Journal of Community Health最新文献

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.

This study aims to examine the situation and factors associated with e-cigarette and heated tobacco products (HTPs) use among Vietnamese adolescents. We used data on e-cigarette use among youth in Vietnam from the 2022 Global Youth Tobacco Survey (GYTS), which is a school-based cross-sectional survey of secondary and high school students aged 13-15. Weighted prevalences of e-cigarette and HTP use were calculated. Factors associated with e-cigarette and HTP use were examined using multivariable logistic regressions. A total of 3,873 students aged 13 to 15 were included in the final analysis. The prevalence of ever use of e-cigarettes and HTPs was 7.8% and 1.5%, while the prevalence of current use was 3.5% for e-cigarettes and 0.6% for HTPs. Peer influence was associated with ever (aOR 2.43, 95% CI 1.78-3.31) and current e-cigarette use (aOR 1.86, 95% CI 1.16-2.97). Advertisement exposure was linked to ever (aOR 1.90, 95% CI 1.36-2.63) and current e-cigarette use (aOR 2.50, 95% CI 1.59-3.93), and ever HTP use (aOR 2.00, 95% CI 1.18-3.38). Current conventional cigarette use showed the strongest associations, with higher odds of ever e-cigarette (AOR 9.56, 95% CI 4.75-19.27), ever HTP (aOR 14.02, 95% CI 5.63-34.93), current e-cigarette (aOR 12.55, 95% CI 6.88-22.87), and current HTP use (aOR 12.35, 95% CI 2.33-65.38). This study highlights the rising prevalence of e-cigarette and HTP use among Vietnamese adolescents. Dual use of conventional cigarettes and these alternative tobacco products is strongly associated, emphasizing the need for targeted interventions.

The LGBTQIA + community faces unique health disparities that can lead to severe barriers to care. The Rainbow Clinic is a specialty clinic at the Columbus Free Clinic, a student-run free clinic affiliated with a large academic institution in the Midwest, that provides free primary and specialty care for uninsured and underinsured patients in Columbus, Ohio. Unfortunately, there is a paucity of literature depicting how to best reach these patient populations. This study sought to examine the outreach strategies for patient recruitment to the Rainbow Clinic with a retrospective chart review of past patients (N = 77). 44.2% of respondents discovered the clinic through social media. Age strongly and negatively correlated with appointment frequency (r = -0.665, p < 0.001), while income showed a moderate positive correlation (r = 0.464, p < 0.001). Preliminary data is a promising foundation for future research to improve recruitment of vulnerable populations. Correlations between age and social-media related appointments and income and social-media associated appointments can be helpful to address specific modes of outreach for target populations in the LGBTQIA + community.

44% of the governmental public health workforce plans to retire by 2026, creating an urgent need to strengthen public health academic pathways. While prior research has examined various aspects of public health education, no studies have investigated Master of Public Health (MPH) deferral patterns. We identified demographic, institutional, and temporal factors associated with deferred enrollment among individuals accepted to MPH programs and evaluated whether associations varied across MPH concentrations in the five core public health disciplines (biostatistics, epidemiology, environmental sciences, health policy & management, and health education & behavioral sciences). We pooled data from the Schools of Public Health Application Service (SOPHAS) spanning the 2012-2013 through 2023-2024 application cycles. The outcome was deferred enrollment (deferred vs. immediately enrolled). Independent variables included demographic (age, sex, race/ethnicity, U.S. citizenship), institutional (type, Ivy League status, MPH program delivery format), and temporal (COVID-19 era indicator, time, time squared) characteristics. Modified Poisson regression estimated adjusted associations between each factor and deferral status. Of 99,143 accepted students, 8,196 (8.3%) deferred enrollment. Primary analyses indicated that older age, minoritized racial/ethnic identity, admission to hybrid MPH programs, and admission during the COVID-19 era were significantly associated with deferring MPH enrollment. Conversely, female sex, U.S. citizenship, and admission to public, Ivy League, or distance-based programs were significantly associated with immediate enrollment. Secondary analyses showed that associations varied across the five core public health disciplines. Future research should examine the specific reasons why accepted students choose to defer MPH enrollment through targeted follow-up data collection.

