Journal of Community Health最新文献

Patient knowledge is a key determinant of hypertension self-management and blood pressure control, yet data from underserved, community-based settings remain limited. We evaluated baseline hypertension knowledge in a predominantly Hispanic, rural population and assessed the short-term effectiveness of a brief teach-back educational intervention delivered in a community health setting. A four-item, Spanish-language version of the Hypertension Knowledge-Level Scale, shortened for feasibility in fast-paced outreach settings, was administered before and immediately after a teach-back session at a free community health fair on the U.S.-Mexico border. Among 30 Spanish-speaking participants (73% female; 30% with a prior hypertension diagnosis), the percentages who responded correctly to the three knowledge questions were 51.7%, 34.5%, and 27.6%, respectively, at baseline, increasing to 100% (p < 0.001), 79.3% (p = 0.021), and 93.1% (p = 0.004) after teach-back. The median total knowledge score increased from 1.0 (interquartile range [IQR] = 2.0) to 3.0 (IQR = 0.0). Participants reporting being "very comfortable" interpreting blood pressure readings increased from 29.6% to 55.2% (p < 0.008). Female sex (p = 0.037) and higher educational attainment (p = 0.043) were independently associated with lower diastolic blood pressure values. Overall, substantial hypertension knowledge gaps were identified in this underserved Hispanic population. A brief teach-back educational session may represent a feasible, low-cost strategy for improving hypertension knowledge in resource-limited, community-based settings.

Nearly all maternal deaths are preventable, yet Nepal's maternal mortality ratio remains high, with social and geographic disparities. Beyond direct obstetric causes, factors such as education, income, and place of residence influence maternal mortality risk, but disaggregated national data remain limited. This study examined the social determinants and timing of maternal deaths in Nepal to identify high-risk groups and inform targeted interventions. A cross-sectional descriptive study was conducted using microdata from the 2021 National Population and Housing Census, applying a stratified, probability-based sampling design to ensure national representativeness. Deaths among women aged 15-49 were identified through household reports. Data were collected on sociodemographic characteristics, household wealth, ethnicity, and place of residence. Deaths were classified by cause, and maternal deaths were further classified by timing, including during pregnancy, childbirth, or within six weeks postpartum. Descriptive statistics were calculated using sampling weights. Of 1,386 deaths among women aged 15 to 49 years, 54 (3.9%) were maternal deaths, with 74.6% occurring within six weeks postpartum. Non-communicable diseases were the leading cause of death overall (49.9%). Maternal deaths were most frequent in Lumbini province, peri-urban and rural areas, and the Tarai region. Socioeconomic disparities were evident, with nearly half of maternal deaths occurring among women from poor households. Most women who died from maternal causes were aged 20-34 years. Maternal mortality in Nepal reflects social and geographic inequalities, with higher risk among poorer women, those in rural and peri-urban areas, and specific provinces, particularly during the postpartum period. Strengthening antenatal care, skilled birth attendance, and equitable, context-specific interventions is essential to reduce preventable maternal deaths.

Advance care planning (ACP) facilitates discussions about future healthcare decisions to ensure alignment with individuals' values, goals, and medical preferences. Despite its benefits, ACP engagement and completion of advance directives (AD) remain limited due to low awareness, misconceptions, and structural barriers. The Tisch Cancer Institute Community Outreach and Engagement Department at Mount Sinai in New York City (NYC) identified this knowledge gap as a key community need. In response, a community-based educational module was created to enhance ACP and AD knowledge. Curriculum development was informed by a literature review and collaboration with health educators, social workers, and palliative care specialists. The intervention included a 30-minute slideshow, a two-page glossary and resource handout, and a healthcare proxy AD form. Workshop impact, acceptability, and feedback were assessed using a validated survey with eight Likert-scale items and two open-ended questions. Descriptive statistics summarized quantitative responses, and thematic analysis was applied to open-ended feedback. Community adult members across NYC participated in eleven workshops held at diverse community sites from June 2024 to June 2025, engaging 141 individuals with a feedback survey response rate of approximately 40% (N = 56). Findings demonstrated acceptability and feasibility. Participants reported increased understanding of ACP concepts and improved confidence in completing ADs. Qualitative comments emphasized clarity, relevance, and practicality of materials. Our community-based educational workshops effectively enhanced ACP knowledge and empowered participants in healthcare decision-making. Future directions include expanding workshop reach, translating materials, and conducting longitudinal follow-up to evaluate sustained engagement and impact on AD completion rates over time.

