Journal of Community Health最新文献

Synthetic oral nicotine pouches (ONP) are an increasingly popular route for non-tobacco nicotine consumption. While there is a growing understanding of ONP use internationally, especially in countries where these products have been available longer, few studies address ONP use in Canada. This cross-sectional study sought to quantify and characterize current ONP use in Canadian post-secondary students. A Qualtrics-based web survey of Canadian post-secondary (university or college) students was conducted in September/October 2024. This collected demographics, participant ONP history, recent use, and other nicotine/non-nicotine substance use. The Penn State Nicotine Pouch Dependence Index (PSNPDI) was embedded within the broader survey to assess nicotine dependence. Descriptive analysis was performed for ever- and recent-ONP use prevalence, poly-use of ONP with other products/substances, and ONP use with key demographic or contextualizing factors. Of 452 post-secondary student respondents (22% male, 78% female; age: 20.2 ± 2.6y), 27% reported ever-use of ONPs, with a mean ± SD age at first use of 19.2 ± 3.0y and 12% of all respondents reporting ONP use in the last 30 days. 77% and 89% of ONP users reported ever-use of tobacco and e-cigarettes, respectively, versus 24% and 44% of non-ONP users (p < 0.001). Among ONP ever-users, 62.3% reported no (PSNPDI score 0-3), 29.5% reported low (PSNPDI score 4-8), and 8.2% reported medium (PSNPDI score 9-12) dependence. These data provide a first glimpse into ONP use in Canadian post-secondary students, against which to assess future use patterns.

To identify demographic and primary care utilization factors associated with distance traveled for healthcare among Medicaid-insured children in South Carolina (SC). Medicaid claims data was analyzed among patients with a weight-related diagnostic code who received primary care services in SC from 2018 to 2022 (N = 1,055,613). Multinomial regression analyses were used to examine associations between demographic and primary care utilization factors and distance traveled to primary care services. Among Medicaid-insured children in SC, those who were Non-Hispanic White, obese, had lapses in coverage, sought non-well-child visits, and lived in rural counties demonstrated higher odds of traveling for primary care, compared to other children. Further, children who were Non-Hispanic White, overweight, and had lapses in coverage demonstrated higher odds of traveling distally for PC, compared to other children. These findings underscore the complex interplay between race/ethnicity, healthcare access, and obesity risk among Medicaid-insured children, emphasizing the need for targeted interventions that address these disparities. The study's insights can inform policy and healthcare practices aimed at improving the accessibility of primary care and supporting effective weight management strategies for pediatric populations in SC.

The involvement of civil society organizations in sexual and reproductive health (SRH) programs in Latin America began to expand during the health sector reforms era. These organizations have undergone significant changes over the decades, being able to collaborate with government agencies, the private sector and international agencies with the commitment to address the specific needs of vulnerable populations in the countries. We provide a synthesized and analytical description of the experiences of 17 civil organizations that carry out actions in the field of SRH in five Latin American countries. The aim is to understand the variety of organizational models, the populations served, the funding, and the activities they perform in the SRH field. A multi-case study focused on 17 organizations that primarily carry actions on SRH, especially for vulnerable populations in Latin America: Colombia, Guatemala, Ecuador, Mexico, and Peru. Data collection was carried out in two stages: gathering preliminary information and semi-structured interviews with 55 members of the organizations. The analysis was based on categories constructed prior to the process. These are described through four categories: Characteristics of target populations; Relationship with government structure and other interested actors; Activities Carried Out in Response to SRH; Achievements and scope of civil organizations in sexual and reproductive health and reproductive rights. Civil society organizations in the studied countries are essential within health systems, acting as agents of equity, expert service providers, and with a strong commitment to their target populations. In this study, they encountered several financial and political challenges. Their ability to adapt and the recognition they receive from the populations they serve stands out. Civil organizations not only fill significant gaps in the provision of SRH services but also become catalytic forces for social change and equity. It is essential to develop funding mechanisms and support policies that allow their continuous operation, expansion, and informed participation in decision-making processes in Latin America.

The adoption of HIVST testing is confronted with significant challenges, particularly among men who have sex with men (MSM) as a key population. This study aims to investigate factors influencing the decision to use HIVST among MSM in Indonesia. A cross-sectional study (July-September 2024) examined factors influencing willingness to use HIV self-testing (HIVST) among MSM in the North Sulawesi region. Participants (n=200), recruited via NGOs and WhatsApp, were ≥17 years and had recent same-sex activity. HIVST kits were distributed by NGO staff who also provided data collection, counseling, and referrals. Willingness was measured using a Likert scale. Data included demographics, HIV testing history, HIVST knowledge, and confidence in test accuracy. Informed consent was obtained, and participants completed anonymous online surveys. Bivariate and multivariable logistic regression analyses identified factors associated with willingness to use HIVST. Among 200 MSM respondents, 32% reported a high willingness to use HIVST. Significant associations were found with age (p<0.001), education (p=0.039), and prior HIV testing (p<0.001). Knowledge of HIVST and trust in test accuracy were both significantly related to willingness (p<0.05). Logistic regression showed that being "slightly" or "very familiar" with HIVST increased the odds of willingness (OR=4.073 and 6.869, respectively; p=0.044 and p=0.009). The HIVST is a potentially effective instrument for the expansion of testing among MSM in Indonesia, with a focus on enhancing awareness, addressing misconceptions, and establishing support systems for linkage to care.

