Journal of Community Health最新文献

Virtual focus groups were conducted in English and in French to gather community feedback on colorectal cancer screening education materials, designed for use among immigrant and non-immigrant Black/African-American men in New York City. Participants were recruited from community health fair events, religious and cultural organizations, and an existing Community Advisory Board. Six total focus groups were conducted, four in English and two in French, with a total of 25 participants, until data saturation. Focus groups were audio recorded, transcribed, two were translated from French into English, and analyzed in NVivo software to develop and consolidate themes in participant responses. Focus groups revealed key knowledge gaps about colorectal cancer screening protocols and cancer risk heritability. Discussing racial health disparities may cause offense to some readers. Participants were interested to see root causes for racial health disparities discussed in health promotion material. Virtual focus groups can be used to gather community member feedback on health promotion materials. Real-time simultaneous language interpreting can be used if facilitator and audience do not speak the same language. Health educators should be mindful that the recommended screening age of 45 years for colorectal cancer is not generally known, and that individuals may believe that cancer is contagious. Readers may be offended by references to health disparities. Health educators should test health promotion materials with target audiences to ensure appropriateness and cultural sensitivity.

Consistent contraceptive use (CCU) is an important public health intervention for the prevention and spread of STIs, as well as unintended pregnancies and abortions, especially among female sex workers (FSWs). This study determines the prevalence and identifies factors influencing CCU among FSWs in The Gambia. Utilizing a cross-sectional study design with a snowball sampling technique, respondents were recruited from various locations within the Greater Banjul Area. Data was collected using a structured questionnaire with the Research Electronic Data Capture application. Descriptive and logistic regression analyses were used to determine the prevalence and examine factors associated with CCU among FSWs. In total 429 respondents were recruited. More than 23% of FSWs reported CCU with majority being male condoms (95.3%), followed by oral contraceptive pills (56.9%), and Intra-Uterine Contraceptive Devices (54%). Results of the multivariate logistic regression analysis showed that having a boyfriend (aOR = 12.44, 95%CI: 4.30 ~ 35.94), obtaining contraceptives from Worldview International Foundation (aOR = 6.34, 95%CI: 2.21 ~ 18.14) and local pharmacy (aOR = 4.83, 95%CI: 1.75 ~ 13.32), ever used OCP (aOR = 5.82, 95%CI: 2.91 ~ 11.67), ever used natural methods (aOR = 2.26, 95%CI: 1.06 ~ 4.84), negative attitude of boyfriend toward contraceptives (aOR = 0.06, 95%CI: 0.03 ~ 0.13), and having a negative HIV test result (aOR = 0.14, 95%CI: 0.02 ~ 0.80) were significantly associated with CCU among FSWs. The study revealed a low prevalence of CCU among female sex workers in GBA. Associated factors with CCU identified in this study as well as increasing access to and education on the importance of contraceptive use should be considered when planning targeted interventions for increase in CCU uptake.

The purpose of this study was to evaluate the activities and impact of Colorado's health extension agents' Regional Health Connectors (RHC) in response to the COVID-19 pandemic. Health extension is gaining momentum across the U.S. with a focus on primary care practice transformation, quality improvement, and broader community health. RHCs aim to increase clinical-community alliances, particularly related to the social determinants of health. During the COVID-19 pandemic, RHC roles drastically shifted, prompting quick responses to address community needs in a public health crisis. We conducted longitudinal, twice-monthly surveys with both quantitative and qualitative responses to better understand which needs RHCs were responding to and how they were responding in communities, primary care practices, and public health organizations. Nine electronic surveys were sent to RHCs from April to August 2020: eight standardized questionnaires administered every two weeks and one final retrospective questionnaire. Analyses using mixed effects logistic model and grounded theory approaches explored the nature of RHC-partner interactions and perceived impacts. Within each region, RHCs worked with primary care practices, local public health agencies, and community organizations to help coordinate the COVID-19 response. Broadly speaking, RHCs assisted with COVID-19 testing and contact tracing, communicated the latest information and recommendations to numerous partners, assisted practices and organizations in addressing social needs, and worked to enhance access to mental health and telehealth services. Partner needs were significantly related to the RHCs host organization. This highlights the roles that health extension programs may play during a public health emergency, such as the COVID-19 pandemic.

