Journal of Community Health最新文献

Latinos face health disparities in Alzheimer's disease (AD), with high disease prevalence relative to non-Latino whites and barriers to healthcare access. Several studies have found misconceptions about AD among Latinos that were linked to reduced preventative or help-seeking behavior. To improve understanding of illness perceptions among Latinos, we examined beliefs about the causes of AD, one of the five dimensions of illness representations from Leventhal's Self-Regulation Theory, among a sample of N = 216 Latinos. We conducted in-depth, semi-structured interviews with participants aged 40 to 64 (average age 53 years) living in northern Manhattan. Seven distinct causes of AD were identified, though participants demonstrated a general understanding of AD as a multifactorial disease. Genetics was found to be the most endorsed cause of AD, followed by unhealthy lifestyle factors. Most Latinos who believed psychosocial factors played a critical role in AD development were first-generation immigrants. No participants attributed AD to a normal process of aging, and few ascribed the disease to brain damage from stroke or head injuries. Several participants expressed the belief that environmental contaminants can cause AD, which has received little mention in prior studies. Though only a small number thought AD could occur by chance, most participants remained uncertain about the exact causes of the disease and used lay knowledge to explain their beliefs. Our findings help identify areas where educational interventions would be beneficial in improving community knowledge and offer perspectives that can foster cultural competency in healthcare.

Vietnamese women have a higher incidence rate of cervical cancer and are less likely to have ever been screened for cervical cancer than their White counterparts in the US. This review synthesizes findings from published interventions to promote cervical cancer screening in this vulnerable population. Articles were identified through a systematic search of PsycInfo, Embase, Pubmed, Web of Science, and the Cochrane Register of Controlled Trials in October 2022. Articles were included if they were published in a peer-reviewed journal, written in English, included one or more interventions promoting cervical cancer screening, assessed at least one outcome relevant to screening, and included a sample of ≥ 70% Vietnamese participants. Quality assessment scores were computed using the Downs and Black Checklist. Fifteen articles met review inclusion criteria. Studies were, on average, of good quality. Most studies were conducted in the US (n = 12), used a quasi-experimental design (n = 9), and employed multiple intervention strategies (n = 12). Intervention strategies included educational sessions, lay health worker (LHW) outreach, small media, mass media, patient navigation, and community or healthcare-based strategies. The most common study outcomes were screening intention and receipt. All but two studies reported improved cervical cancer screening outcomes following intervention. Findings support the effectiveness of multicomponent culturally tailored interventions to improve cervical cancer screening outcomes in immigrant Vietnamese women. Further research is needed to determine whether these interventions will be as successful in non-US countries and to address broader community- and healthcare-based factors in screening.

The increasing reliance on digital tools for standard healthcare practices in uninsured populations is poorly understood. This study aims to assess the impacts of a newly implemented digital reimbursement system at a student-run primary care clinic associated with an academic medical institution serving uninsured New York City residents. Pharmacy records of 94 unique patients receiving a total of 2770 reimbursements between October 17th, 2016, and May 18th, 2023, were analyzed. Patients were divided into two groups (in-person vs. digital) based on their reimbursement preferences type. Demographic analyses were performed in addition to assessing reimbursement volumes, number of refunds, and duration until receipt of payment for each group. The clinic's total monthly reimbursement volume, number of prescriptions, and number of patients for the period before introduction of digital refunds was compared to the period after. The mean age (in-person = 52.7 ± 14.7 years, digital = 54.9 ± 12.9 years) was not statistically different between the groups. Patients in the digital group requested on average more refunds (digital = 47 refunds, in-person = 14 refunds), received higher total reimbursement amount (digital = $1131.24, in-person = $289.36), and they were reimbursed faster (digital = 56 days, in-person = 62 days). Since the introduction of the digital reimbursement option, our three-month reimbursement volume more than doubled from $481 to $1298. The average number of monthly reimbursements increased from 27 to 45 refunds, and the number of monthly patients increased from 6 to 9 patients. In summary, digital reimbursement options can facilitate medication reimbursement among uninsured patients. These results suggest that digital reimbursement systems result in higher utilization, faster refunds, and larger total reimbursements amount for uninsured and underserved patients.