Health challenges affecting American Indian/Alaska Native (AI/AN) individuals are well-documented, but rural/urban differences remain understudied. This analysis describes health and health care access for rural and urban AI/AN adults, with attention to the role of the Indian Health Service (IHS), which primarily serves rural areas. Using 2019-2023 National Health Interview Surveys, we included adult respondents identifying as AI/AN, regardless of other reported races and ethnicities. County of residence was classified as urban (metropolitan) or rural (non-metropolitan). Outcomes included usual place of care, cost-related underuse of care, emergency room visits, clinic visits, worries about paying medical bills, and self-rated health. We found that AI/AN rural residents had greater socio-economic risks (lower education and higher poverty levels), but more access to IHS than urban AI/AN adults (p < .01, all comparisons). Rural-residing AI/AN individuals were more likely than urban AI/AN people to have a usual place of care (93.8% vs. 84.8%, p < .01) and to avoid cost-related underuse of care (75.9% vs. 65.3%, p < .01). Nearly 3 in 4 AI/AN adults -rural and urban - described their health as excellent, very good, or good; however, this was higher for urban (78.5%) vs. rural (73.8%) respondents (p =.015). Rural and urban AI/AN adults with IHS were more likely to have a usual place of care and lower cost barriers than those without IHS (p <.01, all comparisons). Socio-economic risks are higher for rural vs. urban AI/AN adults, but care was more accessible and affordable among rural AI/AN adults, who had comparatively greater access to IHS care.

Malaria remains a public health concern. Asymptomatic individuals are significant reservoirs for onward transmission of malaria. Subclinical infections are directly detrimental to the health of individuals and populations. For effective malaria control, it is crucial to understand the burden of asymptomatic malaria (AM). This study assessed the seasonal prevalence of AM in a suburban community in Lagos, Nigeria. A total of 1,860 asymptomatic individuals were screened for Plasmodium falciparum using a rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). The overall detection rates using microscopy, RDT, and PCR were 2.7% (50/1860, 95%CI: 1.9-3.4), 8.8% (163/1860, 95%CI: 7.5-10.0), and 11.7% (218/1860, 95%CI: 10.3-13.2), respectively. Using PCR outcomes as the ground truth, RDT has a higher sensitivity when compared with microscopy (34.4% versus 22.0%). Although the two methods have high specificity, microscopy has a higher positive predictive value (96.0%) compared to RDT, at 46%. AM infection was more frequent during the wet season (14.9%), with a peak in June at 36.0% (54/150). In contrast, during the dry season, the rate was 7.2%. The frequency of AM was high among the school-age group (5-14 years), at 14.1%. AM carriage was more common in males, at 12.9%, compared to females, at 10.7%. This study presents evidence of a high frequency of AM infection during the wet season and among male individuals residing in Lagos. Curbing the onward transmission of the disease requires increased surveillance for AM nationwide to estimate its frequency, with a focus on younger individuals, especially during the wet season.

Despite the availability of effective preventive measures, women in rural and underserved communities of Louisiana face health disparities regarding human papillomavirus infections. This study explores how perceived risk and socioeconomic factors, such as income, influence HPV vaccine awareness and attitudes toward HPV risk. A cross-sectional study was conducted among women in rural and underserved areas of Louisiana from November 2022 to December 2023. Participants were eligible to be included in the study if they were adult females aged 25 to 64 with no history of hysterectomy and no history of cervical cancer. We used convenience sampling through a mobile health unit that travels to rural and underserved areas of north and central Louisiana, offering cervical cancer screening. A total of 141 women participated in the study. Findings revealed significant gaps in HPV awareness and vaccination knowledge. Only 10.6% of participants considered themselves at risk for HPV. Higher HPV knowledge scores were positively associated with perceived HPV risk, increasing by approximately 20% per correct response. Approximately 40% of the participants were unaware of the existence of the HPV vaccine, 96.5% had never received the HPV vaccine, and 91.4% had never been offered it. Only 42% indicated that they would consider vaccination if offered. Addressing health disparities in rural Louisiana requires targeted interventions to improve healthcare access, education, and community engagement. Efforts to enhance education and awareness and foster community engagement should be prioritized.

