Journal of Community Health最新文献

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.

In addition to individual factors, differences in community-level factors impact mortality rates of cervical cancer (CC), especially in the Southeast United States, where CC one-year mortality is significantly higher than national average. This study investigated the association between community-level social vulnerability measured using the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and overall and one-year CC mortality in Alabama. Retrospective cohort study using Alabama State Cancer Registry data from 2012 to 2021. Outcome of interest was mortality due to CC. Residential addresses were geocoded to determine SVI scores categorized into quartiles. Cox proportional hazards model was used to assess associations between SVI quartiles and overall and one-year CC mortality adjusting for age at diagnosis, race, marital status, and insurance status. Further, CC mortality in younger adults (≤50 years) was compared with older adults (> 50 years). A total of 1,325 women with CC were included in the study. The median age at diagnosis was 49 years (IQR: 39-62) and 69.73% were White. Median follow-up time was 9 months (IQR: 5-17). Among older adults, we observed statistically significant association between higher SVI quartiles and overall mortality (Q4: aHR 1.86; 95% CI 1.15, 3.01; p = 0.012] and one-year mortality (Q3: aHR 2.66; 95% CI 1.34, 5.29; p = 0.005; Q4: aHR 2.45; 95% CI 1.18, 5.08; p = 0.016). This study highlights the role of community factors in CC mortality among older women. Community-level strategies are needed to reduce the burden of CC mortality in Alabama and other high-risk regions.

Medical mistrust is an ongoing concern in the United States, with patient confidence in both individual practitioners and institutions decreasing sharply in recent years. Atlantic County, New Jersey has some of the worst health outcomes in the state and is below the national average. This study sought to investigate medical mistrust by recruiting participants to complete a survey and/or health screening at 12 food pantry distribution events throughout Atlantic County (N = 124). The mean score for the Medical Mistrust Index was 19.06 (SD = 5.6) for participants who reported receiving the annual influenza vaccine and 16.05 (SD = 4.7) for participants who did not report receiving the vaccine (p = 0.002). Participants who reported an "Excellent" self-perception of overall (M = 13.7, SD = 4.6) and dental health (M = 14.6, SD = 5.5) had significantly less trust relative to their counterparts. There was no significant difference in self-perception of mental health and trust. While not statistically significant, a positive correlation was observed between trust and the number of healthcare information sources used: participants reporting use of 1 source had the lowest trust (M = 16.82, SD = 5.73), while those using 2 (M = 17.86, SD = 4.48; p =.509), 3 (M = 17.33, SD = 0.87; p =.536), or ≥ 4 sources (M = 19.38, SD = 3.97; p =.086) showed progressively higher trust. Our findings highlight the responsibility of improving medical mistrust falls on both providers and patients to take agency of their care.

Vaping has become very popular among young generations in Jordan. However, less is known about women's awareness and intention to vape. The aim of this study is to assess women's knowledge and beliefs about vaping, with a focus on vaping women's attitudes and practices. This is an observational cross-sectional study. Data were collected from January through March 2024, by using a self-administrated survey inspired from the WHO GATS questionnaire. Among the 923 participating women, 12.4% were vaping. We observed significant variations in knowledge and beliefs among women. Vaping women have a substantially younger age than non-vaping. 57% of vaping women think that vape is safer to use than cigarettes compared to 14% of non-vaping. 61% of vaping women believed that vaping helps to quit cigarette smoking compared to 24% of non-vaping. Vaping women tended to underestimate the health risks associated with it compared to non-vaping women. They are also supporting legislations that allow vaping indoors and in public places. Women vape primarily for enjoyment, to cope with stress, to pass free time, and to hang out with friends. Luckily, many of them believed that smoking increases the risk of cardiovascular and respiratory ailments and limited life expectancy, which supports their future quitting plans. This study revealed misconceptions and knowledge gaps around vaping among women. Emotional demands and social interactions influenced women's vaping use in Jordan, highlighting the need for targeted public health education and legislative measures to promote women's health.

Mpox is a re-emerging zoonotic illness that has raised concerns worldwide because of its outbreak in nonendemic areas, including Kenya. Following the recent outbreak of mpox in Kenya, the Ministry of Health rolled out a public health campaign via social and mainstream media. However, the impact of these campaigns has yet to be assessed. A descriptive cross-sectional study design was adopted, with a total of 5,920 residents randomly selected. A structured and validated questionnaire was used to collect the data. Data were analysed via Stata version 14.0. Descriptive statistics were used to summarize frequencies and proportions, whereas t tests were performed to assess for any significant difference between those exposed to social and mass media campaigns and those not exposed. Regression analysis was used to determine the impact of age, level of education and wealth index on exposure to social and mass media, awareness of the mpox outbreak, knowledge on its preventive measures and reporting channels for suspected cases. A total of 91.1% of the residents in Kiambu County were exposed to at least one social and mass medium, with 62.9% being aware of the mpox outbreak. A total of 54.9% of the residents were aware of at least one correct preventive measure against the disease. 45% knew at least one correct reporting channel for a suspected mpox case. Radio was the greatest source of information and knowledge, at 36.7%. Radio was the best and most effective channel for public health education.