To share lessons learned from the New York City Department of Health and Mental Hygiene's Brooklyn Breastfeeding Empowerment Zone initiative to increase breastfeeding duration rates in the Brooklyn Community Districts (CDs) of Bedford-Stuyvesant and Brownsville, and to evaluate the degree to which the initiative mobilized community support, and impacted breastfeeding. These neighborhoods were chosen due to historically low breastfeeding rates. Highly frequented community establishments such as restaurants/cafés, beauty salons, pharmacies and retail shops were selected as potential breastfeeding friendly spaces (BFSs) to support and welcome breastfeeding mothers. Staff visited each establishment to explain project objectives and requirements and inquired about interest in becoming a BFS. A Baby Café was also established in Brownsville to offer practical breastfeeding advice for mothers. Of the 178 potential BFSs identified in both CDs, 123 (69%) agreed to become BFSs. The Brownsville Baby Café, established in 2018, surpassed its goal of hosting 26 sessions in the first year. Class feedback surveys indicated that the primary reason for attending was to learn more about breastfeeding and other information to support their babies (52%), and 84% were satisfied with or confident about the responses they received. Between 2009 and 2012 to 2017-2020, there were statistically significant increases in breastfeeding initiation (83.9-95.7%) (P < 0.05), and exclusivity (9.7-29.9%) (p < 0.05) in Brownsville. The BFEZ initiative successfully engaged community establishments, formed a support group to help breastfeeding families, and showed how these initiatives can help to change the social environment and outcomes related to breastfeeding.

India's COVID-19 lockdowns were among the strictest globally, and sex workers were uniquely impacted. Extremely limited literature has examined pandemic consequences on sex workers. We use a qualitative approach to examine the impact of the COVID-19 pandemic and lockdowns on the lives and livelihoods of sex workers in urban West Bengal, India. Cisgender female and male, and transgender female sex workers (N = 40) participated in individual in-depth interviews. Interviews were coded using inductive thematic coding. Nine themes arose from the data: (1) COVID-19 pandemic and lockdowns, (2) Social isolation, (3) Lack of customers, (4) Financial stress, (5) Decreased negotiating power, (6) Food insecurity, (7) Receiving support, (8) Providing support, and (9) Mental health. We propose a Gendered Stress Proliferation Model incorporating Pearlin et al.'s 1997 conceptualization of stress proliferation and Swendeman, Fehrenbacher et al.'s 2018 gendered stress process model. In this model, primary stressors of COVID-19 pandemic and lockdowns proliferated into secondary stressors across multiple domains (social isolation, lack of customers, financial stress, food insecurity, reliance on support, decreased negotiating power). All of these pathways were shaped by pre-existing vulnerabilities and systems of intersectional marginalization. These stressors had significant mental health impacts including feelings of depression and anxiety. Food insecurity has implications for physical health outcomes, and financial stress coupled with decreased negotiating power has implications for sexual health, potentially placing sex workers at increased risk of sexually transmitted infections and HIV. Gendered Stress Proliferation may be a useful framework to examine how marginalized populations uniquely experience population-level crises.

Hookah smoking among young adults is a growing public health concern, especially in low- and middle-income countries (LMICs). Despite its prevalence, comprehensive reviews evaluating theoretical frameworks used to study this behavior are lacking. This scoping review synthesized studies examining hookah smoking behaviors among young adults in LMICs. A systematic search was conducted in PubMed, Embase, Google Scholar, and CINAHL using keywords such as "Hookah OR Waterpipe OR Shisha," "Adverse effects OR Harmful Effects," "Young adults OR Adolescents," "Theory," and "Low-middle-income countries." Articles meeting predefined inclusion and exclusion criteria were screened using Covidence, and data on prevalence, predictors, and theoretical frameworks were extracted. The review included 28 studies involving 13,150 young adults with an average age of 19.2 years. Hookah use prevalence ranged from 2.6 to 89.4%, with a pooled prevalence of 26.4%. Frequently applied theoretical frameworks included the Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT), along with the Protection Motivation Theory and PRECEDE-PROCEED. Facilitators of hookah use included subjective norms, favorable attitudes, perceived low risk, environmental influences, and limited awareness of health risks. Protective factors included self-efficacy, perceived risks, awareness of harmful effects, and anti-smoking attitudes. Interventions based on TPB and SCT showed positive outcomes, though some failed, highlighting the need for culturally sensitive approaches. The findings emphasize the importance of education and policy measures targeting both individual and environmental factors to reduce hookah smoking prevalence and its associated risks in LMICs.

