Journal of Community Health

Published by Springer Nature
Online ISSN: 1573-3610
Print ISSN: 0094-5145
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Distribution and odds ratios of Ever versus Never Used ENDS status for HealthStreet members by year (2014–2021). a Distribution of Ever versus Never Used ENDS by year; b Adjusted and unadjusted odds ratios for Ever versus Never Used ENDS by year, with 95% confidence intervals (CI). Odds ratios (OR) are adjusted for sex, age (categorical), race, ethnicity, ≥ 12 yrs. of education (yes/no), and food insecure (yes/no). Closed symbols indicate statistically significant OR where the 95% CI excludes 1. Wald Chi-square p-value symbols: *<0.05, and ***<0.0001.
Percentage of HealthStreet members by tobacco and ENDS use status, comparing main sample with subset of those with tobacco associated health conditionsa (2014–2021). aAsthma, COPD/emphysema, chronic bronchitis, chronic sinus infections, pneumonia, all cancers, arrhythmias, chest pain/angina, clots, coronary artery disease, heart attack, heart murmur, heart palpitations, high cholesterol, high blood pressure, mitral valve prolapse, deep vein thrombosis, other heart/circulation conditions.
Electronic nicotine delivery systems (ENDS) are relatively new and ENDS use data from community engagement programs may help us understand usage patterns and facilitate targeted longitudinal studies. Community members in Florida, USA, were asked about ENDS use, tobacco use, and health history/concerns by Community Health Workers. Among 7253 members recruited during 2014 to 2021 into our HealthStreet program, 1177 had ever used ENDS; the proportion increased from 12 to 27% from 2014 to 2021 (adjusted odds ratio (aOR) 2.5; 95% CI 1.7–3.5; Ever versus never used ENDS). Ever tobacco use was strongly associated with ENDS use; 69% of ever users were current tobacco users. Demographic determinants (sex, age, race) and food insecurity were strongest predictors of ENDS use. Most who had ever used ENDS were aged 18–25 (aOR 5.9; 95% CI 4.6–7.6; vs. aged 60 + years), White (aOR 3.7; 95% CI 3.2–4.3; vs. Black/African American), male (aOR 1.5; 95% CI 1.3–1.7; vs. female), and recently food insecure (aOR 1.8; 95% CI 1.5–2.0; vs. not recently food insecure). Those with respiratory issues were more likely to have used ENDS compared to those without (aOR 2.0; 95% CI 1.6–2.6; aOR 1.3; 95% CI 1.1–1.5). Members concerned about hypertension were less likely to have used ENDS (aOR 0.7; 95% CI 0.5–0.9). In this relatively rural, micropolitan sample, tobacco use, socio-economic determinants, and certain health history/concerns were strongly associated with ENDS use. Community outreach approaches are needed to further understand these factors and implement interventions.
 
This paper analyses community knowledge, perceptions, and experiences of effectiveness of healthcare service provision on malaria prevention/treatment in two disease-endemic villages of the Okavango Delta panhandle in northern Botswana. A stratified random sampling of 355 households was conducted in October–November 2015. Follow-up retrospective cohort interviews were undertaken in August 2016 from 79 households that reported malaria incidences during the household survey. Data were also collected from 16 key informant interviews and 2 focus group discussions participants. Descriptive statistics and content analyses were used to summarise quantitative and qualitative data, respectively. Results indicate that communities in the study sites had positive perceptions about efficiency of health services based on availability, accessibility and utilization, adequacy of prevention and treatment interventions. Local health clinics were crucial information channels used by respondents. Additionally, factors related to acceptability, availability and accessibility are likely to contribute to perceived effectiveness of the interventions provided by healthcare service providers. Affirmation of efficiency health service provision against malaria has public health implications for adherence to treatment/prevention and participation in community health education campaigns and program implementation in the Okavango Delta region.
 
Study Sample
Understanding COVID-19 vaccine hesitancy among Medicare beneficiaries is critical for increasing COVID-19 vaccine uptake in the US. This study aimed to estimate and compare the vaccine hesitancy rate among community-dwelling Medicare beneficiaries with and without cancer history, also to investigate factors associated with vaccine hesitancy during the first four months after COVID-19 vaccine became available. We used population-based, cross-sectional data on 3,034 community-living Medicare beneficiaries from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement. Sample weights were applied to account for the complex survey design with results generalizable to 16.4 million Medicare beneficiaries. Weighted multivariable logistic regression model was conducted to investigate the association between cancer history and vaccine hesitancy adjusting for covariates. A total of 39.6% were hesitant about getting COVID-19 vaccine. Those with cancer history were significantly less likely to be hesitant to get vaccinated than those without cancer history (adjusted odds ratio = 0.80, 95% confidence interval: 0.64, 0.99, p = .050). The most common reason for being hesitant to get COVID-19 vaccine was that the vaccine could have side effects or was viewed as not safe (19.2%), followed by not trusting what government says about vaccine (11.4%). Those with cancer history were more likely to report ongoing health conditions, lack of recommendation from a doctor, and doctor recommending against COVID-19 vaccination as reasons for not getting the vaccine compared to participants without cancer history. Increasing the confidence and knowledge about vaccine benefits among high-risk and more hesitant individuals are urgently needed to increase the vaccine uptake.
 
Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31–16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44–5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03–2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.
 
Flowchart of the web-survey implementation process from the pre-validation phase to the final version of data analysis
Pharmacists’ perspectives on measures that can increase the reporting of suspected ADR (N = 220)
The close contact between patients and community pharmacists, along with the extensive geographical distribution of pharmacies in Portugal, offer exceptional conditions to detect and report adverse drug reactions (ADR). This study aimed to evaluate the motivation and knowledge of spontaneous reporting of ADR by community pharmacists of Porto, Portugal. Secondly, we aimed to generate real-world evidence on the main factors determining ADR report and at raising potential alternatives to the current reporting procedure in community pharmacy. We performed a descriptive, cross-sectional, observational, anonymous web survey-based study. Between April and July 2021, a web survey was implemented, targeting community pharmacists in the Porto district, Portugal. We validated 217 surveys from pharmacists. Regular notifiers seem to be more familiarised than non-regular notifiers with the Portuguese Pharmacovigilance System (PPS), with the Portal RAM for reporting suspected ADR, and with the update of the concept of ADR. Moreover, regular notifiers seem to be more proactive with their care in questioning patients about ADR and have more self-knowledge to identify suspected ADR. Conversely, non-regular notifiers, seem to be more reluctant to be judged by their ADR reporting activities. Respondents suggested to simplify and optimise the reporting process (31% of the suggestions), or to integrate a reporting platform into the pharmacy’s software (27%). This study identified opportunities to promote the ADR reporting process by community pharmacists, namely receiving feedback from the PPS on the reported case and its regulatory implications, implementing training programs in pharmacovigilance, and creating solutions to simplify the reporting process.
 
