Journal of Community Health最新文献

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.

As the opioid crisis continues, now driven by use of fentanyl, naloxone is an increasingly important intervention to reverse overdoses. More research is needed on the willingness of populations at risk for unintentional fentanyl exposure (through adulterated drugs) to accept naloxone to reverse potential overdoses. Adults (n = 991) entering randomly selected nightclubs in New York City (NYC) were surveyed at the point-of-recruitment in 2024 and were asked about their willingness to accept a free naloxone kit. We examined the prevalence of reported willingness to accept naloxone and reasons for refusal, and we examined prevalence and correlates of participants accepting naloxone. During the survey, 65.2% of participants reported being familiar with naloxone, 62.1% agreed to accept naloxone, and 49.6% were recorded as accepting a kit. Those residing in NYC, compared to visitors, had a higher prevalence of recorded acceptance (aPR = 1.41, 95% CI: 1.11-1.79), as did those reporting familiarity with naloxone (aPR = 1.27, 95% CI: 1.02-1.58), and those with an average higher readiness to intervene in an opioid overdose (aPR = 1.18, 95% CI: 1.04-1.33). The majority who refused (56.1%) reported not being interested; 10.1% reported that they were not worried about overdoses, and 8.2% reported that they already had naloxone. Although 83.4% agreed that naloxone is used to reverse opioid overdoses, 35.4% reportedly thought that naloxone is used to reverse the effects of cocaine or any drug. While at least half of attendees were willing to accept a naloxone kit, lack of interest and lack of knowledge about naloxone were potential barriers to carrying naloxone.

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.

Community-based preceptors provide the clinical training necessary to prepare health professions students for clinical practice. The number of students in need of clinical placement is growing as the number of preceptors declines. The mission of the Georgia Area Health Education Centers is to increase access to primary care services in underserved rural and urban areas by recruiting, training, and retaining health professionals. A survey of preceptors in the State of Georgia was conducted in 2023 to gain insight into motivations for, satisfaction with, and barriers to precepting. Of 11,174 clinicians who had precepted within the past 5 years, 1,270 completed the survey (11% response rate). The survey revealed that, while preceptors reported satisfaction with the precepting experience and impact of students on their practice, they were less satisfied with the incentives provided. Current preceptors were younger, male, and precepted for a longer period of time and for more rotations per year. A regression analysis revealed that satisfaction with precepting was somewhat higher among preceptors who were 60 years old or older, a physician or PA, and practicing in a nonrural clinical site. Satisfaction was also somewhat higher among those who precepted for 2 or fewer years, for 10 or more rotations per year, and intended to continue teaching over the next 5 years. An analysis 114 free-text comments revealed themes that reinforce the concepts of teaching as an enjoyable and rewarding endeavor, the effect of teaching on clinical productivity, and a desire for better compensation for their efforts.

The growing popularity of electronic cigarettes (e-cigarettes) among Indonesian youth presents a new public health challenge in a country with one of the highest tobacco burdens globally. While tobacco control regulations have been implemented, e-cigarettes remain largely unregulated, raising concerns about their health impacts and youth appeal. This study explores the prevalence, determinants and perceptions of e-cigarette use among high school and university students in Indonesia, providing critical insights to inform effective policymaking. A cross-sectional online-based survey was conducted in 2019 among 158 students aged 15-30 years across 17 provinces in Indonesia. Data on tobacco use behaviours, socioeconomic background, social influences and health perceptions were collected. Descriptive and inferential statistical analyses identified key determinants of e-cigarette use. Among the participants, 36.2% reported ever smoking, and 65.2% of these had tried e-cigarettes. Key determinants of e-cigarette use included male gender, urban residency, peer smoking and social acceptance of smoking (all p < 0.05). Notably, participants commonly perceived e-cigarettes as less harmful than combustible cigarettes and helpful for smoking cessation, despite conflicting scientific evidence. Overall, e-cigarette use is prevalent among Indonesian youth, driven by social and environmental factors, as well as misconceptions about safety. Strengthened regulations and targeted public health campaigns are essential to mitigate the health risks posed by e-cigarettes and enhance tobacco control efforts.

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.

Occupational medicine and safety are now very well-established specialties world-wide. They bring together the essentials of clinical medicine and public health. However, the adoption of the principles of occupational medicine and safety was a long process in which both indifference and opposition had to be overcome. A leading pioneer in these fields, P.J. Imperato, MD, launched remarkable initiatives in the workplace some seventy years ago. He did so in the fields of heavy and marine construction. He first entered the field of occupational medicine in the late 1930's when he served as the physician for the Sullivan Drydock and Repair Corporation, a ship yard in Brooklyn, New York. Some ten years later he was appointed Director of the Medical and Safety Department of the Merritt-Chapman and Scott Corporation (MC&S). His comprehensive initiatives led to measurable positive outcomes through a process of formative assessment. These assessments focused on injuries and deaths. As a result of the initiatives he implemented in a high-risk heavy construction industry, injuries and deaths statistically declined leading to savings in workers' compensation and liability insurance payments. Imperato achieved all of this in the context of the high-risk construction of bridges, dams, tunnels, and housing developments by one of the leading construction companies in the United States.

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.

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.

Cancer disparities among populations in the United States are a persistent and ongoing challenge. Medical mistrust (MM), or the tendency to distrust individuals and systems even at the cost of one's own well-being, has been implicated in contributing to worse health outcomes. Thus, understanding the relationship between MM and cancer care disparities may inform effective interventions to improve outcomes for all. We conducted a two-step review: (1) a standard review to examine the relationship between MM and the cancer continuum of care, and (2) a systematic review to assess interventions targeted to mitigate MM in cancer care. The standard review included eleven studies, which revealed that MM impacted cancer screening, treatment adherence, clinical trial participation, and access to social support. Key mediators of MM included patient-provider discordance, health-related and sociodemographic-related discrimination, perceptions of Western medicine, low quality care, and health insurance. Our systematic review yielded twelve interventions-67% tailored towards screening, 17% towards patient navigation services, and 17% towards clinical trial participation. Key methods included adapting patient-centered (e.g. gathering patient perspectives, increasing racial and ethnic representation) and community-based approaches (e.g. use of churches and training family members to disseminate patient education) to overall create culturally tailored interventions against MM across the cancer continuum of care.