Native Americans serve in the U.S. military at the highest rate per capita of any ethnoracial group and have elevated rates of mental health (MH) difficulties compared to other ethnoracial groups, including posttraumatic stress disorder, alcohol use disorders, and suicide. Almost half of Native Veterans live in rural areas; rurality is associated with significant barriers to MH services. Engaging in outreach with Native Veterans is an important pathway for connecting them with MH care, but the outreach process and educational materials must be culturally aligned to be more effective. We collaborated with partners at a rural Department of Veterans Affairs medical center (VAMC) to develop and refine a process for co-creating MH-focused outreach materials that are culturally centered on the needs, preferences, and values of rural Native Veterans. Our model of Co-creating Outreach for Rural Native Veterans' Engagement (CORE) involves five key steps: building strong partnerships with rural VAMC partners (Connect), conducting a needs assessment to identify VAMC partners' and Native Veterans' unique needs (Learn), engaging in ongoing synchronous and asynchronous dialogue during iterative development of materials (Collaborate), piloting materials during outreach (Pilot), and refining materials based on Veteran and partner feedback (Re-evaluate). The process of developing culturally centered outreach materials should involve iterative refinement, partnerships and consultation with cultural experts, and strong relationships founded on respect, trust, and a commitment to bidirectional learning.

Men who have sex with men (MSM) have an elevated risk of adverse health outcomes associated with alcohol use and smoking. Although substantial studies have been conducted globally, little is known about alcohol use and smoking among MSM in Nepal. Therefore, the present study aimed to examine the prevalence and patterns of alcohol use and daily smoking among MSM in Nepal. A cross-sectional respondent-driven survey was conducted among MSM in Kathmandu, Nepal, between October and December 2022. Bivariate and multivariate logistic regression analyses were used to evaluate independent correlates of alcohol use in the past 12 months and daily smoking. Among 250 participants (mean age 27.6 ± 8.9 years), 71.6% had consumed alcohol in the past 12 months, and 42% smoked daily in the last 30 days. MSM who had an income of less than NRs 20,000 (aOR: 2.1; 95% CI: 1.1-3.8), were single (aOR: 2.0; 95% CI: 1.1-3.8), employed (aOR: 2.1; 95% CI: 1.1-4.1), engaged in sex work (aOR: 3.5; 95% CI: 1.1-11.1), ever smoked (aOR: 5.1; 95% CI: 2.6-9.7), and who did not engage in condomless sex (aOR: 2.1; 95% CI: 1.1-4.5) were more likely to use alcohol in the past 12 months. Similarly, participants who were born in Bagmati province (aOR: 3.7; 95% CI: 1.8-7.6), and had a history of drug use (aOR: 2.8; 95% CI: 1.3-5.7), and police detention (aOR: 3.2; 95% CI: 1.3-9.2) were more likely to be involved in daily smoking. The findings underscore the necessity of MSM-specific alcohol and smoking cessation programs in Nepal.

This investigation sought to understand the mental health needs of Black/African Americans during the COVID-19 pandemic and explore the church leaders' perspectives and experiences in supporting the mental health of their communities during this time. This exploratory qualitative study uses semi-structured interviews with 21 church leaders from predominantly Black neighborhoods in Brooklyn and Harlem, New York City (NYC), which were most adversely impacted by COVID-19. Neighborhoods were selected based on COVID-19 infection and mortality data from the NYC Department of Health. Transcripts were coded and thematically analyzed using Dedoose software. Four overarching themes and one subtheme emerged: (1) The COVID-19 pandemic amplified underlying community quality of life challenges, creating a "downward cascade" of mental health, (1a) COVID-19 is a source of collective grief and trauma; (2) Faith-based leaders play a key role in providing mental health support to their community; (3) Faith-based leaders seek strategies to reduce mental health stigma, normalize conversations around mental health; and (4) Faith-based leaders often operate in isolation from citywide mental health services, disconnected from existing programs and resources. Leaders anticipate a higher demand for mental health services. On the road to emotional wellness post-pandemic, public awareness of symptoms of mental health issues must be emphasized and available resources utilized to reduce stigma and encourage help-seeking behavior. Addressing these implications requires comprehensive multi-sector community driven efforts that include collaboration with faith-based communities to support community resilience and improve mental healthcare access.