Theory of change
At the height of the COVID-19 pandemic, the Public Good Projects, Hispanic Communications Network and World Voices Media joined forces to launch a nationwide, multifaceted campaign which aimed to increase vaccine confidence and decrease misinformation on social media within Hispanic communities. We created a Spanish vaccine misinformation tracking system to detect and assess misinformation circulating in online Spanish conversations. We used our media monitoring findings to work with Hispanic social media (SM) influencers, volunteers, and celebrities to spread pro-vaccine messaging online. We created misinformation-responsive SM assets, newsletters, talking points and trainings for Hispanic-serving community-based organizations (CBOs) to help them respond to misinformation and increase vaccine uptake. We used our misinformation findings to inform the creation of mass media communications such as radio PSAs and op-eds. In Year 1, our new Spanish monitoring system captured and organized 35 M Spanish and 212.7 M English posts about COVID-19 misinformation. We recruited 496 paid influencers, 2 Hispanic celebrities and 1,034 digital volunteers. We sent 70 newsletters to an average of 1539 CBO subscribers, containing 206 talking points and 344 resources (SM assets, toolkits, videos) in English and Spanish to support their outreach. Our radio PSAs reached 26.9 M people and the op-eds reached 2.9 M people. This project shows the proliferation of misinformation circulating in online Spanish conversations. It also shows we were effective at reaching our target audience with fact-based COVID-19 misinformation prebunk and debunk messaging.
 
Due to COVID-19 restrictions, academic institutions have changed their modus operandi, particularly in adopting distance learning in lieu of face-to-face instruction. This has sometimes produced unanticipated effects on students. The purpose of this study was to determine COVID-19 pandemic stressors and coping mechanisms utilized as relief measures by students, faculty, and staff in the College of Health Sciences at a historically Black institution. Cross-sectional study. Sampling: A convenience sample of 209 students, 34 faculty, and 9 staff from the College of Health Sciences at a historically Black institution participated in this study. Instrument: A 32-item Qualtrics survey was utilized to gather demographic data, COVID-19-related stressors, and coping mechanisms. Analysis: Descriptive statistics, Chi-square test for categorical variables, and Cochran-Mantel-Haenszel tests for ordinal variables were used. Female students, African American students (AAS), and undergraduates perceived stress related to the risk of contagion during the pandemic higher than the male students (P-value = 0.0096), other races (P-value = 0.0249) and graduate students (P-value = 0.0141) respectively. Female students perceived more stress related to relationships with relatives (P-value = 0.0128). Caucasian students compared to others (P-value = 0.0240) and graduate students compared to undergraduate students (P-value = 0.0011) reported less perceived stress related to the relationships with other colleagues. Top coping strategies of students and staff included interaction with family and friends, social media, hand hygiene, and meditation/spiritualty. Except for "avoidance of public spaces/transportation", all other mechanisms were the same for faculty.
 
Associations between positive childhood experience items and substance use behaviors during adulthood. AOR = Adjusted odds ratio, CR = Count ratio. AOR and CR values >1 indicate positive association and values < 1 indicated inverse associations. Alcohol quantity models only included participants who reported > 0 drinks in the past 30 days. Regression models controlled for age, birth sex, race/ethnicity, and annual household income. N = 6495. *p < .01, **p < .001
Childhood experiences are linked to myriad indices of health and wellbeing in adulthood, including substance use behaviors. Increasingly, there has been a paradigm shift in prevention science focused on healthy outcomes of positive experiences. The current study examined associations between retrospective reports of positive childhood experiences and patterns of smoking and alcohol use in adulthood. Data were from the 2019 Montana Behavioral Risk Factor Surveillance System survey (N = 6,495; Mage = 55.9 years; 49% male as assigned at birth). Outcomes examined with regard to positive childhood experiences included lifetime smoking (> 100 cigarettes), current smoking status, and past-month alcohol use indices (i.e., total drinks, typical quantity, heavy episodic drinking, and peak drinking occasion). Positive childhood experience scores were inversely associated with both smoking outcomes (AORs = 0.66 and 0.61). Curiously, positive childhood experiences were positively associated with any past-month alcohol use (AOR = 1.12), but among respondents who did use alcohol in the past month, positive childhood experiences were inversely associated with all indices of alcohol use patterns: total drinks (CR = 0.94), drinks per occasion (CR = 0.95), heavy episodic occasions (AOR = 0.91), and peak drinking (AOR = 0.95). Findings generally indicated that positive childhood experiences may be protective against cigarette and high-risk alcohol use behaviors in adulthood. Item-by-item analyses identified specific childhood experiences that may be particularly protective, which may inform prevention efforts and policy (prevention recommendations are discussed below).
 
Factors motivating receipt of a COVID-19 vaccine among those vaccinated
Factors discouraging receipt of COVID-19 vaccine among those unvaccinated
Sources of information about the COVID-19 vaccine for both vaccinated and unvaccinated patients analyzed with SAS v. 9.4 with two-tailed p < 0.05 to indicate statistical significance
The full impacts of the COVID-19 pandemic are yet to be determined. While highly effective vaccines are available to prevent and decrease the severity of COVID-19 infection, significant COVID-19 vaccine hesitancy remains. Understanding motivations, discouraging factors, opinions, and information sources regarding COVID-19 is essential to targeting vaccine hesitancy and improving vaccine uptake. A 25 question survey was administered to the patients of a free clinic in the Midwest to assess patient demographic data, opinions about and experience with COVID-19, the COVID-19 vaccines, and information sources. The main outcome of interest was if vaccination status influenced information sources and opinions regarding COVID-19. This study also analyzed motivating and discouraging factors for vaccination. The study had a total of 104 participants with 7 being excluded. There were a total of 97 survey responses included in this study, there were 79 vaccinated patients and 18 unvaccinated patients. This survey study found differences in information sources between vaccinated and unvaccinated groups. Opinions surrounding the COVID-19 vaccine, public health agencies, and perceived severity of COVID-19 also varied between vaccinated and unvaccinated groups. The differential information sources and opinions between vaccinated and unvaccinated groups emphasizes the importance of access to high-quality sources and educating the community to improve public health.
 
Introduction The objective of this study is to characterize the associations between demographic, attitudinal, and leadership factors with COVID-19 vaccination rates, vaccination intentions among those not vaccinated, and attitudes about vaccination safety, effectiveness, and importance. Methods A serial cross-sectional anonymous online survey was administered to soldiers at two large U.S. Army Divisions located in the Southwestern region of the U.S. at two different time points (April-May 2021 [Time 1; T1] N = 24,629; July-August 2021 [Time 2; T2] N = 21,116). Binary logistic regressions were used to assess demographic and attitudinal predictors of vaccination receipt and vaccination intent. Multinomial logistic regressions were used to assess demographic and leadership predictors of endorsement of three vaccination attitudes concerning effectiveness, safety, and importance. Results Approximately 43% of soldiers reported that they received a COVID-19 vaccine at T1, increasing to 67% at T2. Soldiers who agreed with three separate statements on vaccination effectiveness, safety, or importance were more likely to indicate that they intended to get the vaccination at both time points. Soldiers who reported that their immediate supervisor encouraged soldiers to get a COVID-19 vaccine were more likely to indicate that the vaccination was effective, safe, or important at both time points. Discussion Negative attitudes about COVID-19 vaccines were prevalent and correlated with less intention to get a vaccination. However, prioritizing leadership engagement around the importance of vaccinations may be a simple but widely effective intervention point to increase future vaccine uptake following the development of novel vaccines to future COVID-19 variants.
 