The prevalence of risky alcohol consumption differs by occupation: heavy alcohol use is more common among people employed in the alcohol service industry compared with people employed in other sectors. Workplace factors and the psychosocial conditions of work may influence drinking behaviors. Recently developed Canadian guidelines on alcohol and health recognize that the harms of alcohol consumption lie along a continuum of risk. Using data collected from a survey of people employed in the alcohol service industry from Ontario, Canada (n = 583), this study applied the risk categories defined by Canada's Guidance on Alcohol and Health (CGAH) to estimate the prevalence of low (1-2 drinks/week), moderate (3-6 drinks/week), and increasingly high-risk drinking (≥ 7 drinks/week). The study then examined which psychosocial conditions of work were associated with CGAH risk level using multinomial logistic regression. Overall, 23.2% of respondents reported consuming 1-2 drinks/week, 21.7% reported consuming 3-6 drinks/week, and 33.4.% reported consuming ≥ 7 drinks/week. Burnout, emotional demands at work, demands for hiding emotions on the job, and work-life conflict were significantly associated with CGAH risk level in bivariate analysis. Emotional demands at work were significantly associated with increasingly high-risk drinking after adjusting for demographic, employment, and health-related measures. People employed in the alcohol service industry work in fast-paced, emotionally demanding jobs where alcohol is readily available. Employers can support their employees by recognizing the emotionally demanding nature of their work and promoting CGAH to encourage employees to reduce their weekly consumption of alcohol to lower risk levels.

This study aimed to examine recent trends and educational inequality in smoking prevalence among Vietnamese adults between 2020 and 2024, providing evidence to inform targeted tobacco control interventions. Data were obtained from three rounds of the Provincial Global Adult Tobacco Surveys (PGATS) conducted in Vietnam (2020, 2022-2023, and 2024), involving nationwide samples totaling 69,776, 61,763, and 74,962 participants aged 25 or older, respectively. Current smoking and daily smoking rates were estimated. Absolute (Slope Index of Inequality, SII) and relative inequalities (Relative Index of Inequality, RII) of current smoking and daily smoking were analyzed using the Poisson regression-based method in regard of educational level. Overall smoking prevalence among those aged 25 and older declined from 24.4% in 2020 to 20.8% in 2024, with the male smoking rate of 47.3% and 41.1%, respectively. Daily smoking showed a similar trend (19.8% in 2020 to 16.6% in 2024). The smoking prevalence among men was consistently higher than among women, and rural residents, married individuals, and lower educational groups exhibited higher smoking rates across all years. The substantial educational inequalities persisted. Absolute inequalities slightly decreased for current smoking (SII: 18.5% in 2020 to 14.3% in 2024) and daily smoking (SII: 18.1-15.0%), yet relative inequalities remained stable (RII from 0.47 to 0.51 for current smoking; approximately 0.40 for daily smoking). While Vietnam has experienced a moderate decline in smoking prevalence, significant educational inequalities persist. To effectively address tobacco-related disparities, targeted interventions focusing on socioeconomically disadvantaged groups are necessary, underscoring the need for equity-oriented tobacco control policies.

Betel quid chewing is a culturally-rooted oral health risk behavior that is prevalent in many Southeast Asian communities. Among Malaysia's indigenous community, particularly in isolated areas, data on betel quid chewing remain limited. This study investigated the influencing factors and health perceptions of betel quid use among 180 adults from a Proto-Malay Orang Asli community in Peninsular Malaysia. A validated questionnaire adapted from national health survey gathered data on demographics, betel quid chewing habits, and knowledge and attitude on betel quid use. Descriptive statistics determined prevalence and health behavior, while bivariate and multivariate logistic regressions identified associated factors. The prevalence of current betel quid chewing was 75.9%. Chewing was more common among individuals aged ≥ 40, those with lower education, and those with strong family traditions of chewing. Multivariate analysis showed that older age (AOR = 1.126; 95% CI: 1.071-1.183; p < 0.001) significantly predicted current use. The findings highlight the need for culturally sensitive oral health strategies tailored to each indigenous communities.

