Journal of Community Health最新文献

Legalization by states of medical and non-medical cannabis use is increasing the accessibility of cannabis to Americans. While cannabis use remains illegal for youth, enhanced effective approaches preventing youth's cannabis use are important. The Drug-Free Communities (DFC) Support Program is administered by the White House Office of National Drug Control Policy and represents the nation's leading effort to mobilize communities to prevent and reduce youth substance use. Coalitions use the Seven Strategies for Community Change to ensure the creation of comprehensive action plans and a community-wide approach for preventing youth substance use. This study's objective is to review the cannabis programmatic activities implemented by DFC coalitions, identify common themes, and assess whether activities align with the Seven Strategies for Community Change. Review of biannual progress report (PR) data collected from August 2020 to February 2021 was conducted to determine common themes, strengths, and areas of improvement among cannabis programmatic activities. Of the 727 funded coalitions, 73% (n = 532) identified cannabis as a substance they focused their activities on in their PR submissions, and 488 unique cannabis programmatic activities were reviewed. Cannabis programmatic activities were assigned to one of six common themes: 1) dissemination (n = 167), 2) training and education (n = 147), 3) community partnerships (n = 99), 4) policy and enforcement (n = 51), 5) miscellaneous (n = 15), and 6) communities of focus (n = 9). Findings could inform local organizations about common types of youth cannabis-related prevention activities implemented at the community-level. The least commonly reported strategies, such as communities of focus, may highlight opportunities for expanded prevention efforts for coalitions.

Trust in healthcare is declining in the U.S. and is associated with decreased engagement in preventive care, low adherence to treatments, lack of motivation to seek care and poor health outcomes. Using the Health Belief Model (HBM), this study examined the impacts of trust on the healthcare access and utilization among African immigrants in Florida, United States. In-depth interviews were conducted with purposively selected African immigrants (N = 19) over the age of 18, lived in Florida for five or more years, and had recent experience with the U.S. healthcare system. Interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo14. Perceived barriers to trust led to discontinuation and delays of care. Uncertainties on insurance coverage, ambiguous medical bills, and broken patient-provider communication constitute perceived barriers. Perceived benefit determined trust and medical adherence among participants. Findings revealed that being Black immigrant and legal requirements such as proof of legal status fueled perceived susceptibility. To counter their susceptibility and earn trust from providers, participants were pressured to present themselves in an 'acceptable' manner in healthcare settings. Self-efficacy was demonstrated through self-research on their cases and self-advocacy. Cues to action included seeking second opinions and changing providers depending on availability. Healthcare systems should prioritize billing transparency, effective communication, equitable practices, and legal protections for immigrants. Providers need continuous training in cultural humility and trauma-informed care, centered on immigrant experiences. Co-developing multilingual health information and engaging trusted messengers such as community and faith leaders will enhance the credibility of health promotion efforts.

Although American Indian and Alaska Native people make up less than 2% of the US population, they are disproportionally affected by adverse health outcomes, including disabilities. The Indigenous community of the Mohawk Nation at Akwesasne has faced significant environmental contamination since the 1970s, resulting from operations of three aluminum foundries near the community. The aim of this study was to explore the potentially moderating effects of social support and cultural identity on disability, taking into account age, sex, and health comorbidities among 119 Akwesasne Mohawk adults. We used the World Health Organization Disability Assessment Schedule II (WHO-DAS II) to measure disability, the Duke University Social Support Scale with Likert-type responses to quantify social support, and the Orthogonal Ethnic Identification Scale to calculate cultural affiliation. We found that overall social support was significantly negatively associated with disability related to self-care (Relative Risk (RR) = 0.96, 95% Confidence Interval (CI): 0.93, 1.00). Both family support (RR = 0.97, 95% CI: 0.94, 0.99) and non-family support (RR = 0.97, 95% CI: 0.94, 1.00) were negatively associated with disabilities that prevent full participation in society. Cultural affiliation to either the white culture or the Mohawk culture was not significantly associated with disability. Although preliminary, our findings may help inform clinicians advising American Indians and Alaska Natives with disabilities on helpful interventions to provide greater social support. This may in turn improve the quality of life of indigenous communities facing a high prevalence of disability.

Background: In the U.S., responses to the rollout of COVID-19 vaccine varied widely, with contrasting perceptions of the vaccine. We aimed to characterize distinct groups of respondents regarding COVID-19 vaccine perceptions.

Methods: Data came from the 2021-2023 Common Survey (n = 852), collected in Chicago using a community-based participatory approach focusing on communities with low COVID-19 vaccination. Participants answered eight questions about vaccine-related perceptions. We conducted a latent class analysis in R.

Results: The sample included 623 female participants (73.1%), 482 Black participants (56.6%), 259 Hispanic/Latino(a) participants (30.4%), 26 Asian participants (3.1%), and 261 participants with a college degree (30.6%). In a four-class model, Class 1 (skeptic) included 153 participants (18.0%) with low confidence in vaccine safety, effectiveness, and potential to get life back to normal. Class 2 (uncertain) included 163 participants (19.1%) who mostly indicated uncertainty. Class 3 (support with concerns) included 266 participants (31.2%) who recognized many vaccine benefits but also had concerns about its rapid development and "not being studied in people like me." Class 4 (pro-vaccine) included 270 participants (31.7%) with high confidence in vaccine safety and effectiveness and social approval of vaccination. Interestingly, both the skeptic and pro-vaccine groups had somewhat similar agreement with the statement "not enough information on COVID vaccine interaction." Class assignments varied by sociodemographic characteristics. Socioeconomic hardships were associated with a lower likelihood of being in the "pro-vaccine" group.

