We cannot know whether the source

of the knowledge was the fact sheet that accompanied the ROF letter (either because they had read Selleck BMS-777607 and learned from it or had it at hand during the interview), a healthcare provider, or some other source. However, because the interview was conducted 4-5 months after receipt of the fact sheet and letter, it is less likely that respondents would have the fact sheet at hand. Furthermore, one of the questions with a lower frequency of correct responses was regarding vertical transmission of HCV, a topic included in the fact sheet. Two other questions had a relatively low frequency of accurate responses: whether HCV could be transmitted sexually or by kissing an infected person. The first of these, sexual transmission, may require a more specific question to accurately assess knowledge. For example, sexual transmission of HCV among men who have sex with men with human immunodeficiency virus (HIV) infection has been documented,

whereas risk of transmission Proteases inhibitor among monogamous non-HIV-infected heterosexual partners is rare or nonexistent.16 The lower frequency of correct responses to transmission from kissing an infected person might be a result of the fact that this was not explicitly stated on the fact sheet or may reflect a lack of understanding about HCV transmissibility. Approximately 15% of respondents had not heard of hepatitis C before receiving the ROF letter; this proportion was higher for men

and black non-Hispanics, among whom selleck inhibitor the burden of HCV disease is higher, and for persons lacking health insurance or a usual source of medical care. We think it is noteworthy that having previously heard of hepatitis C did not vary by age group. These findings may serve as a roadmap for education programs to prevent infection, because there is currently no vaccine available for HCV. Clearly, more work is needed to bring this disease of public health importance to the attention of the U.S. population, especially those in the subgroups most affected by the disease. The 2010 Institute of Medicine report identified a lack of education about HCV among the public and among healthcare providers as an important barrier to controlling the HCV epidemic in the United States.17 The CDC plans to expand efforts to educate both the public and providers; continued monitoring of the effect of education on prevention is warranted. As with all studies, there are limitations to consider when interpreting these findings. First, NHANES data are generalizable to the U.S.