Journal of Community Health最新文献

Female Veterans experience disproportionately poorer outcomes in mental health and physical health, as well as other conditions, compared to their male counterparts and non-Veteran females. The Arizona Veteran Survey aims to understand the unique experiences of female Veterans in the state of Arizona and assess how these experiences impact their health. The goal is to identify key risk factors contributing to health challenges among this population, enabling the development of targeted interventions. The statewide Arizona Veteran Survey was conducted to analyze the current impact of common social determinants of health for several demographics of Veterans. There were a total of 841 female Veteran respondents. The data on female Veterans' social determinants of health and the association with suicidality was analyzed using chi-square and logistic regression. A variety of social determinants were analyzed to evaluate their association with suicidality. Female Veteran respondents were 1.4 times more likely to experience suicidality if they were seeking care for mental health concerns, 1.8 times more likely if they felt isolated or lonely, 1.7 times more likely if they felt depressed or hopeless, and 2.5 times more likely to experience suicidality if they struggled to pay for or access medication in the past 12 months leading up to the survey. Female Veterans are a growing population disproportionately affected by experiences that elevate their risk of suicidality. The findings in this paper highlight the need for expanding services and resources while addressing inequities to improve overall well-being.

Black women bear a disproportionately higher burden of cervical cancer than any ethnic/racial group. Patient's cancer risk perceptions and patient-provider communication behavior may influence uptake of cervical cancer screening with Papanicolaou (Pap) test. We examined the association of cancer risk perceptions and patient-provider communication behavior and Pap test uptake. Black women completed a cross-sectional survey on sociodemographic, cancer perceptions, and perceived patient-centered communication behaviors. Multiple linear regression models were fitted to explore the association of perceptions and patient communication behaviors. Women (N = 116) average age was 40 ± 12.7 years and 73% had ever received a Pap test. Women who agreed with the statement that it seemed like everything causes cancer had over four times the odds of having had a Pap test (OR = 4.40, 95% CI = 1.38-13.97, p = .012) while those that responded that when they think about cancer, they automatically think of death had 73% lower odds of having had a Pap test (OR = 0.27, 95% CI = 0.08-0.95, p = .040). The odds of Pap test completion were over 4-fold among those who said their health care provider always or usually gave them the chance to ask health-related questions, compared to those who responded sometimes or never (OR = 4.11, 95% CI = 1.36-12.44; p = .012). Interventions to dispel myths and promote effective patient-provider communications are warranted to address anecdotal cancer risk perceptions and promote patient engagements.

Firearm-related injuries remain a significant public health issue in the United States, with patterns and trends among various age groups not well characterized. This study analyzed time series trends and disparities in firearm injury rates among U.S. working-age adults from 2000 to 2021. A retrospective analysis using data from the National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS) was conducted with a focus on non-fatal firearm injuries reported in emergency departments across a nationally representative sample of hospitals. Descriptive statistics were used to explore disparities across different demographic groups. Trends were assessed using locally estimated scatterplot smoothing (LOESS) and Joinpoint regression analysis. Between 2000 and 2021, an estimated 2.36 million non-fatal firearm injuries occurred, with males accounting for 85.7% and non-Hispanic Blacks (NHB) representing 48.8% of injuries. Firearm injuries were commonly associated with crime (29.8%), physical fights (24.7%), alcohol/substance use (17.7%), and verbal arguments (17.2%). Most incidents occurred on weekdays (63.7%) and assaults were the most prevalent intent (68.5%), followed by unintentional injuries (21.9%). Handguns (25.1%) and unspecified firearm types (61.2%) were the most commonly involved weapons. From 2000 to 2021, significant increases in firearm injuries were observed among those aged 26-45 years (23.0%), women (21.97%), NHB (42.15%), and those involving assaults (231.9%). Age-specific trends showed a significant annual percentage change (APC) increase of 4.9% for 18-25 years, 12.4% for 26-45 years, and 7.0% for 46-64 years from 2013 to 2021. Racial/ethnic trends revealed a significant APC increase of 5.0% for Non-Hispanic Whites (2014-2021), 25.0% for NHB (2015-2021), and a decrease of -31.3% followed by an increase of 15.6% for Hispanics (2012-2021). The disproportionate burden of firearm injuries among different age and racial/ethnic groups highlights the need for targeted prevention strategies and ongoing monitoring of injuries.

