Journal of Community Health最新文献

This study aims to examine the situation and factors associated with e-cigarette and heated tobacco products (HTPs) use among Vietnamese adolescents. We used data on e-cigarette use among youth in Vietnam from the 2022 Global Youth Tobacco Survey (GYTS), which is a school-based cross-sectional survey of secondary and high school students aged 13-15. Weighted prevalences of e-cigarette and HTP use were calculated. Factors associated with e-cigarette and HTP use were examined using multivariable logistic regressions. A total of 3,873 students aged 13 to 15 were included in the final analysis. The prevalence of ever use of e-cigarettes and HTPs was 7.8% and 1.5%, while the prevalence of current use was 3.5% for e-cigarettes and 0.6% for HTPs. Peer influence was associated with ever (aOR 2.43, 95% CI 1.78-3.31) and current e-cigarette use (aOR 1.86, 95% CI 1.16-2.97). Advertisement exposure was linked to ever (aOR 1.90, 95% CI 1.36-2.63) and current e-cigarette use (aOR 2.50, 95% CI 1.59-3.93), and ever HTP use (aOR 2.00, 95% CI 1.18-3.38). Current conventional cigarette use showed the strongest associations, with higher odds of ever e-cigarette (AOR 9.56, 95% CI 4.75-19.27), ever HTP (aOR 14.02, 95% CI 5.63-34.93), current e-cigarette (aOR 12.55, 95% CI 6.88-22.87), and current HTP use (aOR 12.35, 95% CI 2.33-65.38). This study highlights the rising prevalence of e-cigarette and HTP use among Vietnamese adolescents. Dual use of conventional cigarettes and these alternative tobacco products is strongly associated, emphasizing the need for targeted interventions.

The LGBTQIA + community faces unique health disparities that can lead to severe barriers to care. The Rainbow Clinic is a specialty clinic at the Columbus Free Clinic, a student-run free clinic affiliated with a large academic institution in the Midwest, that provides free primary and specialty care for uninsured and underinsured patients in Columbus, Ohio. Unfortunately, there is a paucity of literature depicting how to best reach these patient populations. This study sought to examine the outreach strategies for patient recruitment to the Rainbow Clinic with a retrospective chart review of past patients (N = 77). 44.2% of respondents discovered the clinic through social media. Age strongly and negatively correlated with appointment frequency (r = -0.665, p < 0.001), while income showed a moderate positive correlation (r = 0.464, p < 0.001). Preliminary data is a promising foundation for future research to improve recruitment of vulnerable populations. Correlations between age and social-media related appointments and income and social-media associated appointments can be helpful to address specific modes of outreach for target populations in the LGBTQIA + community.

44% of the governmental public health workforce plans to retire by 2026, creating an urgent need to strengthen public health academic pathways. While prior research has examined various aspects of public health education, no studies have investigated Master of Public Health (MPH) deferral patterns. We identified demographic, institutional, and temporal factors associated with deferred enrollment among individuals accepted to MPH programs and evaluated whether associations varied across MPH concentrations in the five core public health disciplines (biostatistics, epidemiology, environmental sciences, health policy & management, and health education & behavioral sciences). We pooled data from the Schools of Public Health Application Service (SOPHAS) spanning the 2012-2013 through 2023-2024 application cycles. The outcome was deferred enrollment (deferred vs. immediately enrolled). Independent variables included demographic (age, sex, race/ethnicity, U.S. citizenship), institutional (type, Ivy League status, MPH program delivery format), and temporal (COVID-19 era indicator, time, time squared) characteristics. Modified Poisson regression estimated adjusted associations between each factor and deferral status. Of 99,143 accepted students, 8,196 (8.3%) deferred enrollment. Primary analyses indicated that older age, minoritized racial/ethnic identity, admission to hybrid MPH programs, and admission during the COVID-19 era were significantly associated with deferring MPH enrollment. Conversely, female sex, U.S. citizenship, and admission to public, Ivy League, or distance-based programs were significantly associated with immediate enrollment. Secondary analyses showed that associations varied across the five core public health disciplines. Future research should examine the specific reasons why accepted students choose to defer MPH enrollment through targeted follow-up data collection.

Health challenges affecting American Indian/Alaska Native (AI/AN) individuals are well-documented, but rural/urban differences remain understudied. This analysis describes health and health care access for rural and urban AI/AN adults, with attention to the role of the Indian Health Service (IHS), which primarily serves rural areas. Using 2019-2023 National Health Interview Surveys, we included adult respondents identifying as AI/AN, regardless of other reported races and ethnicities. County of residence was classified as urban (metropolitan) or rural (non-metropolitan). Outcomes included usual place of care, cost-related underuse of care, emergency room visits, clinic visits, worries about paying medical bills, and self-rated health. We found that AI/AN rural residents had greater socio-economic risks (lower education and higher poverty levels), but more access to IHS than urban AI/AN adults (p < .01, all comparisons). Rural-residing AI/AN individuals were more likely than urban AI/AN people to have a usual place of care (93.8% vs. 84.8%, p < .01) and to avoid cost-related underuse of care (75.9% vs. 65.3%, p < .01). Nearly 3 in 4 AI/AN adults -rural and urban - described their health as excellent, very good, or good; however, this was higher for urban (78.5%) vs. rural (73.8%) respondents (p =.015). Rural and urban AI/AN adults with IHS were more likely to have a usual place of care and lower cost barriers than those without IHS (p <.01, all comparisons). Socio-economic risks are higher for rural vs. urban AI/AN adults, but care was more accessible and affordable among rural AI/AN adults, who had comparatively greater access to IHS care.

