Journal of Community Health最新文献

Despite efforts to diversify research and health programs, Black American men remain a "hard-to-reach" population while collectively suffering from some of the worst health outcomes in the United States. Faith- and community-based approaches have shown potential to engage Black Americans in health promotion and health research activities. The purpose of this article is to examine health research participation and trust in research among a sample of Black American men in rural North Carolina who attended a community-based health symposium, culturally tailored for Black American men (n = 112). A cross-sectional survey was administered among men to learn about health status, health concerns, and perception of health research. Among 106 men who completed the survey, most reported no prior participation in health research (68.87%), but almost a third of men reported interest in participating in health research. No significant differences in trust in research was found based on interest in research participation (interested in research participation, not interested in research participation, no response), presenting an opportunity to increase the trustworthiness of medical institutions and build relationships with this population. These findings will inform future research and health programming for Black American men in rural locations.

Although health promotion is not the primary function of public libraries, it is well documented that many libraries engage in health promotion activities, even when resources are constrained. Less understood is the readiness of the public library workforce, particularly in rural communities, to implement evidence-based health promotion programs. This study uses a modified version of the Competency Assessment for Tier 2 Public Health Professionals to assess the readiness of a small sample (n = 21) of Oregon rural library managers to implement evidence-based health initiatives. Results show that outside of communication skills, most rural library workers do not consider themselves to have proficiency in core health promotion competencies. Although some slight differences were found among librarians based on socio-demographic factors, those differences were not statistically significant. Implications include the need for strengthened support to build the capacity for rural public library workers who are interested in delivering evidence-based health promotion programs.

Refugees arriving to the U.S. experience a high burden of both communicable and non-communicable diseases. There is a potential to improve health outcomes for refugees through well-developed, comprehensive interventions, but the effectiveness of such interventions is poorly understood. The purpose of this review is to identify, characterize and evaluate the effectiveness of patient-level healthcare interventions for U.S. refugee populations. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline via PubMed, Web of Science, Embase, and CINAHL were searched for articles that included a population of refugees of any age, included an intervention aimed at improving health, included an evaluation of the intervention's outcomes, and were conducted in the U.S. from 2000 to 2022. Thirty-seven studies were included, and we identified three main intervention modalities: healthcare provision/management, resource provision, and education. Interventions targeted general health, infectious disease, women's health, diet/exercise, health literacy, oral health, diabetes, family health, and substance use. The outcomes measured included knowledge, satisfaction, behavioral outcomes, and physical health markers. This review demonstrates that a few health conditions, namely tuberculosis, have been addressed with large-scale, sustained interventions. Other conditions (general health and women's health) have been addressed through piecemeal, short-term interventions. The evaluation of interventions often focuses on knowledge or satisfaction rather than health or behavior change outcomes. Future work should focus on the best strategies for developing sustainable interventions that meet the needs of the diverse population of refugees in the U.S.

Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.

The COVID-19 pandemic caused unprecedented disruption in all activities, especially those related to group gatherings. During the lockdown period, faith-based organizations, which are resources for both religious and health promotion activities, had to develop alternative strategies to meet those goals. The purpose of this paper is to describe the sustainability of M.I.C.A.H. Project HEAL, a partnership between an academic medical center and faith-based organizations in underserved communities in New York City, during the initial pandemic lockdown period. The use of virtual platforms facilitated Community Health Advisors (CHAs) in 13 organizations to conduct 47 health education workshops, reaching over 800 participants. Reliance on virtual platforms continued after in person gatherings were permitted. These data further support the benefits of academic partnerships with faith-based organizations to provide timely health information during a public health crisis.

Many factors affect an individual's resilience. Low resilience has been attributed to increased stress, anxiety, depression, and suicidality within the LGBTQIA + population, which is heightened compared to different populations. This study identifies predictors of resilience in the LGBTQIA + population and aims to identify predicting factors at all levels of the socioecological model. This was a cross-sectional study of data from a web-based survey that was conducted from January to February 2022. A national sample of 1033 LGBTQIA + adults was utilized for hierarchical regression analysis. Hierarchical regression analyses were performed for total resilience, which had an average score of 143.66 (SD = 33.88) and accounted for 53.4% of resiliency variance. Factors that were found to decrease an individuals resiliency score were depression, stress, suicidality, and isolation discrimination distress. Factors found to increase an individuals resiliency scores are college graduate 4 years+, married, outness, personal comfortability with being SGM, gender expression discrimination distress, and vicarious discrimination distress. Understanding the factors that influence resilience is vital to improving the resilience of the LGBTQIA + communities. Interventions that focus on decreasing depression, stress, and suicidality may be particularly impactful for all types of resilience.