The Amish are a rapidly growing Christian ethnoreligious group located in the U.S. and Canada. Characterized by self-reliance and a caution regarding the acceptance of modern technologies, the Amish have traditionally relied on community-based mutual aid to finance health care expenditures instead of commercial insurance or public assistance options. However, the cost, structure, and efficacy of Amish mutual aid programs are not well-described. We surveyed 1006 Amish households in 12 states using a 31-question instrument that asked respondents about demographic information, their health, and participation in mutual aid organizations. Statistical analysis was performed with returned surveys. One hundred fifty-five surveys were returned for a response rate of 15.4%. 81% of respondents reported mutual aid membership. The reported annual health care spending ranged from $500 to $18,000 among nine mutual aid organizations. More than 90% of respondents indicated that they "agree" that their community will help them pay for health care, though 39% reported "sometimes" avoiding recommended medical care due to cost. There were statistically significant differences in treatment avoidance due to cost and perceptions of affordability between Indiana Amish and those in Michigan and Wisconsin. The financing mechanisms employed in our cohort included negotiating organizations, subscription models, and voluntary donation. Though mutual aid mechanisms were ubiquitous, the success of individual organizations may depend on Amish population distribution and relationship with health systems. Providers treating this population should understand Amish practices regarding medical billing. Further studies are necessary to develop institutional best practices for Amish and other self-pay populations.

Vaccine confidence is a critical antecedent of vaccine uptake. Little research has examined vaccine confidence among Asian communities, particularly the associations with acculturation and pre-migration experiences. We explored this issue among U.S. Vietnamese parents. Our study uses an explanatory sequential mixed-methods design to investigate the influence of American acculturation, Vietnamese acculturation, and pre-migration experiences on U.S. Vietnamese parents' vaccine confidence for their adolescents. A cross-sectional web-based survey (n = 408) was followed by semi-structured interviews (n = 32). Quantitative analysis showed that many participants reported high or complete trust in scientists involved in vaccine development (61%), federal agencies responsible for vaccine safety monitoring and licensure (53%), the CDC (62%), and the FDA (58%). High or complete trust in scientists was associated with a higher Vietnamese acculturation score [aRR = 1.20 (1.03-1.40)], while trust in federal government agencies was associated with English medical proficiency [aRR = 1.42 (1.15-1.76)]. Qualitative findings provided deeper insights, with many parents expressing trust in vaccine efficacy, safety, and the rigorous development and approval process. Pre-migration experiences in Vietnam had mixed influences on vaccine confidence. Some participants cited positive experiences with the national immunization program, while others were influenced by negative vaccine-related injury stories. Newer immigrants reported limited familiarity with U.S. health authorities. Language preferences (Vietnamese versus English) for vaccine information varied. Our study highlights the complex interplay of acculturation, cultural identity, language, and historical experiences in shaping vaccine confidence among U.S. Vietnamese parents and emphasizes the need to take these factors into account with tailored public health strategies.

Introduction: 50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death. Over 30% of PSH residents have post-traumatic stress disorder (PTSD), and many perceive their built environment (e.g., housing) as inadequate for mental and physical health recovery. It is unknown whether built environment factors moderate the relationship between PTSD and tobacco use among PSH residents.

Methods: We used baseline data from 400 participants in a smoke-free home intervention in PSH sites in the San Francisco Bay Area between 2022 and 2024. We explored whether perceived housing quality and perceived neighborhood safety moderated the relationship between PTSD symptoms and cigarettes per day (CPD) using linear mixed models.

Results: 62.8% of the participants were male, 41.8% were Black, 30.5% screened positive for PTSD, 54.3% rated their housing as average/poor, and the mean neighborhood safety score was 3.4 (SD 0.9). Mean CPD was significantly higher in participants with PTSD compared to those without PTSD among participants who rated their housing as good/excellent (5.1; 95% CI: 2.7, 7.5) or their neighborhood as safer (7.8; 95% CI: 2.8, 12.8). Mean CPD was not significantly different between those with and without PTSD among participants who rated their housing as average/poor or their neighborhood as less safe.

Conclusions: Perceived housing quality and neighborhood safety moderated the association between PTSD symptoms and CPD. Findings have implications for developing trauma-informed, multi-level interventions for tobacco use that combine individually directed approaches with those that consider the built environment.