Malaria remains a public health concern. Asymptomatic individuals are significant reservoirs for onward transmission of malaria. Subclinical infections are directly detrimental to the health of individuals and populations. For effective malaria control, it is crucial to understand the burden of asymptomatic malaria (AM). This study assessed the seasonal prevalence of AM in a suburban community in Lagos, Nigeria. A total of 1,860 asymptomatic individuals were screened for Plasmodium falciparum using a rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). The overall detection rates using microscopy, RDT, and PCR were 2.7% (50/1860, 95%CI: 1.9-3.4), 8.8% (163/1860, 95%CI: 7.5-10.0), and 11.7% (218/1860, 95%CI: 10.3-13.2), respectively. Using PCR outcomes as the ground truth, RDT has a higher sensitivity when compared with microscopy (34.4% versus 22.0%). Although the two methods have high specificity, microscopy has a higher positive predictive value (96.0%) compared to RDT, at 46%. AM infection was more frequent during the wet season (14.9%), with a peak in June at 36.0% (54/150). In contrast, during the dry season, the rate was 7.2%. The frequency of AM was high among the school-age group (5-14 years), at 14.1%. AM carriage was more common in males, at 12.9%, compared to females, at 10.7%. This study presents evidence of a high frequency of AM infection during the wet season and among male individuals residing in Lagos. Curbing the onward transmission of the disease requires increased surveillance for AM nationwide to estimate its frequency, with a focus on younger individuals, especially during the wet season.

After the COVID-19 pandemic, racial and ethnic minority groups experienced disproportionate delays in returning to breast cancer. The GW Cancer Center's Community Outreach and Engagement team developed a novel Neighborhood Health Ambassador (NHA) network to increase knowledge and access to breast cancer screening in the Washington, DC metropolitan region. First, we recruited NHAs to complete a paid 100-h Community Health Worker (CHW) training and 44-h practicum. We coached NHAs to conduct community outreach and breast cancer screening education in their neighborhoods. Second, we partnered with two community-based organizations to arrange direct screenings for Hispanic/Latina and African immigrant women. Twenty-six NHAs completed the CHW Curriculum. Nineteen NHAs completed the practicum. NHAs reached 2,189 direct beneficiaries at 108 events over a year. GW Cancer Center staff navigated 21 women to mammograms. Out-of-pocket costs were paid to allow an additional 102 uninsured women to obtain mammograms. This project piloted a community-based network to strengthen breast cancer screening in the GW Cancer Center catchment area. Creating a grassroots network of community health workers is feasible and impactful, but time-intensive. Directly partnering with longstanding community partners yielded faster screening uptake among priority groups for breast cancer screening.

The Generation End Game (GEG) policy plan represents a groundbreaking initiative by the Malaysian government aimed at creating a smoke-free generation. This cross-sectional study aims to explore the factors influencing knowledge, attitude and perception of Malaysian adolescents towards the policy. A quantitative pre- and post-test survey was conducted among 731 adolescents born in 2007 and above across Malaysia, following a brief informational introduction to the GEG policy. This study utilized ANCOVA and binomial logistic regression to assess the association between various sociodemographic factors with knowledge, attitude and perceptions of the GEG. The results reveal that gender, tobacco-related experiences, peer influences, and health-related beliefs significantly impacted perception outcomes (p < 0.05). Female participants were significantly more likely to express supportive perceptions compared to male participants (unadjusted OR = 2.538, 95% CI = 1.598-4.030, p < 0.001). Non-smokers/vapers were more supportive of the GEG than smokers/vapers (unadjusted OR = 3.308, 95% CI = 2.032-5.384, p < 0.001). Participants who identified tobacco use as "definitely harmful" exhibited significantly greater support (unadjusted OR = 2.563, 95% CI = 1.522-4.315, p < 0.001). Individuals who reported no prior tobacco education were significantly less supportive (unadjusted OR = 0.321, 95% CI = 0.114-0.90, p = 0.031). The findings underline the need for targeted educational campaigns to address knowledge gaps and improve public understanding of the policy. Efforts to enhance perceptions of the harmfulness of tobacco use and its broader societal impacts could further bolster support for the GEG policy.

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.

Student-run clinics (SRCs) serve dual roles of providing essential healthcare services for underserved patients and in facilitating critical learning opportunities for students. However, the goals of service can conflict with the goals of learning. In the context of SRCs, this raises numerous dilemmas whose unintended consequences can have far-reaching effects. Similarly, while systemic inequities fuel the impetus for SRCs, they also simultaneously expose the operational vulnerabilities of these organizations. These can generate difficulties navigating the fine line between providing for our society's vulnerable patients and subjecting these patients to an enterprise that prioritizes training in ways that burden patients. Without an emphasis on sustainable reforms and continued resource investment to support changes, SRCs risk not only failing to meaningfully impact their patient populations but also unintentionally reinforcing the very inequities they aim to address. While some of these challenges have been individually addressed in the literature, attempts to characterize the range of potential conflicts and approaches to formulating best practices for addressing them remain limited.

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.