Journal of Community Health最新文献

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.

Risky behaviours have been a global problem that affects both developed and developing countries. This study explored the risky behaviours and students' academic life in Higher Education Institutions (HEIs) in Tanzania. It was a qualitative study and data were collected through open-ended questionnaires, interviews, and documentary reviews. The study involved a sample of 94 undergraduate students and 3 hostel wardens making 97 participants from the selected university. The findings indicate that students involved in having more than one sexual partner, alcoholism, and unsafe sex, and were prone to be exposed to the Sexually Transmitted Diseases (STDs) that affected their academic life at university. The findings also indicate that having more than one sexual partner was the most alarming risky behaviour among students. The findings indicate further that female students were exposed to early pregnancies, carry-over cases, and poor academic performance in the University Examinations. It is argued in this study that if HEIs have to safeguard their students from risky behaviours, they need to strengthen the orientation programmes, guidance, and counselling services including gender-relation training programmes for students to cope with their studies and survive after their graduation. Nevertheless, enforcing the rules and regulations by dealing with those who violate them and provision of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and sexually transmitted infections (STIs) preventive programmes to safeguard the students also remain imperative.

Timely initiation of antiretroviral therapy (ART) for non-occupational post-exposure prophylaxis (nPEP) is crucial in preventing HIV infection and advancing efforts to end the HIV epidemic (EHE). nPEP must be administered within 72 h of high-risk exposure, ideally within 24 h. Pharmacies may play a role in increasing access to nPEP and facilitating referrals for additional care, such as PrEP. Recent legislation permits pharmacist-prescribed nPEP (PDP), though provider attitudes toward this change have not been studied. A survey querying physicians and medical trainees (students and residents) was conducted in 2024 during an annual state medical association conference. The survey included 24 questions on nPEP knowledge and attitudes towards pharmacist-prescribed nPEP (PDP). The survey was administered in person using electronic tablets, with voluntary participation incentivized by a monetary reward. Statistical analysis was conducted using SAS (9.4 version) software, with differences in responses between physicians and trainees evaluated. P values < 0.05 were considered statistically significant. Of 89 respondents (56% of attendees), 61 were physicians and 28 were trainees. Notably, 28% of licensed providers indicated that pharmacist-directed prescribing (PDP) should not be allowed in the State of Ohio, while no trainees expressed this same opposition (p = 0.001). Trainees were more likely to view pharmacist prescribing as safe and appropriate ((p = 0.0135, p = 0.013). Urban-based providers were more supportive of pharmacist prescribing than their rural counterparts (p = 0.0195). Trainees showed little opposition to PDP, whereas physicians expressed concerns about safety and appropriateness. Addressing these concerns is essential for integrating pharmacists into the EHE strategy.

Numerous medical associations have identified firearm injuries as a public health issue, calling on physicians to provide firearm safety counseling. Data suggest that while many physicians agree with this, few routinely screen and provide counseling. We aimed to survey Maine physicians to assess their current firearm safety counseling practices and knowledge of a new state child access prevention (CAP) law. We conducted an anonymous cross-sectional survey of Maine primary care and psychiatry physicians. We recruited multiple statewide medical organizations, residency programs, and two major health systems to distribute the survey to their membership. Group differences were compared by physician rurality and years in practice using Fisher's Exact and Chi Squared tests. Ninety-five surveys were completed. Though most participants agreed that firearm injury is an important public health issue that physicians can positively affect (92%), few had received prior firearm safety counseling education (27%). There were significant differences in firearm screening frequency, with rural physicians screening more often. More rural physicians and physicians with > 10 years of clinical practice felt they had adequate knowledge to provide meaningful counseling, compared with non-rural and early career physicians, respectively. Overall, 62% of participants were unaware of the 2021 Maine CAP law. This study highlights significant differences in firearm safety counseling practices among Maine physicians based on rurality and years of experience. Participants also reported a significant gap in knowledge of a recent state child access prevention law. Next steps include development of firearm safety counseling education tailored to Maine physicians.

Despite higher income and education, there are profound health disparities among Asian Americans. These disparities are highlighted in particular by screening behaviors for cancer. Between 1998 and 2008, cancer rates increased threefold among Indian Americans, raising concern that cancer screening in this group may be especially low. To better understand cancer screening behavior, we collected data from a total of 157 self-identifying Indian Americans residing in the greater Philadelphia area. Nearly all participants reported having health insurance (98.7%), and most had received a physical exam within a year (87.3%). Only17.4% of the participants were referred for mammography, while 30% of participants over age 30 were referred for ovarian cancer screening. Just 4 participants were recommended for pancreatic cancer screening. The findings contribute new information to the understanding of health needs of Indian Americans residing in the greater Philadelphia region and reveal a need for greater focus on preventive care.