Journal of Community Health最新文献

Health care disparities within the LGBTQIA+ community are readily apparent. Guidelines have been published regarding breast cancer screening for transgender individuals. Uptake of these recommendations is widely unknown. The purpose of this study is to determine the current knowledge base of providers regarding these recommendations within our academic hospital system. A voluntary, anonymous survey was e-mailed to 303 recipients via RedCap to physicians within our academic hospital system. This assessed the respondents' current knowledge and comfort regarding breast cancer screening recommendations in the transgender population. 85 responses were received for a response rate of 28.1%. Descriptive statistics for all survey questions was conducted. 82.4% of respondents report caring for transgender patients. 62.4% report that they are not familiar with the current screening recommendations, and few (10.6%) have received formal education regarding the topic. The majority of respondents reported that they would be interested in receiving formal training. The results suggest that there is no difference in how individuals rate their current comfort level discussing breast cancer screening recommendations for the transgender population despite their current level of education. Our findings suggest that, while the majority of providers within our academic hospital system care for transgender patients, they are unfamiliar with current breast cancer screening recommendations and have received no formal training. The results also suggest that providers are interested in receiving formal education.

Crime is a public health issue that disproportionately affects racially-marginalized populations. Studies have reported that food stores (e.g., grocery stores, convenience stores) often attract crime due to their volume of cash transactions and limited security. Little is known about how exposure to crime at food stores affects nutrition or health. This study aimed to fill this research gap by exploring the lived experiences of Black Americans. In 2023, 502 Black-identifying adults completed a survey online. They reported their socio-demographics, fruit and vegetable (FV) consumption, food security status, height, weight, and experiences with crime at food stores in their community. Multivariable-adjusted regression models were examined to identify associations between exposure to crime at food stores and the following measures: low food security status, obesity status, and daily servings of FVs. Approximately 150 (29%) participants avoided one or more food stores in their community due to crime; 102 (20%) had witnessed a crime at a food store. Those who avoided food stores had greater odds of low food security (OR: 1.94; 95% CI: 1.25-3.02) and obesity (OR: 2.15; 95% CI: 1.33-3.48) compared to others. Those who witnessed a crime had greater odds of low food security (OR: 3.14; 95% CI: 1.82-5.41). Exposure to crime at food stores was not associated with FV consumption after adjusting for socio-demographics. Exposure to crime in food stores may have negative health and nutritional implications. Future studies should explore these implications for populations that are disproportionately affected by crime.

Chemsex entails potential risks that may lead to medical emergencies. This cross-sectional study analyzed data from an anonymous, self-administered online survey on substance use among 1,203 sexual minority men (SMM) who engage in chemsex in Spain. The study aimed to determine the proportion of chemsex users that have sought emergency care following a session, identify their reasons for consultation, examine associated sociodemographic factors, and assess the proportion who felt they should have sought emergency care but did not. Frequencies of emergency consultations following chemsex sessions and episodes where participants felt they should have sought care but did not were calculated. Associations between seeking emergency care and sociodemographic and substance use factors were analyzed using Poisson regressions. Reasons for consultation were categorized based on responses to an open-ended question. 15.4% (95%CI:12.9-17.8) of chemsex users sought emergency care to request HIV post-exposure prophylaxis (PEP), and 4.0% (95%CI: 2.9-5.1) for other reasons. However, 21.8% (95%CI:19.3-24.2) did not seek care despite feeling they should have. The most common reasons for consultation were overdose symptoms, STI symptoms, and trauma. Living in smaller towns was associated with 2.4 times lower likelihood of visiting emergency services (95% CI:1.2-5.0). Injection substance use and mephedrone use were associated with 2.7 (95%CI:1.2-5.9) and 2.3 (95%CI:1.0-5.2) times higher likelihood of seeking care, respectively. Emergency visits for reasons other than requesting PEP were infrequent among chemsex users; however, a notable percentage felt they should have sought care but did not. Risk reduction strategies should prioritize addressing injection use and mephedrone consumption.

Background: With 8.4% of Americans uninsured, free clinics serve as essential safety nets for underserved populations. This study compared the demographics of the patients of a student-run free to Toledo, Ohio, and national census data to evaluate health needs, barriers to care, and the characteristics of the underserved population.

Methods: A retrospective review of 1,338 visits across five clinic sites was conducted from February 2023 to February 2024. Demographic variables, including race, insurance, education, sex, and primary language, were analyzed and compared to 2020 Census data from Toledo, Ohio, and the United States.

Results: Compared to Toledo, the clinic served 22.63% fewer White patients, 17.27% more Hispanic/Latino patients, and 5.62% fewer African American patients. Among clinic patients under 65 years, 61.91% were uninsured, compared to 8.3% in Toledo and 10.2% nationally. Non-English speakers were overrepresented (33.4% vs. 6.8% in Toledo and 9.5% nationally), with Spanish speakers making up 21.72% of clinic patients compared to 3.2% in Toledo. Educational attainment differed slightly, with fewer high school graduates (82.97% vs. 87.10% in Toledo) but more individuals with higher education degrees (27.10% vs. 19.6% in Toledo and 25.6% nationally).

Conclusions: This study underscores the demographic differences between CCC patients and city, state, and national populations, offering insight into the populations most reliant on free clinics. Policymakers and public health agencies must consider these disparities to tailor interventions addressing healthcare access and social determinants of health.

