Journal of Community Health最新文献

The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.

Background: Approaches to prevent and manage diabetes at a community population level are hindered because current strategies are not aligned with the structure and function of a community system. We describe a community-driven process based on local data and rapid prototyping as an alternative approach to create diabetes prevention and care management solutions appropriate for each community. We report on the process and provide baseline data for a 3-year case study initiative to improve diabetes outcomes in two rural Nebraska communities.

Methods: We developed an iterative design process based on the assumption that decentralized decision-making using local data feedback and monitoring will lead to the innovation of local sustainable solutions. Coalitions act as community innovation hubs and meet monthly to work through a facilitated design process. Six core diabetes measures will be tracked over the course of the project using the electronic health record from community clinics as a proxy for the entire community.

Results: Baseline data indicate two-thirds of the population in both communities are at risk for prediabetes based on age and body mass index. However, only a fraction (35% and 12%) of those at risk have been screened. This information led both coalitions to focus on improving screening rates in their communities.

Discussion: In order to move a complex system towards an optimal state (e.g., improved diabetes outcomes), stakeholders must have access to continuous feedback of accurate, pertinent information in order to make informed decisions. Conventional approaches of implementing evidence-based interventions do not facilitate this process.

Backgroud: Socioeconomic status (SES) plays a vital role in determining vaccination uptake and attitudes. Vaccine hesitancy varies among different communities, yet knowledge of vaccine attitudes among Asian-Americans is limited.

Objective: This study aims to investigate the relationship between SES and vaccine attitudes among Asian-Americans in the State of New Jersey (NJ).

Methods: Asian-Americans aged ≥ 18 years living in NJ were included (N = 157). SES was measured by education level, employment type, employment status, and household income. The primary outcomes were vaccine hesitancy, reluctance, and confidence for COVID-19, influenza, and pneumococcal vaccines. Descriptive and inferential statistics were performed. Multivariable logistic regression was used to identify associations between SES and vaccine hesitancy while controlling for confounders such as age, gender, birthplace, and religion.

Results: Among 157 participants, 12.1% reported vaccine hesitancy. There was no statistically significant association between vaccine hesitancy and education level (p = 0.68), employment status (p = 1), employment type (p = 0.48), and household income (p = 0.15). Multivariable logistic regression modeling confirmed that none of the SES predictor variables were associated with vaccine hesitancy. However, as exploratory finding, gender was found to be a significant predictor, with males having lower odds of vaccine hesitancy than females (Adjusted OR = 0.14; p < 0.05). Confidence in influenza and pneumococcal vaccines increased during the pandemic, from 62.34% to 70.13% and from 59.2% to 70.51%, respectively. For the COVID-19 vaccine, 73.1% of participants reported having "a lot of confidence" in taking vaccine.

Conclusion: Most sampled Asian-Americans in NJ have high confidence in taking COVID-19 vaccines, and there is no significant association between vaccine hesitancy and SES.

Air pollution is a pervasive global public health threat. The purpose of this study was to assess the content of 100 widely viewed English language YouTube videos on air pollution using the search term 'air pollution.' Content categories were created using comprehensive fact sheets and were coded as being present or not in each video. Cumulatively, the 100 videos sampled received 32,826,294 views and 303,692 likes, with averages of 328,263 and 3,068 respectively. The majority of videos (n = 72) were created by broadcast or internet-based news, 12 of the videos were created by professionals, 7 were created by a consumer and 9 were created by others. Three kinds of content were featured in a majority (> 50%) of the videos: "sources of pollution," "environmental impacts," and "solutions offered" and the videos covering each of these topics collectively garnered more than 26 million views and 249,000 likes. Independent one-tailed t-tests (α = 0.05) showed an association between covering sources of pollution and the number of views and likes. For both, videos featuring this content had a higher average number of views (467,391.08 vs. 80,924.03, p = .0383) and likes (4,450.78 vs. 647.03, p = .0383). Additionally, videos showing environmental impacts received more views than those that did not (547,901.49 vs. 80,585.43, p = .0373). This research can serve as a starting point to describe information being conveyed about an important global public health problem. Future research is needed to improve understanding about ways to utilize YouTube and other social media for public health education and advocacy to increase consumers' awareness and facilitate the informed decision-making process.