Although widely viewed as a urological condition, nocturia has been increasingly recognized to accompany various non-urological conditions such as hypertension and blood pressure (BP) elevation on office determination. Home BP monitoring (HBPM) has been shown superior to office-based readings and provides an opportunity to assess potential relationships between nocturia and novel indices derived from multiple BP recordings including BP load, BP variability, and arterial stiffness, which have prognostic significance. We retrospectively studied 103 home BP logs and nocturia frequencies provided by 61 stable cardiology patients ≥ 21 years without medication change. Nocturnal voids ranged from 0 to 5 voids per night, median: 1.5. Nocturia frequency was significantly correlated with home and office systolic BPs and with BP load, but not with diastolic BPs, BP variability or arterial stiffness. On Poisson regression analysis, the estimated prevalence ratio (PR) for home and office systolic BPs were 1.025 (CI: 1.01, 1.04; p < .001) and 1.01 (CI:1.00, 1.02; p = .019), indicating 2.5% and 1% increases in the risk of nocturia per mmHg increases in BP respectively. In conclusion, higher mean home and office systolic BPs are associated with self-reported nocturia frequency with stronger associations seen for home BP measurement. Nocturia frequency appears unrelated to mean home and office diastolic BPs. Nocturia may be related to BP load, (percentage of elevated BP values), but not to BP variability or arterial stiffness. Future prospective studies using HBPM are needed to confirm these findings and to contribute to the understanding of the elevated BP-nocturia link.
 
Relative importance analysis of variables predicting any lifetime eviction (n = 1240)
Relative importance analysis of variables predicting any lifetime house foreclosure (n = 1190)
This study examined experiences with eviction, house foreclosures, and homelessness in a large U.S. city sample of adults with Coronavirus Disease-2019 (COVID-19). A total of 3595 adults with COVID-19 participated in an assessment of health and well-being after completing contact tracing activities. The sample had a 5.7% lifetime prevalence of eviction, 3.7% lifetime prevalence of house foreclosure, and 8.2% lifetime prevalence of homelessness. Relative importance analyses revealed drug use was the most important variable associated with any lifetime eviction, lifetime house foreclosure, lifetime homelessness, and being currently at-risk of eviction or recently evicted. Loneliness was also relatively strongly associated with any lifetime eviction or homelessness, while socioeconomic characteristics were the most importance variables associated with late mortgage payments in the past month. Treatment for addiction problems may be important for in the aftermath of the COVID-19 pandemic and adults with histories of housing instability may be particularly at risk.
 
A Proportion (%) of non-Hispanic black youth firearm deaths, 2015–2019 (Causes). B Proportion (%) of non-Hispanic black youth firearm deaths, 2015–2019 (Census Region).
Source: WISQARS, for youths (0–19 years of age)
Firearm injuries are the leading cause of death for youths 19 and younger in general and the third leading cause of death for non-Hispanic Black youths. Child Access Prevention (CAP) laws have been explored concerning their impact on firearm mortality reduction among heterogenous groups of youth, but not specifically among non-Hispanic Black youths. We analyzed data related to non-Hispanic Black youth firearm mortality, non-Hispanic Black poverty rates, firearm dealer density, and CAP laws for each state to ascertain the impact of CAP laws from 2015 to 2019. During the study period, a total of 6778 non-Hispanic Black youths died due to firearm trauma with the leading causes of death being homicides (85.8%); mostly seen among males (96%), and in the South (53.2%). When compared by CAP laws, the states with the strongest laws had statistically significantly lower rates of firearm mortality than states with the weakest laws. After adjusting for state poverty and firearm dealer density, the differences were not statistically significant but still, stronger CAP laws were associated with lower rates of firearm mortality among non-Hispanic Black youth. CAP laws alone can have a modest impact on non-Hispanic Black youth firearm mortality. To adequately reduce firearm mortality among non-Hispanic Black youths, the state and local governments should, along with CAP laws, enact policies to reduce poverty, crime, access to firearms by criminals, and neighborhood dysfunction among non-Hispanic Black communities.
 
Distribution of community benefits among non-profit hospitals
Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research. Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals.
 
Prevalence and confidence interval 95% of internet addiction and social media addiction of the students by sex.
Internet addiction is a growing behavioral health problem in modern societies. In this study, we aimed to determine the prevalence of internet addiction (IA) and social media addiction (SMA) and their relationship with sociodemographic factors, lifestyle habits, and internet usage patterns among medical students. This cross-sectional study was conducted among 280 medical students in a medical faculty, in Istanbul. Self-report questionnaires comprised sociodemographic status, lifestyle habits, internet and social media usage behavior, the Young Internet Addiction Test-short form (s-IAT), and the Bergen Social media addiction scale. The total prevalence of IA was 16.1% (11.8–20.4%), 17.2% (12.8–21.7%) in males and 14.8% (10.7–19.0%) in females. The total prevalence of SMA was 6.1% (3.3–8.9%), 4.8% (2.3–7.3%) in males and 7.4% (4.3–10.5%) in females. No significant difference was found between the sexes in terms of IA and SMA. IA was higher in grade 3 students than in grade 6 students. Multivariate logistic regression analyses showed that reading books at least once per month, high life satisfaction, performing physical activity at least twice per week, and using the internet for communication purposes were independent preventive factors for IA. The current study shows that IA and SMA are common in medical school students. Moreover, IA is associated with socioeconomic characteristics and lifestyle habits such as reading books, life satisfaction, and physical activity. To protect medical school students from IA and develop healthy behaviors, it is necessary to develop prevention strategies and design and implement awareness and education programs.
 
Map of 2020 Chicago Grows Food program locations
COVID-19 exacerbated existing disparities in food security in Chicago. Home gardening can improve food security but there are often barriers to participation and the benefits are understudied. Chicago Grows Food (CGF) formed in 2020 to address food insecurity during COVID-19, and created the Grow Your Groceries (GYG) program to provide home gardening kits to families at risk of food insecurity in Chicago. A participatory program evaluation was conducted to better understand the experiences of and benefits to individuals participating in GYG. Program participants shared feedback via focus groups (n = 6) and surveys (n = 72). Qualitative data were analyzed using an iterative coding process. Quantitative data were analyzed using descriptive statistics. Most participants reported confidence in using a grow kit to grow food, increased healthy food consumption, easier access to healthy food, and high likelihood of growing food again. Additionally, participants described increased connections within their communities, increased interaction with their family, and personal growth as benefits of the program. These results demonstrate the benefits of a novel home gardening program that uses fabric grow bags to address food insecurity. A larger scale program evaluation is necessary to better understand the impacts of participating in this home gardening program.
 
Before the COVID-19 pandemic, geographic mobility, previously viewed as an indicator of economic stability, was declining among young adults. Yet, these trends shifted during the COVID-19 pandemic; young adults were more likely to move during COVID-19 for reasons related to reducing disease transmission and fewer educational and job opportunities. Few studies have documented the individual and neighborhood characteristics of young adults who moved before and during the pandemic. We used data from a cohort of young adults aged 18–34 in six metropolitan areas to examine individual- and neighborhood-level predictors of mobility before and during the COVID-19 pandemic. The sample was majority female, white, and educated with a bachelor’s degree or more. Residents in neighborhoods they lived in were mostly White, US-born, employed, and lived above the poverty level. Before the pandemic, identifying as a sexual minority was significantly related to mobility. During the pandemic, being younger, single, and non-Hispanic were significantly related to mobility. Higher neighborhood poverty was significantly related to mobility before and during the COVID-19 pandemic. Future studies that examine young adult populations who moved during the pandemic are needed to determine whether COVID-19 related moves increase economic instability and subsequent health-related outcomes.
 