Historically, Aboriginal and Torres Strait Islander research in Australia has adhered to Western research paradigms and contributed to the adverse impacts of colonisation. However, recent developments driven by Aboriginal and Torres Strait Islander people and scholars, and development of ethical guidelines for research, have promoted a more inclusive and collaborative research landscape. In this study, published papers and internal documents arising from a long-term partnership between Marninwarntikura Women's Resource Centre (MWRC) and the University of Sydney (USYD) from 2009 to 2023 were analysed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool and consultations with project partners. Every project had Aboriginal and Torres Strait Islander governance, leadership, and inclusive consultation; was driven by community-identified priorities, built local capacity, and benefitted the community. There was an increase in the use of Indigenous research paradigms and data/intellectual property (IP) agreements over time, reflecting responsiveness to community leadership. This partnership exemplifies community-driven, co-designed, Aboriginal-led health research and serves as a model for effective collaboration with Aboriginal and Torres Strait Islander communities.

The WIC program coverage rate of eligible population is suboptimal despite the well-known positive health outcomes of participation. Various factors contribute to this trend. This study aimed to examine beliefs regarding the decision to stay on WIC held by clients using the theory of planned behavior. During May and June of 2023, clients of one WIC office (N = 727) in northern New Jersey participated in a cross-sectional survey. Participants completed an online survey in English or Spanish. In the questionnaire, respondents were asked to rate their degree of agreement to the statement that described intention, attitudes, subject norm and perceived behavioral control of staying on WIC behavior, and their respective underlying beliefs in addition to a set of demography questions. Descriptive analyses and regression analyses were performed to describe and determine most influential factors to the intention to staying on WIC, and the results were compared by program enrollment duration: less than one-year (n = 276) vs. one or more years (n = 451). Most respondents were Hispanic (93.4%) and stay-home mothers (63.8%). Subjective norm was most influential to the intention to staying on WIC as a whole (β=.460, p <.0001) and when compared by the duration of WIC enrollment. Future outreach efforts focusing on participants category could be effective to improve the participation rate. Continued efforts to modernize WIC services by offering online options to appointments, education, and shopping could be attractive to families to enroll and continue their engagement with the program.

Alzheimer's disease (AD) is a debilitating neurodegenerative illness that has become a growing concern for older adults. As such, apolipoprotein E (APOE) genetic testing has become more commonly used to identify individuals' susceptibility to AD. An underrepresented population in AD research, Latinos will be disproportionately affected by AD in the coming decades. To better aid efforts in education and genetic risk counseling for Latino populations, we must first understand the anticipated psychological and behavioral consequences of APOE genetic risk counseling. We conducted semi-structured interviews with 216 Latinos between the ages of 40 and 64 (average age = 53 years) in northern Manhattan to ascertain their hypothetical reactions to learning that they had a higher risk of developing AD compared to other Latinos within their community. Responses were categorized as emotional, practical, and mixed responses. Among our sample, women were more likely to anticipate an emotional response to hearing that they had a higher risk of AD, and participants above the age of 60 were more likely to anticipate disclosing their risk information to immediate family members. Findings support the tailoring of genetic risk counseling sessions across different ethnic groups, genders and age groups. Future work may include the development of psychological and practical support tools for Latinos seeking APOE genetic testing and counseling.

Female Veterans experience disproportionately poorer outcomes in mental health and physical health, as well as other conditions, compared to their male counterparts and non-Veteran females. The Arizona Veteran Survey aims to understand the unique experiences of female Veterans in the state of Arizona and assess how these experiences impact their health. The goal is to identify key risk factors contributing to health challenges among this population, enabling the development of targeted interventions. The statewide Arizona Veteran Survey was conducted to analyze the current impact of common social determinants of health for several demographics of Veterans. There were a total of 841 female Veteran respondents. The data on female Veterans' social determinants of health and the association with suicidality was analyzed using chi-square and logistic regression. A variety of social determinants were analyzed to evaluate their association with suicidality. Female Veteran respondents were 1.4 times more likely to experience suicidality if they were seeking care for mental health concerns, 1.8 times more likely if they felt isolated or lonely, 1.7 times more likely if they felt depressed or hopeless, and 2.5 times more likely to experience suicidality if they struggled to pay for or access medication in the past 12 months leading up to the survey. Female Veterans are a growing population disproportionately affected by experiences that elevate their risk of suicidality. The findings in this paper highlight the need for expanding services and resources while addressing inequities to improve overall well-being.

Black women bear a disproportionately higher burden of cervical cancer than any ethnic/racial group. Patient's cancer risk perceptions and patient-provider communication behavior may influence uptake of cervical cancer screening with Papanicolaou (Pap) test. We examined the association of cancer risk perceptions and patient-provider communication behavior and Pap test uptake. Black women completed a cross-sectional survey on sociodemographic, cancer perceptions, and perceived patient-centered communication behaviors. Multiple linear regression models were fitted to explore the association of perceptions and patient communication behaviors. Women (N = 116) average age was 40 ± 12.7 years and 73% had ever received a Pap test. Women who agreed with the statement that it seemed like everything causes cancer had over four times the odds of having had a Pap test (OR = 4.40, 95% CI = 1.38-13.97, p = .012) while those that responded that when they think about cancer, they automatically think of death had 73% lower odds of having had a Pap test (OR = 0.27, 95% CI = 0.08-0.95, p = .040). The odds of Pap test completion were over 4-fold among those who said their health care provider always or usually gave them the chance to ask health-related questions, compared to those who responded sometimes or never (OR = 4.11, 95% CI = 1.36-12.44; p = .012). Interventions to dispel myths and promote effective patient-provider communications are warranted to address anecdotal cancer risk perceptions and promote patient engagements.