Journal of Community Health最新文献

The rise in demand for firearm licenses in Israel due to the ongoing 2023-2024 Israel-Gaza War, coupled with the easing of regulations for issuing weapons, is expected to lead to a significant increase in the incidence of firearms among civilians. This situation calls for a special awareness of civilian populations of the dangers posed to children by the high prevalence of firearms. We therefore present trends in firearm-related incidents resulting in unintentional mortality and morbidity of children ages 0-17 between the years 2008-2023 in Israel. In total, 202 accidents involving firearms were reported, with an average age of 12.2 (median: 13), and with the youngest child being 2 years old. Of these, 24 cases resulted in fatalities18 of which of children of Arab descent. We provide several recommendations concerning changes and additions to current bylaws concerning firearms licensing and storage in Israel, in order to decrease the risk of child injury due to irresponsible firearm handling.

Free clinics are a widespread, yet limited research has examined the health status of people served and the cost effectiveness of free clinics. The purpose of this study was to describe the sociodemographic characteristics and prevalence of chronic conditions in patients seen at a free clinic and estimate the clinic's cost-effectiveness. The study was a retrospective chart review of 350 randomly selected paper medical charts (2009-2020) and 1,676 electronic medical records (2020-2022) at the Noor free clinic in California supported by private donors, non-profits, and foundations. Cost-effectiveness was calculated from annual clinic operating costs, services provided, quality-adjusted life years (QALYs) saved, and projected savings from preventing emergency department visits. Of the 350 paper charts reviewed, 336 met inclusion criteria. Patients had an average age of 46.6 years, with most identifying as female (60%), Hispanic (69%), Spanish-speaking (62%), and employed (59%). About 64% had incomes below the federal poverty line. Chronic conditions included overweight/obesity (75%), chronic pain (46%), hypertension (28%), hyperlipidemia (24%), type 2 diabetes (24%), and mood disorders (23%). A quarter of patients had at least one chronic condition, and over half had multiple conditions. The clinic's services in 2022 resulted in an estimated 146 QALYs saved, $11.5 million in cost savings, and a return on investment of $13.18 per $1 invested. The free clinic provided medical care to low-income, Hispanic populations without insurance who historically have been disenfranchised from healthcare access. Cost-effectiveness analysis suggested that it provided significant health benefits and cost savings.

Betel quid chewing is a culturally significant practice among the indigenous people (Orang Asli) in Malaysia, but it poses serious health risks, including oral cancer and systemic diseases. Studies on betel quid chewing are limited, making it difficult to develop effective public health interventions. This study aimed to explore the cultural significance, perceived health effects, and misconceptions surrounding betel quid chewing among the indigenous people, assess their awareness of health risks, and explore factors influencing their intentions to quit or reduce betel quid chewing. A qualitative phenomenological design was used, with five groups of Focus Group Discussions conducted with 15 participants from an Orang Asli village in Johor. The discussions revealed that betel quid chewing is deeply embedded in Orang Asli culture, often beginning in childhood and associated with social and ceremonial occasions. However, awareness of health risks, particularly oral cancer, was inconsistent. Social support and personal motivation were critical in influencing quitting behaviors. These findings highlight the need for culturally tailored cessation programs that address the unique social and environmental factors influencing betel quid use in this population.

American Indians and Alaska Natives (AI/AN) have consistently exhibited suicide rates that surpass all other racial and ethnic groups in the United States. However, not much has been published regarding the epidemiology of AI/AN youth suicides. The objectives of this study on AI/AN adolescents were to assess the prevalence of suicidal thoughts and behaviors by age and gender, assess the number of years of life lost to suicide before the age of 80, and assess the most common methods used to commit suicide by AI/AN adolescents. Data utilized for this study were from the national Youth Risk Behavior Surveys and the Web-Based Injury Statistics Query and Reporting System. We conducted a cross-sectional descriptive analysis of the suicide-related data from years 2015, 2017, 2019, and 2021. We found AI/AN adolescents averaged one in four contemplated suicides, one in five planned suicides, and one in six attempted suicides. A total of 257 adolescents committed suicide during the study period where the majority (62.5%) were observed in males and suicides were more common in older adolescents. AI/AN adolescents had the highest crude suicide death rate of any racial or ethnic group and the most common methods used to commit suicide were suffocation (57.5%) and firearms (35.5%). AI/ AN adolescents lost almost 16,000 years of potential life during the four years of the study and the majority were lost by males. Professionals and policymakers desiring to reduce suicidal thoughts and behaviors among AI/AN adolescents need to focus more of their efforts on providing youths with resilience factors to establish sufficient ego strength in them to deal with all types of stressors. Concurrently, federal, state, and tribal leaders need to work together to improve the social and economic circumstances faced by many AI/AN families and children.