Reported patient barriers to completion of order forms (N = 37)
Pre vs post-intervention completion rates for laboratory studies, medical specialty referrals, imaging studies and miscellaneous studies (N(pre-intervention surveys) = 151; N(post-intervention surveys) = 205)
Completion rates for laboratory studies, medical specialty referrals, imaging studies and miscellaneous studies after stratifying for post-intervention completed phone calls (N = 103)
The goals of this study were to determine the completion rates of patient order forms at the Cooper Rowan Clinic, a student-run free clinic, and to implement the use of a post-encounter phone call to improve completion rates, preventive medicine, and medical student clinical involvement. 151 patients completed a pre-intervention questionnaire before their visit. The questionnaire collected information regarding successfully completed order forms. First-year students were trained to perform phone calls and called their patients for five months. 205 patients then completed a post-intervention questionnaire. Dependent variables included completion rates for laboratory studies, specialty referrals, imaging studies and miscellaneous tests. Chi-squared tests were performed. Although the completion rates for laboratory testing (pre = 73.7% vs post = 81.1%), referrals (pre = 50.0% vs post = 65.1%) and imaging studies (pre = 60.9% vs post = 71.7%) increased, the results were not statistically significant. The completion rate of miscellaneous testing (pre = 41.7% vs post = 100.0%) increased following the implementation and was statistically significant. When patients were stratified to those who received a phone call, completion rates of referrals (73.0%), laboratory testing (86.1%), imaging studies (80.5%), and miscellaneous studies (100.0%) substantially increased. Although not statistically significant except for miscellaneous studies, there was an overall increase in completion in all categories. Further evidence to suggest that phone calls improved order completion was the substantial increase in completion rates in patients who received a call. The implementation improves completion of orders which could enhance preventive measures within the clinic. Additionally, it provides an opportunity for earlier student clinical exposure through direct patient contact.
 
Unpaid or informal caregivers are people who provide assistance without compensation to adults and children who require care beyond typical needs. Although often rewarding, informal caregiving can be associated with high rates of depression, stress, anxiety, sleep and endocrine system disruption, immunosuppression, and general morbidity and mortality. Few recent studies of informal caregivers have included data from American Indians and Alaska Natives (AI/AN). Given this noteworthy gap in the literature, we surveyed a total of 225 AI/ANs attending two cultural, community functions in the Pacific Northwest to gain a general understanding of frequency of caregiving, caregiver and recipient characteristics, caregiving duties, support needs, and financial, emotional, and physical strains as a consequence of caregiving. Of the 225 participants who completed the survey, 90 (40%) indicated that they had been an unpaid caregiver for a month or more and 28 (12%) were current unpaid caregivers. Consistent with prior research, most caregivers (84%) reported satisfaction from providing help, but 84% of caregivers reported experiencing “increased stress,” 40% reported financial strain, and 34% reported decreased health “because of involvement with providing care.” Our data also suggested a disproportionate impact on AI/AN women given higher rates of being a caregiver compared to other populations and less support from others in their communities. Our data suggest similarities for AI/AN caregivers with other groups of caregivers but also emphasize the importance of including AI/AN populations in future research in order to understand ways to best serve their unique needs.
 
Geographic distribution of population-adjusted rates in quartiles for each STI and HIV across all counties in South Carolina (rates per 100,000)
Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.
 
To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.
 
Regular walking confers many physical health benefits, including a reduced risk of disease-specific and all-cause mortality and better physical fitness. However, less is known about its role in mental health. Thus, the aims of this study were to determine the associations of outdoor walking per week with costs of psychotropic drugs used and mental health in adults. 500 adults aged 18 to 64 years in Hangzhou (China) reported sex, age, the name of the psychotropic drugs used and their dosage, and outdoor walking during the past 7 days. The cost that a person spends on buying psychotropic drugs for a month was considered psychotropic drugs costs. Overall mental health was assessed using the Chinese Version of the 12-Item General Health Questionnaire. The levels of walking in participants taking psychotropic were significantly lower than participants who did not taking psychotropic (p = 0.002). There was a significant negative correlation between mental health scores and minutes of walking per week and a significant positive correlation between the number of psychotropic drugs used and walking per week (p < 0.05). However, no particular associations were found between costs of psychotropic drug used and walking per week. Outdoor walking is prospectively associated with better overall mental health in adults. Then, awareness should be raised about the possible positive effects of outdoor walking on the mental health of adults.
 
We sought to assess COVID-19 vaccination rates, as well as attitudes and beliefs towards the vaccine, of patients in a Spanish-speaking student-run free clinic in Columbus, Ohio. A cross-sectional study was performed. Surveys were distributed to all individuals over 18 years who presented to La Clínica Latina between July, 2022 and September, 2022. A convenience sample was used: patients in the waiting room and their accompanying family members or friends were invited to participate. Subjects were excluded if under the age of 18 or over the age of 75, or if non-Spanish speaking. Of the 158 individuals who agreed to participate in our study, 146 responded to the question regarding vaccination status, revealing 90.4% of respondents had received a COVID-19 vaccination. Most respondents learned about the vaccine from social media (26.4%) or television (22.7%). The majority of participants sought answers to questions surrounding the vaccine by asking their doctor (49.1%). The most common reason among unvaccinated participants for not undergoing vaccination was fear of an adverse reaction to the vaccine (n = 11). We found that a large proportion (90.4%) of individuals seeking care at a Spanish-speaking free clinic were vaccinated against COVID-19. Our study also provides perspective on the means of health knowledge acquisition and behaviors in this predominantly Latinx patient population in central Ohio. We can utilize our results to optimize and tailor clinic services and initiatives for COVID-19 boosters to meet the needs of this community.
 
Overview of evaluation methods
Focus group validation of emergent themes
COVID-19 caused significant declines in colorectal cancer (CRC) screening. Health systems and clinics, faced with a new rapidly spreading infectious disease, adapted to maintain patient safety and address the effects of the pandemic on healthcare delivery. This study aimed to understand how CDC-funded Colorectal Cancer Control Program recipients and their partner health systems and clinics may have modified evidence-based intervention (EBI) implementation to promote CRC screening during the COVID-19 pandemic; to identify barriers and facilitators to implementing modifications; and to extract lessons that can be applied to support CRC screening, chronic disease management, and clinic resilience in the face of future public health crises. Nine recipients were selected to reflect the diversity inherent among all CRCCP recipients. Recipient and clinic partner staff answered unique sets of pre-interview questions to inform tailoring of interview guides that were developed using constructs from the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and Consolidated Framework for Implementation Research (CFIR). The study team then interviewed recipient, health system, and clinic partner staff incorporating pre-interview responses to focus each conversation. We employed a rapid qualitative analysis approach then conducted virtual focus groups with recipient representatives to validate emergent themes. Three modifications that emerged from thematic analysis include: (1) offering mailed fecal immunochemical test (FIT) kits for CRC screening with mail or drop off return; (2) increasing the use of patient education and engagement strategies; and (3) increasing the use of or improving automated patient messaging systems. With improved tracking and automated reminder systems, mailed FIT kits paired with tailored patient education and clear instructions for completing the test could help primary care clinics catch up on the backlog of missed screenings during COVID-19. Future research can assess the effectiveness and cost-effectiveness of offering mailed FIT kits on maintaining or improving CRC screening, especially among people who are medically underserved.
 