Conclusions: Given the distinct classes of vaccine beliefs, tailored public health messaging is needed to enhance vaccine confidence and uptake.

Transgender and nonbinary (TGNB) individuals are disproportionately impacted by HIV, particularly those who identify as racial/ethnic minorities and those who are socioeconomically disadvantaged. Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV infection, but many TGNB individuals encounter barriers to PrEP uptake and adherence that limit fully realized preventive benefits. We developed PrEP Well, a multicomponent community-led program, to scale and sustain comprehensive PrEP services from a TGNB-led community organization that provides gender-affirming healthcare and social services. We used implementation science frameworks to evaluate initial program outcomes and contextual influences on program implementation. Preliminary data from August 2022 through January 2024 showed promising implementation and effectiveness outcomes. During that time, 113 primarily low-resourced TGNB clients were educated about PrEP and received an HIV test, of whom 60 (53%) attended a visit with a provider and received a PrEP prescription. At 30-day follow-up, urinalysis confirmed uptake of PrEP among 50 (83%) of the clients prescribed PrEP. At 90-day follow-up, 43 (72%) demonstrated continued use of PrEP and 40 (67%) showed protective levels of PrEP adherence. Qualitative interviews and surveys indicated that clients, staff, and leadership viewed the PrEP Well program as highly acceptable, feasible, and sustainable (including willingness to address persistent implementation barriers). Referral patterns and rates of PrEP uptake suggested increasing integration of PrEP Well into the TGNB community center over time. The PrEP Well program demonstrates the potential for TGNB communities to address HIV inequities by integrating community-led HIV prevention services with gender-affirming healthcare in TGNB-specific health centers.

In addition to individual factors, differences in community-level factors impact mortality rates of cervical cancer (CC), especially in the Southeast United States, where CC one-year mortality is significantly higher than national average. This study investigated the association between community-level social vulnerability measured using the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and overall and one-year CC mortality in Alabama. Retrospective cohort study using Alabama State Cancer Registry data from 2012 to 2021. Outcome of interest was mortality due to CC. Residential addresses were geocoded to determine SVI scores categorized into quartiles. Cox proportional hazards model was used to assess associations between SVI quartiles and overall and one-year CC mortality adjusting for age at diagnosis, race, marital status, and insurance status. Further, CC mortality in younger adults (≤50 years) was compared with older adults (> 50 years). A total of 1,325 women with CC were included in the study. The median age at diagnosis was 49 years (IQR: 39-62) and 69.73% were White. Median follow-up time was 9 months (IQR: 5-17). Among older adults, we observed statistically significant association between higher SVI quartiles and overall mortality (Q4: aHR 1.86; 95% CI 1.15, 3.01; p = 0.012] and one-year mortality (Q3: aHR 2.66; 95% CI 1.34, 5.29; p = 0.005; Q4: aHR 2.45; 95% CI 1.18, 5.08; p = 0.016). This study highlights the role of community factors in CC mortality among older women. Community-level strategies are needed to reduce the burden of CC mortality in Alabama and other high-risk regions.

Medical mistrust is an ongoing concern in the United States, with patient confidence in both individual practitioners and institutions decreasing sharply in recent years. Atlantic County, New Jersey has some of the worst health outcomes in the state and is below the national average. This study sought to investigate medical mistrust by recruiting participants to complete a survey and/or health screening at 12 food pantry distribution events throughout Atlantic County (N = 124). The mean score for the Medical Mistrust Index was 19.06 (SD = 5.6) for participants who reported receiving the annual influenza vaccine and 16.05 (SD = 4.7) for participants who did not report receiving the vaccine (p = 0.002). Participants who reported an "Excellent" self-perception of overall (M = 13.7, SD = 4.6) and dental health (M = 14.6, SD = 5.5) had significantly less trust relative to their counterparts. There was no significant difference in self-perception of mental health and trust. While not statistically significant, a positive correlation was observed between trust and the number of healthcare information sources used: participants reporting use of 1 source had the lowest trust (M = 16.82, SD = 5.73), while those using 2 (M = 17.86, SD = 4.48; p =.509), 3 (M = 17.33, SD = 0.87; p =.536), or ≥ 4 sources (M = 19.38, SD = 3.97; p =.086) showed progressively higher trust. Our findings highlight the responsibility of improving medical mistrust falls on both providers and patients to take agency of their care.

Vaping has become very popular among young generations in Jordan. However, less is known about women's awareness and intention to vape. The aim of this study is to assess women's knowledge and beliefs about vaping, with a focus on vaping women's attitudes and practices. This is an observational cross-sectional study. Data were collected from January through March 2024, by using a self-administrated survey inspired from the WHO GATS questionnaire. Among the 923 participating women, 12.4% were vaping. We observed significant variations in knowledge and beliefs among women. Vaping women have a substantially younger age than non-vaping. 57% of vaping women think that vape is safer to use than cigarettes compared to 14% of non-vaping. 61% of vaping women believed that vaping helps to quit cigarette smoking compared to 24% of non-vaping. Vaping women tended to underestimate the health risks associated with it compared to non-vaping women. They are also supporting legislations that allow vaping indoors and in public places. Women vape primarily for enjoyment, to cope with stress, to pass free time, and to hang out with friends. Luckily, many of them believed that smoking increases the risk of cardiovascular and respiratory ailments and limited life expectancy, which supports their future quitting plans. This study revealed misconceptions and knowledge gaps around vaping among women. Emotional demands and social interactions influenced women's vaping use in Jordan, highlighting the need for targeted public health education and legislative measures to promote women's health.

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.

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.