of this paper is to present the findings from a case analysis of how community power affected and was affected by a CBPR project. An Action-Oriented Community Diagnosis (AOCD), a CBPR-informed technique, was conducted with an African American neighborhood in North Carolina over a seven-month period. Three sources of data were collected on power relations within the neighborhood and with the wider community: field notes on participant observations; transcripts from 19 interviews conducted with community residents and service providers; and secondary data sources, such as historical archives, technical documents, and websites. The analysis used the method of coding and retrieving text to determine patterns of meaning on the manifestations of power during the CBPR process.
The manifestations of power within this community that affected the CBPR process were: racism, community competence, and levels of community participation. Power relations with the wider society that affected the CBPR process were: gatekeeping and charismatic authority. Based on these results, we suggest that the CBPR process begin with an AOCD that includes a power analysis of relations among community leaders/members, academic or “outside” researchers, and service providers. The purpose is to provide a context in which an equitable, balanced, and respectful partnership can develop by revealing the power dynamics already present in these relationships.
Do You See What I See? An Application of Inter-Coder Reliability in Qualitative Analysis
Jenine K. Harris, MA, Center for Tobacco Policy Research, Saint Louis University School of Public Health
Other Author: Ryan C. Burke, BS.
Qualitative research is gaining popularity in fields like business, nursing, and public health. Even so, public health has yet to realize many of the advantages of qualitative research due in part to the perception of subjectivity associated with qualitative research. However, subjectivity can be addressed through assessing reliability. Other challenges, such as large amounts of data and time-consuming analysis, can be addressed through a team approach. This research examines how a team can collaborate to code qualitative data with reliable results. In addition, this research will explain how to adapt reliability measures for unusual data characteristics such as multiple coders assigning multiple codes per item. In 2004 the Center for Tobacco Policy Research conducted interviews with 146 tobacco control professionals. The interviews were transcribed, a codebook was developed, and three coders coded the transcripts. Inter-coder reliability was calculated to determine the extent to which coders assigned the same code(s) to the same text units. Kappa is a preferred method of assessing inter-coder reliability. Typically kappa is calculated for two coders assigning single codes to items; this data was unusual in that three coders assigned multiple codes to each text unit. An adaptation of kappa accounting for these characteristics through the use of intraclass correlation coefficients was calculated for a sample of text units. The resulting high kappa value (0.85) showed that a team approach to coding qualitative data can produce reliable results. This adaptation of kappa may be useful to other researchers, allowing public health to benefit from qualitative methods.
Effectiveness of a Computer-Based, Multimedia Cervical Cancer Risk Assessment Implemented Among African American Women
Yu-Mei Schoenberger, Department of Health Behavior, University of Alabama at Birmingham
Other Author: Connie Kohler, DrPH, Department of Health Behavior, University of Alabama at Birmingham School of Public Health
Despite advances in diagnostic tests to detect cervical cancer, women still die from it. Low socioeconomic status, low levels of education, and lack of knowledge of the purpose of the Pap test and cervical cancer risk and risk factors have been established as reasons for not obtaining screening. The Deep South Network for Cancer Control has utilized individuals from the community to develop a Community Health Advisor (CHA) network. This study assessed the effectiveness and feasibility of an innovative, computerized cervical cancer risk assessment when administered by the CHAs to increase intent to participate in cervical cancer screening. The risk assessment provides individualized, tailored feedback back or standard feedback. The study employed a randomized, controlled, pretest-posttest research design. The study population was 120 African American women who reside in Bullock County , Alabama . ANCOVA and logistic regression were used to estimate adjusted group differences between tailored feedback and standard feedback groups. The results indicated that the level of perceived barriers to obtaining a cervical cancer screening decreased in the tailored group compared to the standard group. A statistically significant effect was observed (Mean difference = -1.887, 95% CI(-3.78,0.009)). Post-intervention intention to obtain a cervical cancer screening did not differ significantly between the two groups after accounting for their baseline intentions (Odds Ratio = 1.737, 95% CI (0.46,6.62)). In conclusion, the implementation of a computer-based cervical cancer risk assessment by CHAs was shown to have a positive effect on reducing perceived barriers.
