Journal of Community Health最新文献

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.

This study assesses the livelihoods of waste pickers and the potential health challenges they face, with the primary goal of informing policy development and interventions in Lagos State, Nigeria. A total of 1,274 waste pickers across 20 local governments in Lagos State were interviewed using a structured questionnaire. The data collected were analyzed using descriptive and inferential statistics with SPSS for Windows. Results indicated that most waste pickers were male (69%) and aged between 18 and 40. Common hazards faced by waste pickers included harassment (19%), injuries (13%), accidents (11%), and burns (7%). Despite these hazards, 50% of waste pickers earned between ₦30,001 and ₦50,001 (approximately $23-38.5) per month, with only a few earning above ₦50,000. Additionally, 70% of respondents reported having savings. Respondents highlighted several measures to improve their livelihoods, including recognition, security, financial support, empowerment, and job opportunities. As a result, 71% of waste pickers expressed willingness to leave their jobs if empowered. The major hazards encountered by waste pickers include harassment (19%), injuries (13%), accidents (11%), and burns (7%).

Ending the HIV epidemic in the United States will require increasing the uptake of HIV biomedical prevention strategies, such as injectable pre-exposure prophylaxis (PrEP). One avenue to potentially increase injectable PrEP prescriptions is to educate the next generation of healthcare providers. The purpose of this study was to examine injectable PrEP knowledge, awareness, and willingness to perform injectable PrEP-related clinical activities among medical and pharmacy students. From November 2022-January 2023, we conducted a web-based, cross-sectional observational study among 395 medical and pharmacy students from one public university in New York State. The survey assessed injectable PrEP awareness, knowledge, familiarity with injectable PrEP prescribing guidelines, comfort performing injectable PrEP-related clinical activities, and willingness to perform injectable PrEP-related activities. Overall, participants reported low injectable PrEP awareness, knowledge, and familiarity with prescribing guidelines. Despite this, participants reported relatively high levels of comfort with performing injectable PrEP-related tasks. While there were no statistically significant differences in domains of interest, pharmacy students reported greater awareness, knowledge, familiarity with prescribing guidelines, and comfort performing injectable PrEP-related tasks. Linear regression models illustrated that pharmacy students were statistically significantly less willing to initiate a conversation about injectable PrEP with eligible patients compared to medical students. Future healthcare providers will play a pivotal role in implementing new biomedical prevention strategies for HIV, including injectable PrEP. Results illustrate the need for additional educational programs to increase injectable PrEP knowledge among health professional students.

The current study used a convergent mixed-methods design and identified Arkansas school professionals' perceptions about (1) their schools' tobacco use prevention needs and (2) the implementation of tobacco prevention programming at their schools. Differences in perceptions based on school-related factors and personal tobacco use history were examined. Surveys were collected from teachers, administrators, and school staff from K-12 schools in Arkansas (QUANT; N = 325) and in-depth interviews were conducted with a separate sample of school administrators (QUAL; N = 20). Logistic regressions identified the associations between dependent variables, school-related factors (school type, school position, years of education work experience, and school rurality), and school professionals' tobacco use histories. The tobacco prevention components perceived as most important were parent education, school tobacco-free policies, and up-to-date teacher training. Yet, parent education and up-to-date teacher training were perceived as being poorly integrated into schools. Quantitative and qualitative findings emphasized the importance of integrating parents into tobacco prevention. There were differences in school professionals' perceptions about important tobacco prevention components based on school level, personal tobacco use history, and work experience. There were also differences in perceptions about how well tobacco prevention was integrated into schools between teachers vs. administrators and related to school rurality, school level, and work experience. School professionals in Arkansas, a state with tobacco disparities, identified that: (1) student tobacco use is a top health priority; (2) key strategies include parent education, tobacco-free policies, and teacher training; and (3) barriers exist, particularly in implementing parent education and teacher training.

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.

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.

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.