Racially and ethnically diverse populations and individuals residing in rural areas were disproportionally impacted by the coronavirus pandemic, and Eastern North Carolina (ENC) is one region where such impacts were apparent. To understand at-risk individuals' perceptions and hesitancy to COVID-19 vaccines and the preferred means of receiving vaccination-related messages, we conducted four qualitative focus groups (N = 40) with diverse rural ENC residents. The analysis of the focus group transcripts revealed five themes: (1) reasons people trusted the COVID-19 vaccines, (2) reasons people mistrusted the COVID-19 vaccines, (3) the best means to deliver messages regarding COVID-19 vaccination, (4) the individuals trusted most to deliver such messages, and (5) the decisions people made regarding whether to get vaccinated and how that was connected to God. By incorporating participant perspectives and preferences in receiving messaging into campaigns, there is a potential for greater vaccine uptake.

Purpose: LGBTQ + community connectedness is generally a protective health factor for sexual and gender minorities. However, existing scales have not been validated among Black sexual minority men living with HIV (SMMLWH), who face unique marginalized experiences that disproportionately impact several health outcomes compared to the general LGBT + community. We validated the Connectedness to the LGBT Community Scale among Black SMMLWH.

Methods: We validated the 9-item Connectedness to the LGBT Community Scale from Frost and Meyer using preliminary data from a cohort of Mid-Atlantic Black SMMLWH (n = 650). Factor analysis and intercorrelations were conducted to assess unidimensionality, and Cronbach's alpha was measured for reliability. Correlations and cumulative ordinal regression models were generated using internalized homophobia, hopelessness, depression, HIV stigma, social support, and resilience as criterion constructs. Models were adjusted for sociodemographic and behavioral characteristics.

Results: The Connectedness to the LGBT Community Scale demonstrated high internal consistency (alpha = 0.948) and strong item intercorrelation with a single factor structure. The scale was associated with all criterion measures before and after adjustment, including lower internalized homophobia (aCOR = 0.19, 95% CI 0.15-0.25), lower hopelessness (aCOR = 0.53, 95% CI 0.41-0.68), lower HIV stigma (aCOR = 0.58, 95% CI 0.47-0.72), and lower depression (aCOR = 0.61, 95% CI 0.50-0.75). The scale was also associated with greater social support (aCOR = 2.38, 95% CI 1.91-2.97) and resilience (aCOR = 2.53, 95% CI 2.03-3.15).

Conclusion: The Connectedness to the LGBT Community Scale is a valid measure for use among Black SMMLWH. Future studies should explore relationships between community connectedness and HIV care outcomes and quality of life among Black SMMLWH.

Vietnamese women have a higher incidence rate of cervical cancer and are less likely to have ever been screened for cervical cancer than their White counterparts in the US. This review synthesizes findings from published interventions to promote cervical cancer screening in this vulnerable population. Articles were identified through a systematic search of PsycInfo, Embase, Pubmed, Web of Science, and the Cochrane Register of Controlled Trials in October 2022. Articles were included if they were published in a peer-reviewed journal, written in English, included one or more interventions promoting cervical cancer screening, assessed at least one outcome relevant to screening, and included a sample of ≥ 70% Vietnamese participants. Quality assessment scores were computed using the Downs and Black Checklist. Fifteen articles met review inclusion criteria. Studies were, on average, of good quality. Most studies were conducted in the US (n = 12), used a quasi-experimental design (n = 9), and employed multiple intervention strategies (n = 12). Intervention strategies included educational sessions, lay health worker (LHW) outreach, small media, mass media, patient navigation, and community or healthcare-based strategies. The most common study outcomes were screening intention and receipt. All but two studies reported improved cervical cancer screening outcomes following intervention. Findings support the effectiveness of multicomponent culturally tailored interventions to improve cervical cancer screening outcomes in immigrant Vietnamese women. Further research is needed to determine whether these interventions will be as successful in non-US countries and to address broader community- and healthcare-based factors in screening.

The increasing reliance on digital tools for standard healthcare practices in uninsured populations is poorly understood. This study aims to assess the impacts of a newly implemented digital reimbursement system at a student-run primary care clinic associated with an academic medical institution serving uninsured New York City residents. Pharmacy records of 94 unique patients receiving a total of 2770 reimbursements between October 17th, 2016, and May 18th, 2023, were analyzed. Patients were divided into two groups (in-person vs. digital) based on their reimbursement preferences type. Demographic analyses were performed in addition to assessing reimbursement volumes, number of refunds, and duration until receipt of payment for each group. The clinic's total monthly reimbursement volume, number of prescriptions, and number of patients for the period before introduction of digital refunds was compared to the period after. The mean age (in-person = 52.7 ± 14.7 years, digital = 54.9 ± 12.9 years) was not statistically different between the groups. Patients in the digital group requested on average more refunds (digital = 47 refunds, in-person = 14 refunds), received higher total reimbursement amount (digital = $1131.24, in-person = $289.36), and they were reimbursed faster (digital = 56 days, in-person = 62 days). Since the introduction of the digital reimbursement option, our three-month reimbursement volume more than doubled from $481 to $1298. The average number of monthly reimbursements increased from 27 to 45 refunds, and the number of monthly patients increased from 6 to 9 patients. In summary, digital reimbursement options can facilitate medication reimbursement among uninsured patients. These results suggest that digital reimbursement systems result in higher utilization, faster refunds, and larger total reimbursements amount for uninsured and underserved patients.