Journal of Community Health最新文献

In 2023, there were over 70,000 deaths due to synthetic opioids, which are increasingly being found in all types of illicit drugs, of which 14.7% of youth aged 12-17 years old reported using in the prior year. While several opioid overdose education and naloxone distribution (OEND) programs have emerged, few have focused on the needs of youth. Young HERO, a quality improvement initiative, was developed to provide OEND services specifically to youth and caregivers. The Young HERO initiative consisted of the formation of partnerships with community organizations and the delivery of OEND. Potential organizations were contacted, and if they were interested, a Young HERO event date was set. Partners advertised and hosted the typically one-hour event. After events, attendees were asked to complete a survey assessing their knowledge, confidence, and intervention acceptability. Descriptive statistics were computed. In the first six months, Young HERO events were held, with nine of the initial 13 organizations contacted and two additional events with secondary contacts. A total of 286 individuals received the intervention. The post-event survey was available for 177 individuals, and the overall survey response rate was 77.4% (137). 75% of respondents felt confident that they could administer an opioid overdose reversal medication, and just under 70% strongly recommended the event. In the first six months, Young HERO events were held, with nine of the initial 13 organizations contacted and two additional events with secondary contacts. A total of 286 individuals received the intervention. The post-event survey was available for 177 individuals, and the overall survey response rate was 77.4% (137). 75% of respondents felt confident that they could administer an opioid overdose reversal medication, and just under 70% strongly recommended the event. Young HERO was able to reach youth, young adults, and caregivers to provide both opioid overdose education and naloxone distribution. The initiative offers a model that can be expanded and replicated, supporting efforts to reduce opioid overdose fatalities.

The health and social needs of LGBT older adults remain underrepresented in public health research, particularly in states where data collection on sexual and gender minorities has been limited. This study reports findings from the Kentucky LGBT Health Needs Assessment, a community-generated, statewide evaluation of adults aged 50 and older. Employing a cross-sectional, mixed methods design, the survey was developed in collaboration with LGBT community stakeholders. The assessment captured a broad range of demographic, health, psychosocial, and service access variables, with 672 individuals completing the study. Findings reveal a predominantly white, highly educated sample with a mean age of 59.5 years. Participants reported relatively positive perceptions of their general health, yet high rates of chronic conditions such as arthritis, hypertension, and obesity. While most found healthcare information accessible, 21% had unmet medical needs and 18% delayed care due to lack of affirming providers. Mental health and counseling services were especially difficult to access, particularly among rural respondents. Long-term care concerns were prominent, with strong preferences for LGBT-specific facilities and uncertainty about future caregiving arrangements and financing. Although participants largely expressed pride and comfort in their LGBT identity, experiences of discrimination, verbal abuse, and stereotyping were common. Despite high identity affirmation, community engagement was limited, often reflecting safety concerns and structural stigma. This needs assessment provides one of the first statewide snapshots of LGBT aging in Kentucky, highlighting both strengths and vulnerabilities in health and social well-being. Findings underscore the urgent need for inclusive policies, provider training, and tailored aging services.

Firearm-related injuries and fatalities among youth in the United States represent a critical public health crisis. Secure firearm storage (i.e., keeping guns unloaded, locked, and stored separately from ammunition) is a proven strategy to reduce these risks. However, many households do not consistently adopt these practices. This review examines four key family-level factors that influence firearm storage decisions: (a) early firearm socialization, (b) family decision-making dynamics, (c) other household safety practices, and (d) parent understanding of child development and motivations regarding storage. Findings indicate that interventions may benefit from empowering parents to reflect on their early firearm socialization experiences, improving their understanding of children's development, integrating firearm safety into broader household safety frameworks, and promoting collaborative decision-making in multi-adult households. Future research should further investigate how these factors intersect to shape firearm storage practices, including the long-term effects of early firearm exposure through longitudinal studies, and variations across diverse family structures and contexts, including multigenerational households.

Whole food plant-based (WFPB) nutrition supports prevention and management of cardiometabolic disease. Greater intake of whole plant foods may lower chronic disease burden in high-risk communities. Exposing community leaders to the benefits of WFPB nutrition may lead them to recommend it to constituents. The intervention consisted of online live classes and peer mentorship. Participants strove to adopt an ad-libitum WFPB diet without added oil and with minimal sugar and salt for 21 days. The program was assessed in a focus group, and with pre/post-program surveys measuring nutrition knowledge, health-related QOL, dietary intake, and mental health. Program-related changes in outcomes were measured using paired t-tests or McNemar's tests. Qualitative data evaluation used inductive methods. Of the 26 participants who agreed to participate, 13 (62%) completed the program. All were Black female community leaders with average age of 59.2±13.1 years. Most (84.6%) reported ≥ 1 chronic disease. Statistically significant program-related improvements were found in nutrition knowledge, BMI, energy levels and mental clarity. Other changes did not reach statistical significance. Most (92%) said they would recommend the program to others. Participants identified high quality educational content and peer mentorship as program strengths. Potential barriers to future community participation included inconsistent healthcare provider support of WFPB nutrition, the perception that WFPB nutrition is expensive/lacks variety, and difficulty giving up meat due to cultural traditions. This pilot study demonstrated the feasibility of conducting an online WFPB dietary intervention for this population. The data collected will inform a planned expanded study.