The aim of this project is to explore perceptions towards and adherence to COVID-19 public health preventive measures in Indigenous communities within Northwest Territories, Canada. Utilizing a cross-sectional study design the project took place within ten Northwest Territories communities between 1st April and 30th November 2021. Convenience sampling methods were utilized and adhered to public health restrictions. Self-identifying Indigenous adults (≥ 18 years old) were invited to complete a semi-structured interviewer-administered questionnaire. Participants (n = 287; 33.1% men, 66.6% women) had a mean age of 41.6 years (SD ± 13.5). Preventive measures were practiced by 98.6% of participants. Most participants reported often or always practicing three measures: avoiding gatherings (67.2%), avoiding usual greetings (63.3%), and limiting contact with high-risk individuals (71.4%). Most participants reported rarely/never practicing self-isolation (67.5%) and self-quarantining (76.5%) measures. Significant associations existed between the August 2021 COVID-19 outbreak and self-quarantining (p = 0.0023), self-isolating (p = 0.0023), and going onto the land (p = 0.0001). Participants found masking and travel restrictions challenging. Sadness and loneliness resulted from limited access to Elders. Kinship and community safety were important to Indigenous community members and influenced COVID-19 preventive measure utilization. The findings can inform culturally specific COVID-19 public health policy development.

The COVID-19 pandemic led to an increased use of social media, with many people turning to it for social support. Given the varying effects of social media, this study examines how social media use influences the willingness of adults in the State of Florida to participate in COVID-19-related research. The study used data collected through the Florida Statewide Registry for Aging Studies (FSRAS), which included 587 participants who were 25 years and older. The primary outcome variables were COVID-19 treatment and COVID-19 vaccine research. Ordinal logistic regression was used to evaluate the association between social media use and willingness to participate in COVID-19 treatment and vaccination research, adjusting for sociodemographic variables. The analysis did not find a statistically significant relationship between social media use and the likelihood of participating in COVID-19 research. However, significant differences were observed across racial/ethnic groups. Participants who identified as "Hispanic/Latino" (OR-2.44, 95% CI-1.11-5.35, p = 0.03) and "Other" (OR-12.51, 95% CI-1.98-79.22, p = 0.01) were significantly associated with willingness to participate in a COVID-19 treatment research. Similarly, participants of all other races/ethnicities were significantly more willing to participate in research testing COVID-19 vaccines. Additionally, females were more likely to express willingness to participate in COVID-19 vaccine research. Social media use did not significantly affect willingness to participate in COVID-19 treatment and vaccine research; however, racial and ethnic differences significantly influenced willingness to participate. These findings suggest that implementing targeted culturally sensitive recruitment strategies and community engagement efforts can improve participation in COVID-19 research.

Little is known about how location of specialty care affects accessibility for uninsured patients at free clinics. To address this gap, the specialty referral completion rate by location and role of demographic and referral-specific factors were analyzed at an urban-based free clinic. A retrospective review was performed at a single site, student-run free clinic exclusively serving uninsured patients. Referral completion rate and predictors of referral completion were examined including age, race, ethnicity, sex, referral type, and location of referral. Significant predictors (p < 0.05) were included in the adjusted model if the associated odds ratio (OR) was meaningful. A total of 351 referrals met criteria. Completion rate was 53.6%. Co-location of specialty services was associated with a higher completion rate (64.7%, p < 0.001) and counseling referral type had a lower completion rate (11.5%, p < 0.001). Significant predictors of referral completion included sex, ethnicity, location of referral, and referral type (p < 0.001). Hispanic patients had higher rates of completion (68.4%, p < 0.001). On multivariable analysis, non-co-located fee-for-service hospital referrals had lower odds of completion when compared to co-located referrals at the free clinic (OR = 0.25, CI 95% [0.12-0.54], p < 0.001). Also, when compared to other types of referrals, counseling referrals had a 25 times lower odds of referral completion (p < 0.001). There was a higher completion rate of co-located referrals suggesting that multiple locations and health systems may deter patients from seeking necessary care. The lower rate of counseling referral completion indicates that additional efforts are needed to make these services more accessible to uninsured patients.

This study examines the relationship between health insurance literacy, as indicated by confidence in comprehending health insurance terms, and health status using cross-sectional data from 8 waves of the Health Reform Monitoring Survey (HRMS), covering 61,895 individuals from 2013 to 2017. An ordered logistic regression model was employed with self-rated health status on a five-point Likert scale as the dependent variable and the score of confidence in understanding health insurance terms as the primary independent variable. The model adjusts for variables such as access to care, insurance status, concerns about affordability leading to missed care, household size, family income, employment, education, race, marital status, and gender. Results suggest a positive association between higher confidence in understanding health insurance and superior health statuses. These findings underscore the significance of improving health insurance literacy and advocating for potential policy interventions to enhance public understanding of health insurance benefits and coverage options.