This study is the first to report the results of a scan of the official webpages of all public and private colleges and universities in the state of Oregon, including but not limited to student health services webpages and student handbooks, to identify available services, policies, and educational information on HPV vaccination. The purpose is to describe vaccination services (with a focus on the HPV vaccine), prevention efforts, and institutional policies on vaccination on college and university websites in Oregon. An online scan was conducted from September to November 2020 to collect and describe data from college/university websites across Oregon. Colleges/universities were obtained from the National Center for Education Statistics website. The final sample included 48 colleges/universities. Twenty colleges/universities have a health center with 11 providing the HPV vaccine on campus: most are large public universities and non-religious private colleges. A few religious private universities and one community college offer the vaccine on campus. More than half (n = 26) of Oregon colleges/universities had a webpage specifically designated for immunization information, but only 11 mentioned the HPV vaccine on their immunization webpage. Twelve colleges/universities recommend, and none require the vaccine. Information on HPV vaccination services and education was limited on college/university websites, especially on community college and religious private university websites. Most colleges/universities with a student health center recommend and offer the HPV vaccine on campus. College/university websites may be a low-cost and effective medium to increase HPV vaccination awareness, encourage immunizations, and prevent HPV-associated cancers.

Acute myocardial infarction is a significant health issue, particularly in Jordan where ischemic heart disease is the leading cause of death. Effective management of acute myocardial infarction is essential to mitigate its consequences. Although health literacy is crucial for the successful management of acute myocardial infarction, research about the strengths and needs of health literacy among acute myocardial infarction patients is still limited. This study was conducted to identify the health literacy strengths and needs of Jordanian acute myocardial infarction patients using cluster analysis. A cross-sectional design was used to conduct this study in a sample of acute myocardial infarction patients in Jordan (N = 114). A demographics questionnaire and the Health Literacy Questionnaire were used to collect the data. Data analysis was performed using hierarchical cluster analysis using Ward's method. Seven distinct clusters of acute myocardial infarction patients were identified, each characterized by unique health literacy profiles and sociodemographic characteristics. Cluster 7 had the highest health literacy scores across all nine Health Literacy Questionnaire scales. Sociodemographic factors such as age, education level, and gender influenced health literacy levels, with female, younger, more educated patients exhibiting higher health literacy. Through identifying the specific strengths and needs, this research provides a foundation for developing targeted health literacy interventions for acute myocardial infarction patients. Improving health literacy among acute myocardial infarction patients can enhance their ability to manage their health and potentially reduce the complications associated with acute myocardial infarction.

Background: The purpose of this study was to evaluate potential predictors of no-shows and late cancellations in an outpatient clinic within a large healthcare system serving vulnerable communities.

Methods: Demographic data and appointment status were recorded for 537 consecutive patients scheduled for neuropsychological evaluation in an outpatient psychiatry clinic. Patients include 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.20).

Results: The overall rate of no-shows or late cancellations was 20%. Of the 106 patients who no-showed/late cancelled, 41% rescheduled, and of those, 23% missed or late cancelled their second appointment. No-shows and late cancellations were associated with historical/prior no-show rate, while race/ethnicity and activation of MyChart had slight impacts.

Conclusions: These data suggest that prior no-show rates and MyChart access may be targets for interventions to improve show rates. This is important for the patients' gaining access to care as well as minimizing financial strains for the system and increasing wait times/delays to care for other patients.

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Children from diverse ethnic groups are at significantly increased risk for dental caries. In particular, American Indian (AI) children have the highest incidence of detal caries of any ethnic group. The COVID-19 pandemic dramatically restricted health care access, including preventive oral health care. Given this context, it is unclear whether or not preventive oral health care for AI children has resumed since lockdown. To address this question, we surveyed adult AI caregivers (N = 152) of children aged 0-5 years, assessing recent (12-month) and pre-COVID (for caregivers of children aged 3-5 years) preventive oral and medical health services. We also examined medical health care access and utilization among caregivers. Among children aged 3-5 years old, both pre-pandemic and past year medical care utilization were generally high (80 and 90%, respectively) as was any oral health care utilization (64 & 78%, respectively). Oral health check-ups were more common over the last year (62%) compared to pre-COVID (44%). Recent health care utilization among children 1-5 years old in this sample were generally comparable to national estimates, except for higher reported preventive medical care (99% vs. 87.6%, respectively) and higher preventive oral care (96% vs. 59.6%, respectively). More caregivers reported delaying or foregoing needed health care due to COVID (28-38%) versus due to cost (8-17%). In this survey of AI caregivers, recent child preventive health care utilization was high, and changes in utilization following the lockdown phases of the pandemic were comparable for oral and medical health care.

United States Veterans are at an elevated risk for suicide despite the expansion of public outreach initiatives. Department of Veterans Affairs (VA) health care centers may not be accessible to a large proportion of Veterans, but on the other hand, community-based physicians often do not feel they have tools to meet these patients' unique needs. This issue may be addressed via collaboration between VA and community-based providers to develop military cultural competence alongside increased education on the breadth of resources available to Veteran patients.