Firearm-related injuries remain the leading cause of mortality in children in the United States. It is not well-characterized how often clinicians perform firearms access screening and safety counseling. We examined documentation of these services in a cross-sectional study of well child exams (WCEs) at a tertiary academic center in Southeast Michigan. Overall, we found that clinicians documented screening in 25,469 of 32,582 WCE encounters due to categorical Pediatrics clinicians doing so in 73.8% of encounters; Family Medicine and Internal Medicine-Pediatrics clinicians documented some form of screening in nearly all (> 99%) encounters. Clinicians documented counseling in 21.8% of encounters with Family Medicine clinicians lagging the other two specialties (8.2% versus 23.9% and 18.4% for Pediatrics and Internal Medicine-Pediatrics, respectively). Multinomial logistic regression for screening (conducted only for Pediatrics given the near universal screening by Family Medicine and Internal Medicine-Pediatrics) and counseling (conducted for all specialties) showed decreased likelihood of both screening and counseling for certain age and sociodemographic groups; however, while there was decreased likelihood for non-attending physician clinicians (i.e. advanced practice providers and resident/fellow physicians) and high inter-clinic variability (77.1%) for screening, the opposite was true for counseling with decreased likelihood for attending physicians and inter-clinic variability of 16.7%. Findings suggest that quality improvement efforts and clinician training are needed to eliminate gaps in risk-stratified screening and counseling regarding firearm safety.

Legalization by states of medical and non-medical cannabis use is increasing the accessibility of cannabis to Americans. While cannabis use remains illegal for youth, enhanced effective approaches preventing youth's cannabis use are important. The Drug-Free Communities (DFC) Support Program is administered by the White House Office of National Drug Control Policy and represents the nation's leading effort to mobilize communities to prevent and reduce youth substance use. Coalitions use the Seven Strategies for Community Change to ensure the creation of comprehensive action plans and a community-wide approach for preventing youth substance use. This study's objective is to review the cannabis programmatic activities implemented by DFC coalitions, identify common themes, and assess whether activities align with the Seven Strategies for Community Change. Review of biannual progress report (PR) data collected from August 2020 to February 2021 was conducted to determine common themes, strengths, and areas of improvement among cannabis programmatic activities. Of the 727 funded coalitions, 73% (n = 532) identified cannabis as a substance they focused their activities on in their PR submissions, and 488 unique cannabis programmatic activities were reviewed. Cannabis programmatic activities were assigned to one of six common themes: 1) dissemination (n = 167), 2) training and education (n = 147), 3) community partnerships (n = 99), 4) policy and enforcement (n = 51), 5) miscellaneous (n = 15), and 6) communities of focus (n = 9). Findings could inform local organizations about common types of youth cannabis-related prevention activities implemented at the community-level. The least commonly reported strategies, such as communities of focus, may highlight opportunities for expanded prevention efforts for coalitions.

Background: In the U.S., responses to the rollout of COVID-19 vaccine varied widely, with contrasting perceptions of the vaccine. We aimed to characterize distinct groups of respondents regarding COVID-19 vaccine perceptions.

Methods: Data came from the 2021-2023 Common Survey (n = 852), collected in Chicago using a community-based participatory approach focusing on communities with low COVID-19 vaccination. Participants answered eight questions about vaccine-related perceptions. We conducted a latent class analysis in R.

Results: The sample included 623 female participants (73.1%), 482 Black participants (56.6%), 259 Hispanic/Latino(a) participants (30.4%), 26 Asian participants (3.1%), and 261 participants with a college degree (30.6%). In a four-class model, Class 1 (skeptic) included 153 participants (18.0%) with low confidence in vaccine safety, effectiveness, and potential to get life back to normal. Class 2 (uncertain) included 163 participants (19.1%) who mostly indicated uncertainty. Class 3 (support with concerns) included 266 participants (31.2%) who recognized many vaccine benefits but also had concerns about its rapid development and "not being studied in people like me." Class 4 (pro-vaccine) included 270 participants (31.7%) with high confidence in vaccine safety and effectiveness and social approval of vaccination. Interestingly, both the skeptic and pro-vaccine groups had somewhat similar agreement with the statement "not enough information on COVID vaccine interaction." Class assignments varied by sociodemographic characteristics. Socioeconomic hardships were associated with a lower likelihood of being in the "pro-vaccine" group.