The resurgence of monkeypox (MPX) as a global public health emergency in 2024 highlighted the challenges faced by healthcare systems worldwide, particularly in resource-limited settings like Iraq. Understanding the knowledge, attitudes, and anxiety levels among healthcare providers and medical students is crucial to enhance preparedness and response strategies during outbreaks. This study aimed to evaluate the knowledge, attitudes, and anxiety levels of Iraqi healthcare providers and medical students regarding MPX, identifying gaps that may hinder effective outbreak response and public health education. A cross-sectional study was conducted among healthcare providers and medical students across Iraq. Data were collected through an online, self-administered survey distributed via digital platforms between September 1, 2024, and January 15, 2025. The questionnaire assessed participants' knowledge, attitudes, and anxiety regarding MPX. A total of 200 participants were included, with a mean age of 21.84 ± 2.49 years, predominantly female (74%) and single (96%). While 73.8% of participants recognized isolation as a prevention method, 63.8% identified multiple transmission routes, and only 40% were aware of MPX prior to the study. The average anxiety score was 17.92 ± 5.76, reflecting moderate anxiety, with higher scores observed among females. Knowledge gaps persisted in recognizing symptoms like lymphadenopathy (51.3%) and treatment options, with 38.8% believing there was no treatment. Vaccination willingness was moderate, with only 65% willing to be vaccinated. Social media was the primary source of information (63.7%), often contributing to misinformation. Significant gaps in knowledge and varying attitudes highlight the need for targeted educational campaigns and improved communication strategies to prepare healthcare professionals for managing emerging infectious diseases like MPX. Addressing these gaps can mitigate anxiety and enhance healthcare preparedness in Iraq and similar settings.

The Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and a leading cause of cervical cancer. Latinas have higher rates of cervical cancer incidence and mortality compared to non-Latina White women. The HPV vaccine is a primary form of prevention recommended for pre-adolescents but, vaccine completion of the two dose vaccine series is low among Latina adolescents. The purpose of the study was to investigate the association between sociocultural variables, mother-daughter connectedness, and communication about sexual health on HPV vaccine completion thereby moving beyond prior research that has focused on individual attitudes or provider recommendations. A cross-sectional survey was administered to 192 Latina mothers of Mexican descent. Linear regression and an exploratory model depicting associations between the variables and vaccination completion was tested through path analysis. Mother-daughter conversations about birth control emerged as the strongest predictor of vaccination completion. Indices of fit for a modified exploratory model were χ2(18) = 1.28 χ2/df = 5.76, p = .001; CFI = 0.96; TLI = 0.94; RMSEA = 0.03. Estimates of indirect effects indicated that mother-daughter connectedness had an indirect effect on comfort having sexuality-related conversations which in turn, had an indirect effect on conversations about birth control. Findings contribute by elucidating the nuanced mechanisms through which parental relationship quality and communication practices shape parental uptake of sexual and reproductive health behaviors for children. Findings respond to calls for culturally relevant family-level approaches to HPV vaccination.

Black adults experience the highest incidence and/or mortality rates for many commonly diagnosed cancers; yet they are underrepresented in cancer basic, applied, and translational research. This underrepresentation is greatest among Black adults living in low-income communities. There are many barriers to these individuals participating in cancer research, including limited effective research engagement strategies. This paper describes the University of Florida (UF) Health Cancer Center Community-Partnered Cancer Disparities Research Collaborative (CDRC) model and its implementation. The UF CDRC model consists of human and physical infrastructure for the sustained engagement of Black adults within low-income communities in cancer research. The CDRC model is culturally sensitive and informed by the community-based participatory research approach, which requires equitable partnerships between scientific researchers and community members. The human infrastructure of the CDRC model includes faculty and community researchers, pastors, and culturally diverse university students. The physical infrastructure of the CDRC model consists of 10 predominantly Black churches and a community-based multipurpose building, all of which are community outreach and research sites. Examples of evidence supporting the use of the CDRC model includes (a) the successful recruitment, training, and retention of trusted community members and leaders as major research partners in the CDRC, and (b) the pipeline development of culturally sensitive student and faculty health equity researchers. The CDRC model is a novel, replicable infrastructure model for the sustained engagement of Black adults within low-income communities in cancer prevention, treatment, and survivorship research. It is dedicated to reducing cancer disparities that plague Black communities.