This study aimed to determine diet, physical activities, and the frequency and risk factors for body weight problems in children aged between 5 and 13 who attend public primary schools in Constantine, Algeria. A total of 811 children (403 girls and 408 boys) enrolled in three random primary schools in Constantine took anthropometric measurements to calculate body mass index (BMI = weight/size). A questionnaire was created to collect information about the children's lifestyles, which was completed online by their parents. Obesity and overweight were determined according to the standards of the World Health Organization (WHO). A statistical analysis was conducted to identify risk factors for overweight and obesity. The results showed that overweight affects 1.726% of children (57.15% boys and 42.85% girls). The results also showed a 0.616% prevalence of obesity (60% boys, 40% girls). In addition to that, the results of this study revealed that 72.133% of the children are underweight (51.96% boys, 48.04% girls), and 25.524% of them have normal weight (44.92% boys, 55.08% girls). In risk factor analysis, the results show that body weight problems are associated with different factors like sex, age group (8-10 years old), number and composition of meals, and lack of physical activity. Body weight problems are a severe condition that deserves significant healthcare expenses, and for that, urgent protective measures are required. The promotion of a healthy diet and regular physical activity is a top priority in body weight problem prevention, especially for children.

Suicide prevention is a top priority for the US Department of Veterans Affairs (VA), and suicide is often associated with adverse social factors (e.g., financial, legal, and housing problems). The VA provides social services integrated with healthcare services, which may increase the opportunities to detect and document suicide attempt in EHR records. Using VA administrative data, we examined three cohorts of all patients from 2014 to 2018 who had housing instability (n = 659,987), justice involvement (n = 200,487), and unemployment (n = 346,556). Administrative records were used to determine ordinal indicators of receipt of VA social services (no services, low, or high). The outcome was suicide attempt noted in the healthcare record (i.e., documented suicide attempt) in the 1-6 months following the incident adverse social factor. We conducted logistic regressions utilizing a discrete-time survival framework with person-month as the unit of analysis, which facilitated accounting for covariates while isolating the independent association of social service utilization. After adjusting for covariates, high receipt of housing services (vs. no services) was significantly associated with documented suicide attempt during the 6-month observation period (aOR = 1.14, 95%CI = 1.06-1.22). A similar association was observed for high vs. no use of justice programs (aOR 1.24; 95% CI:1.12-1.37). There was no significant association between employment services utilization and documented suicide attempt during the 6-month observation period. Our finding that utilization of social services as positively associated with documented suicide attempt likely reflects increased suicide attempt surveillance and documentation with social service involvement. Future research should explore operationalizing patient-level distress in administrative data.

People who use opioids (PWUO) face a higher risk of overdose, often resulting in significant morbidity and mortality within this population. Understanding the factors that contribute to non-fatal overdose among PWUO is essential for developing effective prevention strategies. Thus, the present study aimed to report on the history of and factors associated with non-fatal opioid overdose among PWUO. From April to June 2024, 199 adults with a recent history of opioid use were enrolled in a cross-sectional study to evaluate past experiences of non-fatal overdose. Participants self-reported their socio-demographic characteristics, experiences with overall overdose, history of opioid use, alcohol consumption, and mental health symptoms. Bivariate and multivariate logistic regression analyses were conducted to assess the correlations between the outcome variables. The mean age of participants was 44.2 years (SD = 10.2). Approximately 49.2% of participants had experienced an opioid overdose at some point. Opioid dependence, alcohol use disorder, and depressive symptoms were reported by 83.9%, 65.8%, and 58.3% of participants, respectively. Older participants were less likely to experience an overdose (aOR: 0.9, 95% CI: 0.9-0.9). On the other hand, participants who were opioid-dependent (aOR: 4.4, 95% CI: 1.7-11.7) and those experiencing suicidal ideation (aOR: 1.8, 95% CI: 1.0-3.5) were more likely to have ever experienced an opioid overdose. Our study demonstrated high rates of non-fatal opioid overdose among PWUO. This finding highlights the need for targeted harm reduction interventions and cross-sector collaboration to address opioid dependency and suicidal ideation, aiming to prevent overdoses in this population.