Conclusions: Given the distinct classes of vaccine beliefs, tailored public health messaging is needed to enhance vaccine confidence and uptake.

Although American Indian and Alaska Native people make up less than 2% of the US population, they are disproportionally affected by adverse health outcomes, including disabilities. The Indigenous community of the Mohawk Nation at Akwesasne has faced significant environmental contamination since the 1970s, resulting from operations of three aluminum foundries near the community. The aim of this study was to explore the potentially moderating effects of social support and cultural identity on disability, taking into account age, sex, and health comorbidities among 119 Akwesasne Mohawk adults. We used the World Health Organization Disability Assessment Schedule II (WHO-DAS II) to measure disability, the Duke University Social Support Scale with Likert-type responses to quantify social support, and the Orthogonal Ethnic Identification Scale to calculate cultural affiliation. We found that overall social support was significantly negatively associated with disability related to self-care (Relative Risk (RR) = 0.96, 95% Confidence Interval (CI): 0.93, 1.00). Both family support (RR = 0.97, 95% CI: 0.94, 0.99) and non-family support (RR = 0.97, 95% CI: 0.94, 1.00) were negatively associated with disabilities that prevent full participation in society. Cultural affiliation to either the white culture or the Mohawk culture was not significantly associated with disability. Although preliminary, our findings may help inform clinicians advising American Indians and Alaska Natives with disabilities on helpful interventions to provide greater social support. This may in turn improve the quality of life of indigenous communities facing a high prevalence of disability.

Trust in healthcare is declining in the U.S. and is associated with decreased engagement in preventive care, low adherence to treatments, lack of motivation to seek care and poor health outcomes. Using the Health Belief Model (HBM), this study examined the impacts of trust on the healthcare access and utilization among African immigrants in Florida, United States. In-depth interviews were conducted with purposively selected African immigrants (N = 19) over the age of 18, lived in Florida for five or more years, and had recent experience with the U.S. healthcare system. Interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo14. Perceived barriers to trust led to discontinuation and delays of care. Uncertainties on insurance coverage, ambiguous medical bills, and broken patient-provider communication constitute perceived barriers. Perceived benefit determined trust and medical adherence among participants. Findings revealed that being Black immigrant and legal requirements such as proof of legal status fueled perceived susceptibility. To counter their susceptibility and earn trust from providers, participants were pressured to present themselves in an 'acceptable' manner in healthcare settings. Self-efficacy was demonstrated through self-research on their cases and self-advocacy. Cues to action included seeking second opinions and changing providers depending on availability. Healthcare systems should prioritize billing transparency, effective communication, equitable practices, and legal protections for immigrants. Providers need continuous training in cultural humility and trauma-informed care, centered on immigrant experiences. Co-developing multilingual health information and engaging trusted messengers such as community and faith leaders will enhance the credibility of health promotion efforts.

Transgender and nonbinary (TGNB) individuals are disproportionately impacted by HIV, particularly those who identify as racial/ethnic minorities and those who are socioeconomically disadvantaged. Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV infection, but many TGNB individuals encounter barriers to PrEP uptake and adherence that limit fully realized preventive benefits. We developed PrEP Well, a multicomponent community-led program, to scale and sustain comprehensive PrEP services from a TGNB-led community organization that provides gender-affirming healthcare and social services. We used implementation science frameworks to evaluate initial program outcomes and contextual influences on program implementation. Preliminary data from August 2022 through January 2024 showed promising implementation and effectiveness outcomes. During that time, 113 primarily low-resourced TGNB clients were educated about PrEP and received an HIV test, of whom 60 (53%) attended a visit with a provider and received a PrEP prescription. At 30-day follow-up, urinalysis confirmed uptake of PrEP among 50 (83%) of the clients prescribed PrEP. At 90-day follow-up, 43 (72%) demonstrated continued use of PrEP and 40 (67%) showed protective levels of PrEP adherence. Qualitative interviews and surveys indicated that clients, staff, and leadership viewed the PrEP Well program as highly acceptable, feasible, and sustainable (including willingness to address persistent implementation barriers). Referral patterns and rates of PrEP uptake suggested increasing integration of PrEP Well into the TGNB community center over time. The PrEP Well program demonstrates the potential for TGNB communities to address HIV inequities by integrating community-led HIV prevention services with gender-affirming healthcare in TGNB-specific health centers.