Diagram of study progression and details of measures collected at each appointment
In early-2020, the epidemiology of the SARS-CoV-2 virus was still in discovery and initial reports about the role of asymptomatic individuals were developing. The Waco COVID Survey was implemented in mid-2020 with targeted serological surveillance to assess relationships among risk factors and asymptomatic transmission in McLennan County, Texas, USA. Because large-scale random sampling of the population was not feasible, a targeted and repeated sampling of specific clustered groups of asymptomatic individuals was employed. This included four waves (initial intake [n = 495], two follow-ups separated by a month [n = 348; n = 287], and a final follow-up one year later [n = 313]) of sampling participants in different risk categories: (a) healthcare workers (e.g., physicians, nurses, etc.) and first responders, (b) essential service employees (e.g., convenience and grocery stores, restaurants focused on delivery and carry-out), (c) employees whose businesses began reopening on May 1 (e.g., dine-in restaurants, churches, etc.) including church attendees, and (d) individuals that practiced intensive isolation. The survey collected information on demographics, compliance with public health recommendations, satisfaction with government responses, health history, attitudes regarding the SARS-CoV-2 virus and COVID-19 disease, health behaviors, personality, stress, and general affect. Results illustrate pandemic fatigue over time, the influence of political leniency on opinions and behaviors, the importance of face coverings in preventing infection, and the positive impact of vaccination in the community. This project remains one of the largest longitudinal SARS-CoV-2 antibody seroprevalence surveys in the US, and details for successful implementation and community involvement are discussed.
 
Aim This study aimed to determine the knowledge and attitudes of physicians and nurses as parents about human papillomavirus (HPV) vaccination and their views on vaccination in children. Materials and Methods This cross-sectional study included 72 physicians and 128 nurses who had children. Data were collected using questionnaires prepared by researchers. Descriptive statistical analysis and chi-square tests were used for data analysis. Results In this study, 84.7% of physicians and 70.3% of the nurses knew that HPV is a cancer factor, and two-thirds of the healthcare professionals believed that the HPV vaccine is protective. Moreover, 62.5% of physicians and 74.2% of nurses reported that they did not intend to vaccinate their children. The reasons for vaccination hesitancy of healthcare professionals was believing it was unnecessary, thinking it was expensive, having insufficient knowledge about vaccine, thinking it may have side effects, and not trusting the vaccine. In this sample, 70.8% of physicians and 53.9% of nurses stated that they could have their children vaccinated only if the HPV vaccines were in the national vaccination schedule. Discussion Further studies should be conducted to include the HPV vaccine in the childhood national vaccination program to reduce vaccine hesitancy.
 
Martial status × race/Ethnicity predicting any barrier to care, MEPS 2005–2015, N = 128,355
Education × race/ethnicity predicting any barrier to care, MEPS 2005–2015, N = 128,355
Income × race/ethnicity predicting any barrier to care, MEPS 2005–2015, N = 128,355
Insurance status × race/ethnicity predicting any barrier to care, MEPS 2005–2015, N = 128,355
Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005–2015) of women ages 18–74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called “any barriers to healthcare” was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02–1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87–0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.
 
Correlation among independent and dependent variables. DME durable medical equipment; MHSA mental health and substance abuse
In 2018, the University of Maryland Medical Center and the Baltimore City Fire Department implemented a community paramedicine program to help medically or socially complex patients transition from hospital to home and avoid hospital utilization. This study describes how patients’ social determinants of health (SDoH) needs were identified, and measures the association between needs and hospital utilization. SDoH needs were categorized into ten domains. Multinomial logistic regression was used to measure association between identified SDoH domains and predicted risk of readmission. Poisson regression was used to measure association between SDoH domains and actual 30-day hospital utilization. The most frequently identified SDoH needs were in the Coordination of Healthcare (37.7%), Durable Medical Equipment (18.8%), and Medication (16.3%) domains. Compared with low-risk patients, patients with an intermediate risk of readmission were more likely to have needs within the Coordination of Healthcare (RRR [95% CI] 1.12 [1.01, 1.24], p = 0.032) and Durable Medical Equipment (RRR = 1.13 [1.00, 1.27], p = 0.046) domains. Patients with the highest risk for readmission were more likely to have needs in the Utilities domain (RRR = 1.76 [0.97, 3.19], p = 0.063). Miscellaneous domain needs, such as requiring a social security card, were associated with increased 30-day hospital utilization (IRR = 1.23 [0.96, 1.57], p = 0.095). SDoH needs within the Coordination of Healthcare, Durable Medical Equipment, and Utilities domains were associated with higher predicted 30-day readmission, while identification documentation and social services needs were associated with actual readmission. These results suggest where to allocate resources to effectively diminish hospital utilization.
 
This study examined relationships between duration of stay and self-rated health among international students in South Korea and compared participants’ health-related characteristics according to duration of stay. The study recruited a convenience sample of 165 international students enrolled in undergraduate or graduate programs. For this cross-sectional, descriptive study, participants were recruited at one South Korean university. Data were subjected to ordinal logistic regression analyses. After controlling for covariates, a stay of 6 months or less was a significant predictor of better self-rated health. Compared to those in their first semester, international students staying more than 6 months more frequently experienced short sleep duration, physical health symptoms, healthcare utilization, unmet healthcare needs, and perceived discrimination. Study findings indicate that international students’ health tends to deteriorate after their first semester. To promote the health and academic success of international students, universities should provide timely health promotion programs.
 
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Demographic characteristics of teachers
COVID-19 vaccines are safe at a very high rate and protect against severe disease, hospitalization, and mortality. Schools are workplaces with high transmissibility of coronavirus and teachers are at risk of infection. The study aimed to find out the predictors of COVID-19 vaccine uptake in teachers. An on-line cross-sectional survey with a convenience sample was conducted, in Greece, during December 2021. We collected demographic data of teachers and we measured their attitudes towards COVID-19 vaccination and the pandemic. The sample included 513 teachers. The majority of them was vaccinated against COVID-19 (85.8%). The most important reasons for teachers' decline in COVID-19 vaccination were their concerns about safety, effectiveness and the side effects of COVID-19 vaccine. Also, furthermore they were characterized by strong self-assessment that they will not be infected by the COVID-19, and self-assessment that the COVID-19 vaccination will be useless for those who have already been diagnosed with COVID-19. After multivariable analysis, we found that increased age (OR 1.08, 95% CI 1.02-1.14, p = 0.011), and trust in COVID-19 vaccination (OR 2.57, 95% CI 2.07-3.18, p < 0.001) were related with an increased probability of a COVID-19 vaccine uptake. Also, teachers who lived with elderly people or vulnerable groups (OR 4.81, 95% CI 1.55-14.89, p = 0.006) during the COVID-19 pandemic, demonstrated greater probability to take COVID-19 vaccine. The study highlighted the need for reliable and accurate public information on both the risks of coronavirus infection and the vaccines' safety and efficacy.
 
