Journal of Community Health最新文献

Chemsex entails potential risks that may lead to medical emergencies. This cross-sectional study analyzed data from an anonymous, self-administered online survey on substance use among 1,203 sexual minority men (SMM) who engage in chemsex in Spain. The study aimed to determine the proportion of chemsex users that have sought emergency care following a session, identify their reasons for consultation, examine associated sociodemographic factors, and assess the proportion who felt they should have sought emergency care but did not. Frequencies of emergency consultations following chemsex sessions and episodes where participants felt they should have sought care but did not were calculated. Associations between seeking emergency care and sociodemographic and substance use factors were analyzed using Poisson regressions. Reasons for consultation were categorized based on responses to an open-ended question. 15.4% (95%CI:12.9-17.8) of chemsex users sought emergency care to request HIV post-exposure prophylaxis (PEP), and 4.0% (95%CI: 2.9-5.1) for other reasons. However, 21.8% (95%CI:19.3-24.2) did not seek care despite feeling they should have. The most common reasons for consultation were overdose symptoms, STI symptoms, and trauma. Living in smaller towns was associated with 2.4 times lower likelihood of visiting emergency services (95% CI:1.2-5.0). Injection substance use and mephedrone use were associated with 2.7 (95%CI:1.2-5.9) and 2.3 (95%CI:1.0-5.2) times higher likelihood of seeking care, respectively. Emergency visits for reasons other than requesting PEP were infrequent among chemsex users; however, a notable percentage felt they should have sought care but did not. Risk reduction strategies should prioritize addressing injection use and mephedrone consumption.

Background: With 8.4% of Americans uninsured, free clinics serve as essential safety nets for underserved populations. This study compared the demographics of the patients of a student-run free to Toledo, Ohio, and national census data to evaluate health needs, barriers to care, and the characteristics of the underserved population.

Methods: A retrospective review of 1,338 visits across five clinic sites was conducted from February 2023 to February 2024. Demographic variables, including race, insurance, education, sex, and primary language, were analyzed and compared to 2020 Census data from Toledo, Ohio, and the United States.

Results: Compared to Toledo, the clinic served 22.63% fewer White patients, 17.27% more Hispanic/Latino patients, and 5.62% fewer African American patients. Among clinic patients under 65 years, 61.91% were uninsured, compared to 8.3% in Toledo and 10.2% nationally. Non-English speakers were overrepresented (33.4% vs. 6.8% in Toledo and 9.5% nationally), with Spanish speakers making up 21.72% of clinic patients compared to 3.2% in Toledo. Educational attainment differed slightly, with fewer high school graduates (82.97% vs. 87.10% in Toledo) but more individuals with higher education degrees (27.10% vs. 19.6% in Toledo and 25.6% nationally).

Conclusions: This study underscores the demographic differences between CCC patients and city, state, and national populations, offering insight into the populations most reliant on free clinics. Policymakers and public health agencies must consider these disparities to tailor interventions addressing healthcare access and social determinants of health.

Historically, Aboriginal and Torres Strait Islander research in Australia has adhered to Western research paradigms and contributed to the adverse impacts of colonisation. However, recent developments driven by Aboriginal and Torres Strait Islander people and scholars, and development of ethical guidelines for research, have promoted a more inclusive and collaborative research landscape. In this study, published papers and internal documents arising from a long-term partnership between Marninwarntikura Women's Resource Centre (MWRC) and the University of Sydney (USYD) from 2009 to 2023 were analysed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool and consultations with project partners. Every project had Aboriginal and Torres Strait Islander governance, leadership, and inclusive consultation; was driven by community-identified priorities, built local capacity, and benefitted the community. There was an increase in the use of Indigenous research paradigms and data/intellectual property (IP) agreements over time, reflecting responsiveness to community leadership. This partnership exemplifies community-driven, co-designed, Aboriginal-led health research and serves as a model for effective collaboration with Aboriginal and Torres Strait Islander communities.

The WIC program coverage rate of eligible population is suboptimal despite the well-known positive health outcomes of participation. Various factors contribute to this trend. This study aimed to examine beliefs regarding the decision to stay on WIC held by clients using the theory of planned behavior. During May and June of 2023, clients of one WIC office (N = 727) in northern New Jersey participated in a cross-sectional survey. Participants completed an online survey in English or Spanish. In the questionnaire, respondents were asked to rate their degree of agreement to the statement that described intention, attitudes, subject norm and perceived behavioral control of staying on WIC behavior, and their respective underlying beliefs in addition to a set of demography questions. Descriptive analyses and regression analyses were performed to describe and determine most influential factors to the intention to staying on WIC, and the results were compared by program enrollment duration: less than one-year (n = 276) vs. one or more years (n = 451). Most respondents were Hispanic (93.4%) and stay-home mothers (63.8%). Subjective norm was most influential to the intention to staying on WIC as a whole (β=.460, p <.0001) and when compared by the duration of WIC enrollment. Future outreach efforts focusing on participants category could be effective to improve the participation rate. Continued efforts to modernize WIC services by offering online options to appointments, education, and shopping could be attractive to families to enroll and continue their engagement with the program.

Alzheimer's disease (AD) is a debilitating neurodegenerative illness that has become a growing concern for older adults. As such, apolipoprotein E (APOE) genetic testing has become more commonly used to identify individuals' susceptibility to AD. An underrepresented population in AD research, Latinos will be disproportionately affected by AD in the coming decades. To better aid efforts in education and genetic risk counseling for Latino populations, we must first understand the anticipated psychological and behavioral consequences of APOE genetic risk counseling. We conducted semi-structured interviews with 216 Latinos between the ages of 40 and 64 (average age = 53 years) in northern Manhattan to ascertain their hypothetical reactions to learning that they had a higher risk of developing AD compared to other Latinos within their community. Responses were categorized as emotional, practical, and mixed responses. Among our sample, women were more likely to anticipate an emotional response to hearing that they had a higher risk of AD, and participants above the age of 60 were more likely to anticipate disclosing their risk information to immediate family members. Findings support the tailoring of genetic risk counseling sessions across different ethnic groups, genders and age groups. Future work may include the development of psychological and practical support tools for Latinos seeking APOE genetic testing and counseling.

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.