Cutaneous leishmaniasis (CL) is an endemic disease prevalent in many parts of Iran, including Ilam Province. Conducted in Dehloran City from April 12 to 24, 2025, this study aimed to assess the determinants of the disease, particularly among schoolchildren, as the most vulnerable societal stratum. This descriptive-analytical study included 1,302 schoolchildren selected using a random cluster sampling method. Data was collected based on self-reporting using a validated (by an expert panel) and reliable (with a Cronbach's alpha of 78%) questionnaire. The data was analysed using SPSS version 22 software. Approximately 85% of participants had weak to average knowledge scores, with a mean of 1.88 ± 5.46. The average attitudes score of participants was 5.77 ± 20.97, with only 9.52% exhibiting positive preventive attitudes. More than 95% of participants had poor preventive behaviours. Most participants had weak or average knowledge, attitudes, and behaviours towards CL. There is an obvious shortcoming in health education in the elementary education system. Elementary schools should adopt CL educational intervention to control disease. This may be achieved by applying the theory and models of behaviour change.

This study aimed to examine recent trends and educational inequality in smoking prevalence among Vietnamese adults between 2020 and 2024, providing evidence to inform targeted tobacco control interventions. Data were obtained from three rounds of the Provincial Global Adult Tobacco Surveys (PGATS) conducted in Vietnam (2020, 2022-2023, and 2024), involving nationwide samples totaling 69,776, 61,763, and 74,962 participants aged 25 or older, respectively. Current smoking and daily smoking rates were estimated. Absolute (Slope Index of Inequality, SII) and relative inequalities (Relative Index of Inequality, RII) of current smoking and daily smoking were analyzed using the Poisson regression-based method in regard of educational level. Overall smoking prevalence among those aged 25 and older declined from 24.4% in 2020 to 20.8% in 2024, with the male smoking rate of 47.3% and 41.1%, respectively. Daily smoking showed a similar trend (19.8% in 2020 to 16.6% in 2024). The smoking prevalence among men was consistently higher than among women, and rural residents, married individuals, and lower educational groups exhibited higher smoking rates across all years. The substantial educational inequalities persisted. Absolute inequalities slightly decreased for current smoking (SII: 18.5% in 2020 to 14.3% in 2024) and daily smoking (SII: 18.1-15.0%), yet relative inequalities remained stable (RII from 0.47 to 0.51 for current smoking; approximately 0.40 for daily smoking). While Vietnam has experienced a moderate decline in smoking prevalence, significant educational inequalities persist. To effectively address tobacco-related disparities, targeted interventions focusing on socioeconomically disadvantaged groups are necessary, underscoring the need for equity-oriented tobacco control policies.

Investing in a diverse public health workforce has implications for strengthening cultural humility and addressing health inequities within minoritized populations. First-generation (FG) students pursuing graduate level degrees are an important population with the potential to strengthen such efforts in their transition into the public health workforce. However, research on the factors influencing job satisfaction and job decisions is limited. The main objective of this study was to examine how personal, social, and economic resources influence job satisfaction among public health master's and doctoral level graduates, and to explore differences across education generation and racial/ethnic background. Drawing on Conservation of Resource and Intersectionality theories, we conducted secondary analysis using a recent national survey investigating factors that are associated with public health career choices (n = 751). Adjusted and weighted linear regression models, both with and without interaction terms, were analyzed to examine the associations between resource domains and job satisfaction. Our findings revealed significant moderating effects of FG status across personal, social, and economic resource domains in shaping job satisfaction, both within the full sample and among specific racial and ethnic subgroups. Further analysis revealed stronger influence of these resources among Black FG, White FG and total FG groups compared to non-FG groups, suggesting these resources may play a role in influencing job satisfaction among first-generation individuals. Therefore, public health graduate level academic programs and employers should consider strategies that improve access to resources to better support first-generation individuals' completion of degrees and transition into the workforce.

Betel quid chewing is a culturally-rooted oral health risk behavior that is prevalent in many Southeast Asian communities. Among Malaysia's indigenous community, particularly in isolated areas, data on betel quid chewing remain limited. This study investigated the influencing factors and health perceptions of betel quid use among 180 adults from a Proto-Malay Orang Asli community in Peninsular Malaysia. A validated questionnaire adapted from national health survey gathered data on demographics, betel quid chewing habits, and knowledge and attitude on betel quid use. Descriptive statistics determined prevalence and health behavior, while bivariate and multivariate logistic regressions identified associated factors. The prevalence of current betel quid chewing was 75.9%. Chewing was more common among individuals aged ≥ 40, those with lower education, and those with strong family traditions of chewing. Multivariate analysis showed that older age (AOR = 1.126; 95% CI: 1.071-1.183; p < 0.001) significantly predicted current use. The findings highlight the need for culturally sensitive oral health strategies tailored to each indigenous communities.