SARS-CoV-2 PCR/antigen positives in NJ LTCFs by month, Resident, n = 129, Staff, n = 129
a Residents' interval from infection to serology date by S protein antibody, n = 81. b Staff's interval from infection to serology date by S protein antibody, n = 101
S protein antibody by interval from vaccine dose one to serology in staff, n = 56
Mean neutralizing antibody titer by interval from vaccine to serology in staff, n = 66
a Interval (from PCR/antigen to serology) versus mean neutralizing antibody titer, Residents n = 71. There is no upper error bar because there is no result beyond 186. There was no resident with an interval between 60 to 149 days. Median for 210–239, 240–269, and 270–299 days was 186. b Interval (from PCR/antigen to serology) versus mean neutralizing antibody titer, Staff, n = 84. Legend: ◊ mean ─ median ○ outlier. There is no upper error bar because there is no result beyond 186.. Median for 30–59 and 240–269 days was 186.
Expanding a previous study of the immune response to SARS-CoV-2 in 10 New Jersey long-term care facilities (LTCFs) during the first wave of the pandemic, this study characterized the neutralizing antibody (NAb) response to infection and vaccination among residents and staff. Sera from the original study were tested using the semi-quantitative enzyme-linked immunosorbent cPass neutralization-antibody detection assay. Almost all residents (97.8%) and staff (98.1%) who were positive for IgG S antibody to the spike protein were positive for NAb. In non-vaccinated subjects with a history of infection (positive polymerase chain reaction (PCR) or antigen test), the distribution of mean intervals from infection to serology date was not significantly different for S antibody positives versus negatives. More than 80% of both were positive at 10 months. Similarly, the mean NAb titer for residents and staff was not associated with interval from PCR/antigen positive to serology date, F = 0.1.01, Pr > F = 0.4269 and F = 0.77, Pr > F = 0.6548 respectively. Titers remained high as the interval reached 10 months. In vaccinees who had no history of infection, the NAb titer was near the test maximum when the serum was drawn seven or more days after the second vaccine dose. In staff the mean NAb titer increased significantly as the vaccine number increased from one to two doses, F = 11.69, Pr > F < 0.0001. NAb titers to SARS-CoV-2 in residents and staff of LTCFs were consistently high 10 months after infection and after two doses of vaccine. Ongoing study is needed to determine whether this antibody provides protection as the virus continues to mutate.
 
Appalachian residents face substantial barriers to accessing health care and these barriers have negative ramifications for this community’s health-related quality of life (HRQoL) [1, 2]. Pop-up medical clinics address some of these barriers by offering a range of free health care services throughout Appalachia. Although these services are undoubtedly helpful, information on how these clinics may be linked to HRQoL changes among under-resourced communities is limited. The present study is among the first to examine how (1) individuals attending pop-up medical clinics present on HRQoL indicators, (2) how HRQoL changes 3-months post-clinic, and (3) how individual, social, and community factors interact with HRQoL at presentation and change in HRQoL 3-months post-clinic. Data were collected from 243 individuals attending one of seven pop-up medical clinics across Central, South Central, and Southern Appalachia. During the week of the clinic, participants completed a survey assessing individual, social, and community factors as well as HRQoL variables (i.e., overall health, depressive symptoms, pain, sleep quality, and several physical symptoms). Participants completed the same survey 3-months post-clinic. Results revealed that baseline individual, social, and community factors were predictive of HRQoL indicators at baseline; individual and social factors also uniquely predicted change in HRQoL at 3-months post-clinic. Within the Social Ecological Framework, these data emphasize the significance of individual and social level factors on an individual’s HRQoL. Clinical implications and directions for future research are discussed.
 
Final measurement model
Final structural model
Limited health literacy is a significant predictor of engaging in unhealthy behaviors. However, the literature regarding the association between health literacy and smoking in university students is very limited. Thus, this study was conducted to examine the association between university students' health literacy and smoking habits. A cross-sectional design was used. A sample of university students (N = 327) was recruited to conduct this study. Data collection was performed using a demographics questionnaire and the health literacy questionnaire. AMOS was used to conduct data analysis using structural equation modeling analysis with maximum likelihood estimation. Different versions of the structural model were compared and evaluated based on specific fit indices criteria. The results showed that 30% of the participants were current smokers. Smoking cigarettes was the most common type of smoking in this study, and 23.1% of the participants were current users of two or more types of smoking (e.g., cigarettes and hookah). The structural model with three latent variables (health literacy, smoking status and type, and smoking frequency and duration) was the one that best fit the data; the model fit indices were X² = 305.84, df = 102, p < .001; RMSEA = .068; CFI = .95; CMIN/df = 2.51; TLI = .929; and AIC = 355.75. A single standard deviation increase of health literacy causes .38 decrease in smoking status and type and .13 decrease of smoking frequency and duration. The results showed that health literacy is negatively associated with smoking in a sample of Jordanian university students.
 
Human Papillomavirus (HPV) is associated with six cancers and widespread immunization with HPV vaccine could reduce the number of these cancers. Although HPV vaccination rates are available for the state of Illinois and the city of Chicago, data are limited for specific areas. We assessed rates of HPV vaccine initiation and completion among adolescents in central Illinois and identified factors associated with initiation and completion. This was a retrospective study of adolescents (aged 11–17) who receive care at the Southern Illinois University Medicine Department of Pediatrics. The outcome variables were HPV vaccination initiation (receipt of ≥ 1 dose) and completion (receipt of ≥ 2 or 3 doses, depending on age of initiation). Multivariable logistic regressions were used to identify factors associated with HPV vaccine uptake. A total of 9,351 adolescents were included in the study. Overall, HPV vaccine initiation was 46.2% and completion was 24.7%. In adjusted analyses, adolescents residing in rural areas were 38% and 24% less likely to initiate (aOR = 0.62; 95 CI: 0.54–0.72) and complete (aOR = 0.76; 95 CI: 0.65–0.88) the HPV vaccine compared with those residing in urban areas. Similarly, adolescents were less likely to initiate and complete the HPV vaccine if they were not update to date on the hepatitis A, meningococcal, or Tdap vaccinations. HPV vaccination rates in central Illinois were low, and far below the national average and the Illinois state average. Future directions should include interventions to increase HPV vaccine uptake, particularly in rural areas.
 
Racial demographics of patient cohort
Household income demographics of patient cohort
Differences in average ED visits from Wilcoxon Signed Rank Test
Types of insurance patients reported at initial visits
Student-faculty collaborative clinics, like the Crimson Care Collaborative (CCC), provide primary care access to underserved communities. Affiliated with a community health center, CCC-Chelsea serves a largely immigrant and refugee population. This study aimed to analyze patients’ reported ED use before and after they presented to CCC-Chelsea and whether types of insurance affect ED use. We prospectively surveyed 229 patients presenting to CCC-Chelsea between 2013 and 2019. Patients who presented for two or more visits at least one year apart were included in the study. A two-sided Wilcoxon signed rank test was used to compare reported ED use before and after presenting to CCC-Chelsea, and a Kruskal–Wallis test analyzed the association between ED use and insurance status. Most patients (77.7%) presenting to CCC-Chelsea identified as Hispanic, 70.9% were male, 50.6% of patients reported an income of less than $15,000 yearly, and 30.4% had an income between $15,000–$30,000. Most patients (51.9%) did not specify the type of insurance used, followed by public insurance (36.7%), with the remaining having private or no insurance. Results from our survey showed that patients who returned to CCC-Chelsea reported a decrease in the average number of yearly ED visits after attending CCC-Chelsea (pre-CCC 1.544, post-CCC 0.696, p < 0.001 at the 95% CI). There was no difference in reported average number of ED visits yearly and insurance type (p = 0.579). Patients’ reported ED utilization after accessing care at CCC-Chelsea decreased. Increased access to student-faculty collaborative clinics could reduce ED use in underserved populations.
 
