Public Health Reports最新文献

Vulvovaginal candidiasis (VVC) is an infection caused by the yeast Candida that affects more than 50% of women in their lifetime. We aimed to describe VVC among American Indian/Alaska Native (AI/AN) girls and women who were receiving care in the Indian Health Service (IHS) system during 2016-2022. We calculated the annual VVC prevalence per 1000 IHS user population and examined underlying medical conditions, previous diagnoses, and antifungal treatment. Among 6 million female patient-years, 70 766 patients had ≥1 VVC diagnosis code (2022 prevalence: 14.2 per 1000 IHS user population). Frequent previous or concurrent diagnoses included diabetes (24.8%), urinary tract infection (13.6%), screening for sexually transmitted infection (13.2%), and unspecified acute vaginitis or vulvitis (13.0%). Approximately one-third (33.1%) of patients received fluconazole, and 25.7% received prescription topical antifungal medication. VVC was a common condition among AI/AN patients who accessed care in the IHS health care system. VVC prevalence among AI/AN patients was similar to the prevalence among the broader US population. These data provide a baseline for future studies to evaluate diagnostic and treatment practices for VVC among AI/AN people.

Objectives: Menthol flavoring is a critical public health issue, but prior research has largely represented the voices of White adults who smoke menthol cigarettes, who represent a small subset of adults who smoke menthol cigarettes in the United States. This study compared perceptions of a hypothetical menthol cigarette or flavored cigar (MC/FC) ban among Black and White adults who smoke menthol cigarettes.

Methods: Participants were a convenience sample of 2113 Black and 1087 White adults who smoke menthol cigarettes, collected through Amazon Mechanical Turk from July 2023 through January 2024. Participants reported opinions about an MC/FC ban, the likely public health outcomes, and a hypothetical impact of the ban on their smoking behavior. We used stepwise logistic regression to model factors associated with ban opposition or ambivalence.

Results: More than one-third of adults who smoke menthol cigarettes supported an MC/FC ban (37.2% Black vs 34.5% White; P = .13), but Black (vs White) adults who smoke menthol cigarettes were more likely to endorse the public health benefits of a ban, as assessed via agreement with 5 statements of US Food and Drug Administration rationale (mean [SD] number of statements endorsed, 3.0 [1.7] vs 2.4 [1.8]; P < .001). Smoking more cigarettes per day, believing that menthol cigarettes are more addictive or harder to quit than nonmenthol cigarettes, and intending to continue using nicotine under a ban increased the odds of opposition or ambivalence to the ban.

Conclusions: Targeted outreach to those who consume predominantly menthol products and those who do not intend to quit nicotine could increase support of an MC/FC ban among adults who smoke menthol cigarettes.

Objective: Homelessness is a pervasive and pressing problem in the United States and is associated with health risks and premature mortality. However, accurately defining and classifying homeless status can be complex, and assessment of homelessness status requires careful consideration of the data collection process. We assessed the validity of the ascertainment of homeless status on death certificates.

Methods: We quantitatively compared the classification of homeless status from 2023 Multnomah County, Oregon, medical examiner data (considered the gold-standard source, due to the in-depth investigation and extensive data available as a case narrative) with housing status from Oregon Health Authority 2023 vital record (death certificate) data alone. We also described people with an indication of homelessness in the 2023 medical examiner data but not in the 2023 vital record data and considered possible causes of this misclassification.

Results: A total of 171 of 394 (43%) decedents whom we classified as homeless via medical examiner data had an address listed in the final death certificate; all were significantly younger (aged 42 y) than the 223 people with concordant records (aged 46 y).

Conclusions: We found that the presence of an address on a death certificate does not rule out homelessness at the time of death, especially among younger decedents. Other jurisdictions should assess the accuracy of their homeless classification data, as more research is necessary to quantify the presence of misclassification.

Objective: Disease intervention specialists (DISs) play a crucial role in the public health workforce by conducting essential tasks such as contact tracing, contact interviews, and providing referrals for services to control disease spread. Despite the importance of DISs, research is lacking on the job tasks that they perform and the role that they serve in public health agencies. The objective of this study was to identify the unique skill sets of DISs relative to other public health occupations.

Methods: We used a national dataset of job postings in the United States to conduct a comparative analysis of the skills required for 3 occupations: DISs, epidemiologists, and community health workers. We examined job listings posted from July 2022 through February 2023 to determine the frequency of certain skills, and we tested for significant differences in skill mentions across these occupations.

Results: Job postings for DISs were significantly more likely than those for community health workers and epidemiologists to require expertise in areas such as case management (30%), communicable disease control (49%), infectious disease knowledge (33%), and disease prevention techniques (18%).

Conclusions: This study highlights the specialized nature of DISs in managing disease-related public health interventions and supporting population health. Improved data collection is needed to support workforce planning, training, and policy development to ensure the continued effectiveness and reach of DISs in public health systems.

Objectives: Despite recent decreases in overdose deaths in the United States, an opportunity remains to connect with people who have had a nonfatal overdose. We analyzed data collected from the Maricopa County Department of Public Health (MCDPH) nonfatal opioid overdose case investigations program, highlighted findings from investigations conducted during the first 2 years of the program (September 1, 2021-August 31, 2023), and compared findings across the 2 years.

Materials and methods: We reviewed data collected through the MCDPH nonfatal opioid overdose case investigations program, wherein MCDPH staff members conduct telephone interviews with a sample of case patients with a recent nonfatal opioid overdose. During interviews, MCDPH staff asked questions about overdose event circumstances, knowledge and practice of harm reduction strategies, substances used, and interest in treatment. MCDPH staff offered harm reduction kits to all case patients and transferred case patients interested in treatment to the Arizona Opioid Assistance and Referral Line.

Results: MCDPH interviewed 529 of 2029 case patients (29.5%) who met sampling criteria. Among 354 case patients who self-reported recreational drug use, the number of cases reporting recreational fentanyl use increased from 117 of 179 (62.6%) in year 1 to 129 of 175 (73.7%) in year 2. Of 352 case patients, 187 (53.1%) reported access to naloxone. Smoking (208 of 295 case patients; 70.5%) was the most commonly reported route of consumption.

Practice implications: MCDPH's novel nonfatal opioid overdose surveillance program identified trends in drug use and harm reduction among people who use drugs who are at the highest risk of a subsequent overdose. The program continues to operate, and survey questions are routinely evaluated to ensure data collected inform overdose prevention strategies.

Wastewater monitoring is a useful tool to complement case-based surveillance. A hepatitis A virus (HAV) investigation in North Carolina demonstrated that wastewater monitoring detections preceded identification of 2 clinical cases by 12 days. State and local health officials used a preestablished decision tree to respond to wastewater detections of HAV and implement public health actions. The investigation determined that HAV detected in wastewater was likely from 2 people who had not yet developed symptoms or sought testing at the time of detection, providing early information for public health response, including vaccination of family members. Targeted outreach to hospitals as well as medically or socially vulnerable groups at high risk of HAV infection could be recommended in response to consistent HAV detections in wastewater.