Racially and ethnically diverse populations and individuals residing in rural areas were disproportionally impacted by the coronavirus pandemic, and Eastern North Carolina (ENC) is one region where such impacts were apparent. To understand at-risk individuals' perceptions and hesitancy to COVID-19 vaccines and the preferred means of receiving vaccination-related messages, we conducted four qualitative focus groups (N = 40) with diverse rural ENC residents. The analysis of the focus group transcripts revealed five themes: (1) reasons people trusted the COVID-19 vaccines, (2) reasons people mistrusted the COVID-19 vaccines, (3) the best means to deliver messages regarding COVID-19 vaccination, (4) the individuals trusted most to deliver such messages, and (5) the decisions people made regarding whether to get vaccinated and how that was connected to God. By incorporating participant perspectives and preferences in receiving messaging into campaigns, there is a potential for greater vaccine uptake.

Although health promotion is not the primary function of public libraries, it is well documented that many libraries engage in health promotion activities, even when resources are constrained. Less understood is the readiness of the public library workforce, particularly in rural communities, to implement evidence-based health promotion programs. This study uses a modified version of the Competency Assessment for Tier 2 Public Health Professionals to assess the readiness of a small sample (n = 21) of Oregon rural library managers to implement evidence-based health initiatives. Results show that outside of communication skills, most rural library workers do not consider themselves to have proficiency in core health promotion competencies. Although some slight differences were found among librarians based on socio-demographic factors, those differences were not statistically significant. Implications include the need for strengthened support to build the capacity for rural public library workers who are interested in delivering evidence-based health promotion programs.

Refugees arriving to the U.S. experience a high burden of both communicable and non-communicable diseases. There is a potential to improve health outcomes for refugees through well-developed, comprehensive interventions, but the effectiveness of such interventions is poorly understood. The purpose of this review is to identify, characterize and evaluate the effectiveness of patient-level healthcare interventions for U.S. refugee populations. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline via PubMed, Web of Science, Embase, and CINAHL were searched for articles that included a population of refugees of any age, included an intervention aimed at improving health, included an evaluation of the intervention's outcomes, and were conducted in the U.S. from 2000 to 2022. Thirty-seven studies were included, and we identified three main intervention modalities: healthcare provision/management, resource provision, and education. Interventions targeted general health, infectious disease, women's health, diet/exercise, health literacy, oral health, diabetes, family health, and substance use. The outcomes measured included knowledge, satisfaction, behavioral outcomes, and physical health markers. This review demonstrates that a few health conditions, namely tuberculosis, have been addressed with large-scale, sustained interventions. Other conditions (general health and women's health) have been addressed through piecemeal, short-term interventions. The evaluation of interventions often focuses on knowledge or satisfaction rather than health or behavior change outcomes. Future work should focus on the best strategies for developing sustainable interventions that meet the needs of the diverse population of refugees in the U.S.

Purpose: LGBTQ + community connectedness is generally a protective health factor for sexual and gender minorities. However, existing scales have not been validated among Black sexual minority men living with HIV (SMMLWH), who face unique marginalized experiences that disproportionately impact several health outcomes compared to the general LGBT + community. We validated the Connectedness to the LGBT Community Scale among Black SMMLWH.

Methods: We validated the 9-item Connectedness to the LGBT Community Scale from Frost and Meyer using preliminary data from a cohort of Mid-Atlantic Black SMMLWH (n = 650). Factor analysis and intercorrelations were conducted to assess unidimensionality, and Cronbach's alpha was measured for reliability. Correlations and cumulative ordinal regression models were generated using internalized homophobia, hopelessness, depression, HIV stigma, social support, and resilience as criterion constructs. Models were adjusted for sociodemographic and behavioral characteristics.

Results: The Connectedness to the LGBT Community Scale demonstrated high internal consistency (alpha = 0.948) and strong item intercorrelation with a single factor structure. The scale was associated with all criterion measures before and after adjustment, including lower internalized homophobia (aCOR = 0.19, 95% CI 0.15-0.25), lower hopelessness (aCOR = 0.53, 95% CI 0.41-0.68), lower HIV stigma (aCOR = 0.58, 95% CI 0.47-0.72), and lower depression (aCOR = 0.61, 95% CI 0.50-0.75). The scale was also associated with greater social support (aCOR = 2.38, 95% CI 1.91-2.97) and resilience (aCOR = 2.53, 95% CI 2.03-3.15).