Research examining Arab and Middle Eastern and North African (MENA) health disparities faces several research limitations. These obstacles include unrepresentative national data due to the absence of a MENA identifier on the US Census, and a lack of Arab/MENA American participant trust in surveying bodies. This research hesitancy prompts the need for targeted investigation of the barriers preventing Arab/MENA Americans from participating in health research. Using community- and patient-centered methods, we created and disseminated a patient-facing survey to identify barriers to Arab/MENA American research participation. Through regular meetings and collaboration with stakeholders on research instrument development and participant recruitment, a novel quantitative survey was created (April-May 2023) to identify barriers affecting Arab/MENA American participation in health research and to explore their experiences and opportunities for improvement in the healthcare sector. The survey instruments assessed interest in research, as well as the motivators and barriers to clinical research participation. The data were analyzed quantitatively using descriptive statistics and logistic regression models. A total of 149 respondents had non-missing values on both outcomes. The study sample was largely college educated and foreign-born. Over three quarters of respondents (77.5%) felt they knew what health research was while slightly less than three quarter of respondents (72.5%) would accept to participate in a health research study in the future. Those who were foreign-born, in lower income levels (< $65 k), or had low English proficiency or acculturation were less likely to report knowing what health research was. Facilitators to participating in research included a belief that participation would improve health, the idea of contributing to science, if monetary compensation was available, and if participation could be withdrawn at any time. These data further enhance our knowledge of Arab/MENA American comfortability with health research participation and can help inform future interventions. Immigration and sociodemographic factors are related to knowledge and willingness to participate as are several ideals including a desire to improve community health.

Teaching assistants (TAs) play a significant role in students' learning environment and experience but receive limited training in the non-curricular aspects of teaching and student support. Graduate students frequently engage in near-peer teaching, with student teachers with one or more years' experience compared to learners engaged in a structured teaching role. Academic institutions may perpetuate racism and its effects on health through institutional norms and pedagogy; training TAs to foster inclusive learning environments is therefore essential. In a complex, interdisciplinary public health Core curriculum, a required TA Training Institute was established to address the specific challenges of near-peer teaching. Content included managing sideways; effective modes of communication; boundary setting; referring students for support while taking care of one's own needs; and maintaining an inclusive learning environment, including managing heated, offensive, and/or tense (HOT) moments. The mixed-methods evaluation among 181 participants assessed 12 learning objectives; for all outcomes assessed, confidence in performing each job function was consistently high (87-100%) and increased statistically significantly post-training (McNemar p < 0.001). Lowest confidence was reported for responding to HOT moments (87%). TAs need training to support belonging and inclusion. This evaluation of a replicable training revealed significant improvements, with additional support needed to manage HOT moments.

The booming online shopping industry has accelerated the growth of logistic services, often subjecting workers to irregular schedules. This study aims to examine the association between night-shift work and health-related quality of life among logistics workers, with a special focus on the mediating role of sleep characteristics. A survey was conducted among logistics workers across China, who filled out an online questionnaire. The questionnaire collected information about shift work, sleep characteristics, health-related quality of life, various sociodemographic factors, and specific job categories. The Insomnia Severity Index measured sleep quality, while the 12-Item Short Form Health Survey assessed health-related quality of life, including the physical and mental components. Linear regression analysis and structural equation modeling were used to examine the proposed associations and conduct mediation analysis, respectively. Out of the 484 respondents, 352 (72.7%) worked night shifts. These workers were predominantly males, smokers, alcohol users, less educated, and those with longer working hours involved in goods transportation and distribution. Our results showed a considerable trend of declining general health when transitioning from day to night shifts. There was a negative association between the frequency of night shift work and physical health. Specifically, those who worked more than 12 night shifts a month reported poorer health compared to those working permanent daytime, after adjustments for confounding variables. Sleep quality emerged as a significant mediator in this relationship. Our findings underscore the need to prioritize improving sleep quality to enhance the health and well-being of logistics workers.

Black Americans are disproportionately affected by COVID-19 related disease and mortality due to longstanding social, political, economic, and environmental injustices. Although structural determinants of health have clear links to both COVID-19 disease and vaccine uptake, many public health researchers focus on the contribution of individual level trust in vaccine uptake, obscuring how distrust develops and is reinforced through continued systemic injustice. While much is known about relationship between individual trust and receipt of the COVID-19 vaccine, less is known about how structural racism and exposure to discrimination influence that association. Using survey data collected in the Chicago metropolitan area, we examined associations between structural racism, discrimination, and trust on two measures of vaccine acceptance: self-report receipt of any vaccine and completion of the primary series. Multiple variable logistic regression results suggest that participants who trusted the federal government to ensure a safe pediatric COVID-19 vaccine had higher odds of being vaccinated and completing the primary series. NH Black and Hispanic participants' distrust of their doctor to provide COVID-19 information reduced their odds of vaccine uptake. Trust in medical professionals was linked to higher odds of vaccine receipt for Hispanic participants but not for NH Black participants. Education consistently influenced the likelihood of receiving any vaccine for both NH Black and Hispanic participants, but not completing the primary series. Conversely, employment was strongly related to completing the primary series but not initial vaccine receipt. Measures of structural racism and discrimination had minimal impact on vaccine uptake in this sample.