The increasing use of social media today has raised the risk of social media addiction among adolescents. Although there are studies examining the level and effects of social media addiction in adolescents, research addressing its relationship with social appearance anxiety or alexithymia is limited. This cross-sectional and correlational study was conducted to determine the relationship between social media addiction, social appearance anxiety, and alexithymia in adolescents. The sample consisted of 756 adolescents aged 15-17. After obtaining institutional approval, ethical committee approval, and participant consent, data were collected by using the Adolescent Introductory Information Form, the Social Media Addiction Scale for Adolescents (SMASA), the Toronto Alexithymia Scale-20 (TAS-20), and the Social Appearance Anxiety Scale for Adolescents (SAAS-A). Descriptive statistical analyses, correlation, and regression analyses were used to evaluate the data. The average age of the adolescents included in the study was 16.04 ± 0.74 years, and 57.8% were female. The mean score on the Social Media Addiction Scale was 22.35 ± 7.68; on the Social Appearance Anxiety Scale, 39.63 ± 15.09; and on the Toronto Alexithymia Scale total score, 52.38 ± 8.78. A moderately positive correlation was found between the Social Media Addiction Scale and the Social Appearance Anxiety Scale scores (p< 0.05). The total score of the Toronto Alexithymia Scale showed a moderate positive correlation with both the Social Appearance Anxiety and Social Media Addiction scale scores (p< 0.05). It was also found that social media addiction and social appearance anxiety significantly predicted total alexithymia scores among adolescents (p< 0.05). Based on these findings, it is recommended that pediatric nurses conduct education, counseling, and intervention programs for adolescents.

Integrated healthcare models show great promise for addressing health disparities affecting Indigenous people, which are often rooted in the enduring effects of colonisation. These models align with Indigenous holistic views of health, recognizing the importance of community, cultural knowledge, and connection to land. To understand how these models are being developed and implemented, we conducted a systematic scoping review. Guided by Indigenous methodologies and community needs, we searched four databases (Web of Science, PubMed, Scopus and ProQuest) for peer-reviewed literature on integrated healthcare for Indigenous communities in Australia, Canada, the United States, and New Zealand. Included articles were appraised using the Indigenous quality appraisal tool and analysed from a relational perspective supported by the Joanna Briggs Institute's convergent integrated method. Nineteen publications met the inclusion criteria. Most studies were from Australia (53%) and Canada (26%), and most (74%) were published in the last five years, indicating a recent surge in interest. The review identified several key factors critical to the effective implementation of these models. These included strong community leadership and ownership, culturally and contextually relevant approaches, meaningful partnerships with stakeholders, and flexible service delivery. The review further highlights the importance of having motivated and well-trained health providers, as well as adequate funding. The wide variety of methods found in the studies reflects the complexity of integrated care and the influence of distinct cultural, disciplinary and contextual factors. The findings suggest that to improve healthcare and well-being for Indigenous populations, it is crucial to strategically address these key elements.

This study aimed to comprehensively understand how children engaged with physical activity in after-school programs developed through a university-community partnership initiative. The program was designed to enhance physical activity opportunities for elementary school students by offering a variety of structured and unstructured activities, facilitated by physical education teacher education (PETE) major students serving as mentors. A mixed-methods approach was employed, using both quantitative and qualitative data. Seventy children completed the Physical Activity Enjoyment Scale (PACES) before and after participating in a 12-week program. Additionally, 68 children participated in focus group interviews, and 32 physical education major students provided written reflections. Data were collected during the spring semester of 2025 from four elementary schools. Quantitative findings indicated an increase in children's enjoyment of physical activity from pre- to post-test. Qualitative analysis revealed four central themes: (a) enjoyment of the after-school program, (b) engagement in physical activity, (c) learning through play, and (d) positive relationships with mentors. This study demonstrates that prioritizing enjoyment, autonomy, social connection, and authentic learning within playful physical activity in after-school programs is paramount for fostering children's long-term engagement. The university-community partnerships create a synergistic "win-win" environment, where the involvement of PETE major students as mentors not only enriched children's experiences but also provided valuable teaching practice for university students. Such partnerships are essential for building high-quality after-school programs that equip children with lifelong healthy habits and foster their overall well-being.