Effects of Prior Exercise on Glucose Tolerance in African-American Women
Rebecca E. Hasson, Department of Exercise Science, University of Massachusetts
Sedentary and overweight are risk factors for Type 2 diabetes and the risk for African-Americans is 2-fold greater than for Caucasians. The ethnic disparity has been linked to a greater insulin response to ingested glucose in African Americans. A single bout of exercise reduces the insulin response to glucose in previously sedentary individuals. Because there is a reasonable possibility that there is an ethnic difference in the exercise response, the purpose of this study was to evaluate the impact of a single bout of exercise on insulin response to glucose in African-American women. Five sedentary overweight/obese African-American women completed 2 conditions. In the sedentary condition participants sat quietly. In the exercise condition, participants completed 75' of moderate intensity exercise. Ninety minutes following either condition, participants underwent a standard oral glucose tolerance test (OGTT). Three hours later, subjects consumed a meal high in carbohydrate (meal tolerance test, MTT). Venous blood samples were taken every 30' and glucose and insulin responses calculated as the area under the curve.
These results are preliminary and no statistical comparison will be made until data collection (n=9) is complete. To date, exercise has no obvious effect on the glucose or insulin area under the curve during the OGTT or MTT. If this pattern is maintained, the results suggest that a single bout of moderate-intensity exercise does not modify the insulin response to glucose in African-American women.
Alcohol Consumption and HIV-1 Vaginal Shedding
Katherine Theall, Tulane University School of Public Health and Tropical Medicine
The objective of the study was to examine the association between alcohol consumption and HIV-1 vaginal shedding. Methods: HIV 1- infected women attending a large urban HIV primary care clinic in New Orleans , Louisiana between June 2002 and October 2004, who underwent a gynecological exam and were > 18 years of age were included. Subjects underwent clinical exams and were interviewed using a computer-assisted survey at baseline, one and three months. Women (N=187) were mostly African American (86.4%), median age of 38 (range 19-61), on antiretroviral therapy (ARV) (56.7%) and had a median CD4 of 404 copies/ìL and plasma viral load of 3196 copies/mL at baseline. Self-reported adherence to ARV on the prior day was 89.6%. Overall period prevalence of vaginal shedding (> 50 copies/swab) was 24.5%, with a baseline prevalence of 27.3%. At baseline, 30% reported any alcohol consumption, 32.6% were weekly drinkers, 25.5% were binge drinkers, and 10.0% were heavy drinkers. Prevalence of various consumption patterns was similar over the course of follow-up. Recent heavier alcohol consumption and binge drinking were both strongly and positively associated with vaginal shedding, but only among women on ARV. After adjusting for plasma viral load, immunosupression, and ARV adherence, recent heavy alcohol consumption (> 2 drinks yesterday) was significantly associated with vaginal shedding (adjusted POR=2.29, 95% CI=1.18, 14.43). Plasma viral loads were not different between heavy alcohol consumers and those who were light consumers or abstinent.
Recent and heavier binge alcohol consumption may increase expression of HIV-1 RNA in vaginal fluids of women on ARV.
Assessing Post-Abortion Contraceptive Use Among Women Receiving Surgical and Medical Abortion Services
Cheryl Vamos, Department of Community and Family Health, University of South Florida College of Public Health
Utilization of contraception can be impacted by a multitude of behavioral, psychosocial, economic and societal factors. Knowledge of attitudes and behaviors of women who have abortions is useful for understanding the motives and barriers influencing post-abortion contraception use. Data from patient charts receiving medical and surgical abortions performed in 2003 in reproductive health clinics in Florida were abstracted and analyzed. Variables included: patient demographics; high risk behaviors; reproductive, gynecological, sexual and birth control history; and birth control prescription and continuation data.