Frequency of medical conditions among laundromat users (n = 193)
Innovative community-based public-private partnerships are forming to address health needs of underserved communities. This study partnered with laundromats in San Antonio, Texas to understand the health and healthcare needs of laundromat users as a possible underserved population. A total of 193 laundromat users across eight laundromats participated in a survey based on the Texas Behavioral Risk Factor Surveillance System (BRFSS) that asked about health status, access to care, vaccinations, and use of preventive healthcare services. Responses were compared to population estimates from Bexar County and the state of Texas. Results showed that over half of the sample of laundromat users were female, racial/ethnic minorities, living at poverty level, and did not have health insurance coverage. Compared to county and state population estimates, laundromat users were significantly more likely to report poor health and physical impairment; and were less likely to have a primary care provider, to have received a routine medical checkup in the past year, and to have been tested for HIV. Laundromat users were also less likely to receive some gender-specific preventive healthcare screenings such as pap smears and mammograms for women, and prostate exams for men than county or state population estimates. In the laundromat sample, 78% expressed interest in receiving healthcare services on-site at laundromats. Together, these findings suggest laundromats may be a unique setting for healthcare intervention to reach undeserved, racial/ethnic minority communities. Pilot programs that target this setting are needed to explore this opportunity to deliver community-based public health practice.
 
Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.
 
Most graduate medical education programs dedicate almost no time in their curricula to the topic of transgender health. This study aimed to assess medical (MD), physician assistant (PA), and clinical nutrition (CN) students’ self-reported knowledge, skills, and attitudes toward healthcare for transgender patients and identify differences between groups. This cross-sectional study was conducted at a single United States academic health center. Students were surveyed using a questionnaire with 16 Likert-type items. A total of 178 MD, 96 PA, and 28 CN students completed the survey. Most (67%) respondents reported a “high” level of personal comfort in caring for a transgender patient, with no difference between groups (p = .57). MD students were more likely than PA or CN students to report greater knowledge of gender dysphoria management (p < .001) and transgender care guidelines (p < .001), as well as a greater skill level in caring for patients with gender dysphoria (p = .009) and inquiring about gender identity (p < .001). All three groups, however, reported overall “low” or “intermediate” levels of knowledge and skills. Our research demonstrates that MD, PA, and CN students exhibit an equally high degree of personal comfort in caring for transgender patients but lack the knowledge and skills to confidently care for them.
 
Newer immigrants to the United States, whether undocumented, recent legal immigrants, those here on temporary visas, or migrant workers, are far less likely than native-born residents of the United States to have reliable health insurance. This entire group of patients is then at risk for delayed or absent medical care. Our study focused on what effects a free, quality prenatal care program had upon prenatal care and delivery outcomes for an underinsured population, primarily of immigrant women. With a recent change in Iowa’s eligibility criteria for Presumptive Medicaid (referred to as Temporary Medicaid), pregnant patients who have less than a 5-year legal permanent residency status, undocumented status, or out-of-country resident status can receive up to two months of covered antepartum care, whereas previously eligible for coverage for the entirety of their pregnancy. With that reality, several faculty members from the Department of Family Medicine at the University of Iowa started a weekly prenatal care clinic in collaboration with the longstanding Iowa City Free Medical Clinic. This study sought to compare outcomes for patients who utilized only Temporary Medicaid to those who also had access to this prenatal free medical clinic (FMC), as well as to compare outcomes for the FMC program to typical Medicaid patients who had access to full prenatal care. Compared to the Temporary Medicaid-only group, our FMC patients had a significantly greater number of prenatal visits. This increased access of continuity prenatal care led to increased screening for gestational diabetes, receipt of recommended vaccinations, and screening for group B streptococcus. Our effort has shown that expanding prenatal healthcare coverage to this underinsured population can greatly increase the quality of maternity care and reduce the potential for high-risk pregnancies, bettering the care for these pregnant women and their newborns.
 
Introduction: Marital infidelity is an interpersonal and traumatic event that can produce cognitive, emotional, and behavioral symptoms in the victim. The present study aimed to investigate the effect of self-healing training on anxiety, self-esteem, and forgiveness in betrayed women in Isfahan in 2021. Materials and Methods: The research method was quasi-experimental with a pre-test, post-test, and follow-up design and a control group. The study population included all betrayed women who were members of the Naranon society (Anonymous sufferers’ family group) in district one of Isfahan. Using convenience sampling, 30 betrayed women were selected and randomly assigned to the experimental group and the control group. The experimental group underwent 14 sessions (one session per week, 60 minutes each) of self-healing training. The research instruments included Pollard et al’s Family Forgiveness Scale (FFS) (1998), Coopersmith Self-Esteem Inventory (1996), and Zank Anxiety Scale (1970). The repeated measures variance analysis in SPSS software were further employed to analyze the data. Results: The results showed that self-healing training had a significant effect on reducing anxiety, improving self-esteem and forgiveness in betrayed women (p< 0.05). The changes remained stable until the follow-up stage. Conclusion: It is recommended to pay more attention to Self-care education in families due to its role in improving the psychological health of betrayed women, as well as increasing self-esteem and forgiveness and reducing anxiety.
 
PRISMA flow diagram
Our goal was to identify strategies aimed at increasing Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment and participation rates. The WIC program provides many health benefits for pregnant women, mothers, and children. WIC offers nutrition education, formula, fruits and vegetables, and other food to pregnant and postpartum women and their children until they reach the age of five. Despite the availability of this program nationwide, enrollment and participation rates remain low across the country. Several states have tried various interventions to combat this deficiency of engagement with the goal of increasing WIC enrollment and participation. We conducted a scoping review to identify articles based on pre-specified inclusion and exclusion criteria. Two reviewers independently identified and screened articles. Subsequently, three reviewers independently extracted study details and outcomes related to WIC enrollment and participation rate changes. We included 14 studies reporting on 12 interventions from 3945 citations reviewed. Seven of these were published papers, while the others were final reports of USDA WIC Special Grant Projects. All the observed interventions had some success increasing WIC participation. Virtual interventions demonstrated the most success based on preliminary evidence. Successful interventions showed percentage gains in enrollment close to 8% and changes in participation over 9%. Overall, the literature surrounding WIC enrollment interventions reveal a mixed impact on improving participation. Many successful interventions involve an online or virtual engagement component which can provide educational resources on WIC benefits, nutrition, and living a healthy lifestyle.
 