Introduction: Although leprosy was declared eliminated in Malaysia in the 1990s, it continues to affect the indigenous Penan community in rural Baram, Sarawak, with prevalence rates of 2.08-35.5 per 10,000-far above the WHO threshold. Previous studies noted delayed diagnoses and geographical clusters among the Penan, but the drivers of ongoing transmission remain unclear.

Objective: This study examined factors contributing to the persistent high incidence of leprosy within the Penan community in Upper Baram, Sarawak.

Methods: Semi-structured qualitative interviews were conducted from January-May 2022 with Penan individuals and healthcare professionals (HCPs), using guides based on the Socioecological Model. Villages with high leprosy incidence and relevant rural health facilities were purposively sampled. Interviews were recorded, transcribed, and thematically analysed.

Results: Thirty-seven participants were interviewed: 22 Penan (aged 19-82) and 15 HCPs (aged 28-62). Three themes emerged: (i) transmission was linked to family-level spread, inter-village movement, and disease characteristics; (ii) community factors included low awareness, nomadic lifestyle, overcrowding, and poor nutrition; (iii) health system barriers included limited access, inadequate diagnostic capacity, fear of slit skin smear procedures, and infrequent active case detection.

Conclusion: Leprosy transmission among the Penan is sustained by cultural, environmental, and healthcare system challenges. Addressing this requires a multifaceted response, including stronger rural health infrastructure, improved diagnostics, regular active case detection, and culturally tailored health education to halt transmission in this underserved community.

To document the characteristics, costs, and services of lodging organizations that support domestic medical travelers and introduce a publicly accessible, geocoded national dataset to inform health services research and policy. We conducted a cross-sectional descriptive study of lodging organizations serving patients and caregivers traveling for medical care across the United States between April 2023 and May 2024. Structured data collection and geospatial mapping were performed. We used chi-square tests to compare characteristics of pediatric-only versus adult- or all-age-serving facilities. Primary data were collected through systematic review of publicly available websites, national directories, and direct outreach to facilities. The analytic sample included 502 U.S.-based lodging organizations meeting eligibility criteria: providing temporary accommodations to patients and caregivers traveling for care. Data were geocoded and analyzed using ArcGIS and R (version 2024.04.2). Among the 502 organizations, 52.4% offered free lodging and 84.7% advertised financial assistance. Pediatric-only facilities (40.8% of the sample) were significantly more likely to offer support services (99.0% vs. 77.1%) and lower-cost accommodations than those serving adults or all ages. Services varied: 53% offered meals, 41% transportation, and 33% domestic activity support (e.g., laundry or kitchens). Organizational affiliation also varied, with 44.4% being independent or hospital-based. A geocoded national map of all facilities was developed and made publicly available at https://www.umaryland.edu/navigator . Lodging organizations form a decentralized but vital support system for patients and caregivers navigating medical travel. This study reveals structural variation in access and highlights equity gaps, particularly for adults and patients with less common diagnoses. Findings support recognition of lodging as a health-related social need and its potential integration into value-based care, Medicaid waivers, and hospital community benefit strategies.

Hepatitis B is a severe liver infection caused by the Hepatitis B virus (HBV), potentially leading to liver cirrhosis, failure, and carcinoma. Transmission occurs through contact with infected bodily fluids, such as blood. Immunization against HBV is the most effective measure to prevent infection. Healthcare employees, particularly those who are under-vaccinated, are at elevated risk due to potential exposure. Although healthcare workers should have access, 24% of the healthcare workforce worldwide remains unvaccinated. Ensuring adequate immunization for this group is essential to maintaining a safe workplace and minimizing the risk of downstream transmission. We aimed to decrease the number of overdue Hepatitis B vaccinations among employees and dependent patients in an Internal Medicine (IM) practice at a large academic medical center At baseline, 3,052 IM patients were under-vaccinated. Our intervention identified 1,000 random patients. An EMR message was sent to the intervention group. The message provided instructions on scheduling an appointment or retrieving documentation from their occupational health records. Four weeks after the initial message, a follow-up message was sent as a reminder. The intervention resulted in a 14% increase in HepB medical record compliance updates. 780 patients interacted at least once with message broadcasts. Our intervention significantly increased Hepatitis B vaccination and documentation for patients within the intervention group. This study identified several barriers, such as a lack of willingness to receive recommended vaccines or update records to reflect accurate vaccination status. Additionally, limitations in record retrieval and difficulties pulling vaccination records from external databases hindered documentation.