Findings indicate that of 737 abortions, 47.2% were surgical and 52.8% were medical. At time of abortion, 43.6% (n=320) and 34.7% (n=255) of women were between the ages of 18 and 24, and 25 and 34, respectively. Age at first intercourse between 15 and 17 years were reported by 59.2% (n=365) of the females. Fifty-nine percent (n=427) of the females reported previous pregnancies, and 39.9% (n=221) indicated that they have had at least one previous abortion. Forty-two percent (n=309) of women responded that they were using a current form of birth control at time of abortion visit. In total, 56.8% (n=400) of women obtained a birth control prescription, while only 32.1% (n=119) continued to receive birth control afterwards. The discrepancy between birth control requested and continuance rates could be attributed to women lacking contraception knowledge, seeking reproductive health care elsewhere, and the focus of abstinence-only education inhibiting women from making empowered decisions. This outcome data validates future research examining women's rights and their antecedent behaviors concerning their reproductive health.
Trends in Secondhand Smoke Exposure in the Coronary Artery Risk Development in Young Adults Study (1985-2001)
Rachel Widome, MHS, Division of Epidemiology, University of Minnesota
Other Authors: Pamela J. Schreiner, PhD, MS, MS, School of Public Health, Division of Epidemiology, University of Minnesota; Catherine Loria, PhD, MS, MA, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute; Carlos Iribarren, MD, MPH, PhD, Division of Research, Kaiser Permanente; and J. Jeffrey Carr, MD, MSCE, Division of Radiological Sciences & Department of Public Health Sciences, Wake Forest University School of Medicine
Secondhand smoke exposure is linked to increased risk of cardiovascular disease and cancer. The reduction in active smoking during the time period of the CARDIA study, coupled with a decreasing societal acceptance for smoking indoors led to this exploration into secondhand smoke exposure epidemiology. Exposure to secondhand smoke and workplace policies were self-reported in a bi-racial cohort of adults aged 18-30 years, recruited from 4 urban areas in 1985/86 and re-examined 2, 5, 7, 10, and 15 years later. Field center and sex adjusted means across the 6 examinations were used to describe the secondhand smoke exposure trend for baseline non-smokers, former smokers, and current smokers by educational level and ethnicity (black vs. white). Baseline self-reported smoking status and secondhand smoke exposure were validated with serum cotinine levels.
In white non-smokers, total secondhand smoke exposure declined from 20.5 hr/wk in 1985-86 to 6.6 hr/wk in 2000-2001; in black non-smokers, this decline was from 22.8 hr/wk to 7.8 hr/wk. Less education tended to be associated with more exposure. In years 10 and 15, working in an environment that prohibited smoking was associated with less exposure to secondhand smoke in non-smokers. However, within policy types, black and less educated participants tended to report more exposure to workplace smoke than whites and those better educated. There has been a substantial decline in self-reported secondhand smoke exposure since 1985, although exposure differs across ethnicity and education levels. The increasing presence of restrictive workplace policies may contribute to the reduction.
"She Calls Us Both 'Mama'": Shared Kinship Caregiving Among Low-Income, African-American Families
Katie Sellers, Tulane University School of Public Health and Tropical Medicine
Shared kinship caregiving is a common practice among young mothers, particularly in low-income African-American and Latino families. Interventions with these families, however, are often developed assuming a nuclear family structure. Thus the implications of shared caregiving are rarely translated into practice. For instance, parenting interventions delivered solely to the young mother may be diluted by the influence of kin caregivers, particularly when the caregiving relationships are strained by conflict. This poster describes an in-depth, qualitative study of shared caregiving among low-income African-American adolescent mothers. We moderated serial focus groups with young African-American mothers, grandmothers, and fathers in Baton Rouge (total n=58), using a loosely structured interview guide. A grounded theory analysis of the focus group data followed. Because this research was exploratory in nature, the analysis was more oriented toward hypothesis generation than hypothesis testing.