Conclusion: The Connectedness to the LGBT Community Scale is a valid measure for use among Black SMMLWH. Future studies should explore relationships between community connectedness and HIV care outcomes and quality of life among Black SMMLWH.

Each year in the United States (U.S.) thousands of older adults die from firearm-related injuries. The purpose of this study was to characterize the similarities and differences in the three main forms of firearm mortality (homicides, suicides, and unintentional) in older adults. Using the Web-based Inquiry Statistics Query and Reporting System (WISQARS) for the year 2021 we conducted a descriptive analysis (e.g. frequencies, percents, crude rates, rank orders) by gender, race/ethnicity, age, and census region of the U.S. Older adult firearm-related homicides were most likely to occur in males (61.2%), non-Hispanic whites (61.9%), ages 65-69 (42.4%) and in the South (53.6%). Firearm-related suicides were most common in males (91.4%), non-Hispanic whites (93.5%), ages 65-69 and 70-74 (24.8 and 24.7%, respectively), and in the South (45.1%). Firearm suicides were 12 times more common than firearm homicides and 99 times more common than unintentional firearm-related deaths. Both firearm homicides and suicides decreased with age. Years of potential life lost before 80 paralleled the demographic mortality data, resulting in over 45,000 potential years of life lost in 2021. These findings underscore the need to focus primary prevention of firearm-related mortality in older adults on the role of suicides, especially in non-Hispanic white males. In addition, improving mental health care access for older adults and their social connections are essential elements of preventing firearm-related suicides.

Health care disparities within the LGBTQIA+ community are readily apparent. Guidelines have been published regarding breast cancer screening for transgender individuals. Uptake of these recommendations is widely unknown. The purpose of this study is to determine the current knowledge base of providers regarding these recommendations within our academic hospital system. A voluntary, anonymous survey was e-mailed to 303 recipients via RedCap to physicians within our academic hospital system. This assessed the respondents' current knowledge and comfort regarding breast cancer screening recommendations in the transgender population. 85 responses were received for a response rate of 28.1%. Descriptive statistics for all survey questions was conducted. 82.4% of respondents report caring for transgender patients. 62.4% report that they are not familiar with the current screening recommendations, and few (10.6%) have received formal education regarding the topic. The majority of respondents reported that they would be interested in receiving formal training. The results suggest that there is no difference in how individuals rate their current comfort level discussing breast cancer screening recommendations for the transgender population despite their current level of education. Our findings suggest that, while the majority of providers within our academic hospital system care for transgender patients, they are unfamiliar with current breast cancer screening recommendations and have received no formal training. The results also suggest that providers are interested in receiving formal education.

Crime is a public health issue that disproportionately affects racially-marginalized populations. Studies have reported that food stores (e.g., grocery stores, convenience stores) often attract crime due to their volume of cash transactions and limited security. Little is known about how exposure to crime at food stores affects nutrition or health. This study aimed to fill this research gap by exploring the lived experiences of Black Americans. In 2023, 502 Black-identifying adults completed a survey online. They reported their socio-demographics, fruit and vegetable (FV) consumption, food security status, height, weight, and experiences with crime at food stores in their community. Multivariable-adjusted regression models were examined to identify associations between exposure to crime at food stores and the following measures: low food security status, obesity status, and daily servings of FVs. Approximately 150 (29%) participants avoided one or more food stores in their community due to crime; 102 (20%) had witnessed a crime at a food store. Those who avoided food stores had greater odds of low food security (OR: 1.94; 95% CI: 1.25-3.02) and obesity (OR: 2.15; 95% CI: 1.33-3.48) compared to others. Those who witnessed a crime had greater odds of low food security (OR: 3.14; 95% CI: 1.82-5.41). Exposure to crime at food stores was not associated with FV consumption after adjusting for socio-demographics. Exposure to crime in food stores may have negative health and nutritional implications. Future studies should explore these implications for populations that are disproportionately affected by crime.