Most research on suicides focuses on youth or the elderly and dominant groups of a population. The purpose of this study was to assess suicide trends for non-elderly adult Hispanics (age 20–64 years) over the past decade (2010–2020). Data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the study period. Suicides for Hispanics in 2010 were the 7th leading cause of death and became the 5th leading cause of death by 2020. During the decade of analyses, suicide rates increased 35.7% for males and 40.6% for females. Non-elderly Hispanic males were most likely to die by hanging/suffocation (2010 = 42%, 2020 = 41%), or firearms (2010 = 39%, 2020 = 42%). Whereas, Hispanic adult females were most likely to use hanging/suffocation (2010 = 36%, 2020 = 43%) or poisoning (2010 = 27%, 2020 = 19%) for completed suicides. In 2020, the top three states for non-elderly Hispanic adult suicides (per 100,000 population) were Colorado (25.52), New Mexico (23.99), and Utah (21.73). The Hispanic population continues to grow, but also faces chronicity of prejudice, underemployment, lack of healthcare access, multiple stressors, and rising levels of suicide. The reduction of adult Hispanic suicides would require additional resources, interventions, and research to understand prevention and risk factors.
 
Home smoking bans reduce exposure to second-hand smoke. Understanding how psychosocial factors are related to having a home smoking ban may lead to better interventions for populations less likely to have home smoking bans, including low-income smokers. In this study, we used baseline data from 1,944 participants in a randomized trial of low-income smokers in Missouri to explore psychosocial correlates of a total home smoking ban. Using logistic regression, we examined associations between psychosocial variables (social support, unmet social needs [e.g., food, housing], perceived stress, and depressive symptoms) and a total home smoking ban. 72% of participants were female, and 58% were Black/African American; 26% reported a home smoking ban. In unadjusted and adjusted models, greater social support was associated with greater likelihood of a home smoking ban. Stress was negatively associated with a ban in adjusted models only. The fact that most participants did not have a home smoking ban highlights the need for further intervention in this population. Results suggest links between social support and having a home smoking ban, although effect sizes were small. Smoke-free home interventions that increase social connectedness or leverage existing support may be especially effective. Tobacco control planners may also consider partnering with agencies addressing social isolation.
 
The Affordable Care Act includes a call for community health care workers (CHWs) to be integrated into health care delivery systems to improve health care quality. In recent years, there have been increasing calls for community-based participatory research (CBPR) and patient-centered outcomes research (PCOR), as such types of research hold much potential for identifying interventions to reduce health and health care disparities. Yet, little is known about the research training, knowledge, experience, and even interest of CHWs in these types of research or in health research in general (HR). Thus, the purposes of this study include determining if there are differences between participating CHWs (N = 202) in their levels of training, knowledge, experience, and interest in relation to CBPR, PCOR and HR. Findings suggest that certified CHWs, as compared to non-certified CHWs, have significantly higher knowledge levels across all three types of research (β = 1.3, p = .007). Additionally, participants had significantly higher knowledge of HR compared to CBPR (β = 0.5, p = .015), but not higher than their knowledge of PCOR (p > .5). Qualitative data analyses performed to determine research areas of interest among the participating CHWs resulted in eighteen major research interest themes. Examples of these major themes are chronic illness (n = 95), health promotion (n = 39), healthcare services and administration (n = 30), mental health (n = 29), and research evaluation and methodology (n = 26). Together, the findings suggest that though CHWs have an interest in a wide range of health research areas, they could benefit from research trainings tailored to their responsibilities and interests.
 
Due to the sudden rise in the cases of COVID-19 in the North-Eastern region of India, this study was conducted to survey the felt needs of the medical professionals with regards to education on the evidence-based management of COVID-19. A total of 25 North-East leaders were recruited and a baseline survey was conducted through the digital medium. Out of 25 North-East leaders, 52% were undergoing training in evidence-based medicine in the capacity-building program for evidence-based child health. Participants (48%) strongly agreed and 40% agreed on the possibility of enhanced care by capacity building in the areas of COVID-19 management through discussing cases. Out of 25 North East leaders, 48% agreed to join both as a speaker as well as a participant. Various priority topics on COVID-19 management e.g. childhood, adult, ocular manifestation, ICU management, telemedicine, vaccines, lab protocols, psychological distress, and treatment strategy have emerged. We have presented the findings of the survey which will help guide the mentoring program focusing on evidence-based management of COVID-19 in remote areas through Tele-education.
 
Addressing mental stigma is a key component of improving mental health outcomes. A digital media campaign was implemented to reduce mental health stigma in the Omaha Metropolitan area. The campaign used evidence-based approaches within a collective impact framework. Two surveys were conducted at baseline and at 10-month follow-up to evaluate the campaign within the Omaha and Council Bluffs intervention region, and a control region in Iowa. Analysis revealed significant improvements in desires for social distance and perceptions toward treatment efficacy within the intervention group. Improvements were seen across measures of personal and community attitudes towards mental health conditions, confidence in supporting others, and likelihood of disclosing a mental health condition. The trends were generally not replicated within the control group. Respondents who were aware of the campaign showed fewer stigmatizing views, including lower desires for social distance, improved attitudes toward treatment, and significant improvements in providing support and caring for their own mental health. The results suggest that the implemented evidenced-based approach could potentially create positive shifts in stigma reduction. This evaluation further supports the potential for scaling and adapting digital media campaigns for stigma reduction in different geographic locations.
 
Moderation effect of informational social support on the association between depression problems and past two-week suicide ideation among Black and Latinx adults, Washington Heights, New York, 2015
Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation. We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator. Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44–29.93) and severe (OR = 16.84,95% CI = 2.88–98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation. Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.
 
Leishmaniasis is a major health problem caused by a protozoan of the genus Leishmania, most commonly transmitted by infected female sand flies. Intersectoral collaboration is essential for the implementation of integrated vector management control with community participation. The present study aims to evaluate the knowledge, attitude and practices of the population toward leishmaniasis in central Morocco. A quantitative cross-sectional study was conducted using an administered questionnaire assisted by health professionals, on 750 people in the Marrakech Safi, endemic region of cutaneous leishmaniasis (CL). Of those, 702 agreed to be recruited for our study, of which 63,5% were women, 48,1% were aged between 18 and 40 years, and more than half of the participants (60%) were from rural areas. Overall, the knowledge, attitude and practices (KAPs) for leishmaniasis are too poor for more than 85% of the population in the study area. Basic knowledge and perceptions of leishmaniasis were good for 14,6% of respondents. While, 4,5% of the members had good knowledge of CL, only 0,7% had good level of knowledge about vesciral leishmaniasis (VL). Furthermore 3,7% of those polled have favorable attitudes and preventive practices. No association was found between knowledge and age, province or occupation. However, rural residents were four times more likely than urbain residents to have good basic knowledge (ORA = 4,74; CI95%: 1,04 -22,05). In addition, the female gender also has the chance to possess good basic knowledge and perceptions 3 times more than the men (ORA = 3,18; CI95%: 1,16 -8,69). The low level of KAPs regarding leishmaniasis proves the lack of community participation in the fight against leishmaniasis in central Morocco.
 
Top-cited authors
James Price
  • University of Toledo
Jagdish Khubchandani
  • New Mexico State University
Lisa Sharp
  • University of Illinois at Chicago
Maha Emad Ibrahim
  • Suez Canal University
Mohamed Alorabi
  • Ain Shams University