Despite widely varying family structure and childcare arrangements, almost all respondents shared caregiving to some extent. Most young mothers acknowledged the importance of assistance from kin network members, but many described conflict in care-sharing relationships. Specifically, some mothers felt criticized and undermined by their own parents, some disagreed with other caregivers on particular childrearing issues, and some had open hostility with care providers within the kin network members. Kin networks contribute to childrearing in important ways. However, conflict among family members can undermine efforts to provide an optimal environment for the child. Public health practitioners should consider kin network relationships in designing and implementing programs to improve child health in similar populations.
How Traditional Beliefs About Pregnancy and Childbirth in Bali May Affect Maternal Mortality
Melissa H. Withers, MHS, Community Health, University of California at Los Angeles
Bali, Indonesia has the highest maternal mortality rate (between 350 and 450 per 100,000 live births) in south-east Asia . Although lack of health care among some populations may be a factor, traditional beliefs and practices may also contribute to maternal mortality. The purpose of this study was to explore traditional beliefs and practices regarding pregnancy and childbirth, and to determine whether these contribute to maternal mortality. The health belief model was utilized in the study design. The study site was a community of 10,000 in East Bali with 19 sub-villages. Three focus groups and over thirty in-depth interviews were conducted with key informants, including local mothers, government midwives, traditional and formal health care providers and community health volunteers. Content analysis was performed.
Numerous traditional beliefs and practices were uncovered that may contribute to maternal mortality, including: practices of local traditional healers, food taboos leading to poor nutrition, inaccurate myths surrounding high risk pregnancies, distrust of formal health care providers, and fear of witchcraft and evil spirits. Programs should address the traditional beliefs that put women at risk and may make them more susceptible to poor birth outcomes. Women who express concerns about witchcraft and distrust of health care providers need to be convinced of the benefits of immunization and pre-natal care. Women could benefit from education programs to recognize the symptoms of problem-pregnancies and proper nutrition. These findings demonstrate the need for culturally-sensitive programs targeting women with little previous experience in the formal health care system.
Rapid Response Vaccination Protects Against Lethal Human Outbreak Avian Influenza
Adam Soloff, Graduate School of Public Health, University of Pittsburgh
The ability of highly pathogenic avian influenza strain H5N1 to be transmitted between humans with an associated seventy-five percent mortality rate is raising concerns over the potential for an influenza pandemic. Conventional vaccination methods fail to account for such lethal strains, and require prohibitively long preparation times limiting their utility in outbreak containment. Adenoviral-based vaccines targeting regions of the H5N1 surface protein hemagglutinin(HA) were developed in 36 days based on sequences from the 1997 Hong Kong or 2004 Vietnam outbreaks. Four groups of mice received prime-boost immunization regimens targeting either full or partial length Vietnam HA, partial length Hong Kong HA, or mock vaccination. 16 weeks following the final immunization, animals were challenged with a lethal dose of the H5N1 Vietnam virus.
Although all animals rapidly developed HA-specific antibody titers post-immunization, only mice receiving the full-length Vietnam HA vaccine developed antibody responses capable of neutralizing heterologous virus. In contrast, vaccination induced broad and potent cellular immunity in all animals regardless of viral strain or HA region immunized against. Characterization of vaccine induced cellular immune responses identified cross-reactive epitopes conserved within both Vietnam and Hong Kong viruses targeted by all immunizations. In addition, strain specific epitopes were isolated in non-conserved regions between the viral strains. Upon viral challenge, control animals died within nine days, whereas all vaccinated animals survived showing minimal transient weight loss. These findings illustrate the potential efficacy of adenoviral-based vaccination in containing influenza outbreaks through the rapid induction of cellular and humoral immunity.