Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241250223
Greer McCollum, Ashleigh Allgood, April Agne, Dave Cleveland, Cicily Gray, Eric Ford, Stefan Baral, Michael Mugavero, Allyson G Hall
Objectives: The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama.
Methods: From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ2 tests, Kruskal-Wallis tests, Mantel-Haenszel χ2 tests, and Fisher exact tests to examine the associations between vaccination status and survey responses.
Results: Respondents in majority-African American counties were significantly more likely than those in majority-White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; P < .001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; P < .001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose (P = .001), and those who were encouraged to avoid vaccination by family (P = .007), friends (P = .02), coworkers (P = .003), and health care providers (P < .001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated (P < .001).
Conclusions: Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions.
目标:COVID-19 大流行表明,接种疫苗的决定如何受到错误信息、虚假信息和社会压力的影响,从而导致不同和不公平的接种率。在本研究中,我们考察了阿拉巴马州农村地区通过社交网络接收到的 COVID-19 疫苗信息与疫苗接种率之间的关系:从 2021 年 11 月到 2022 年 3 月,我们在阿拉巴马州的 4 个农村县收集了 700 份电话调查回复。我们要求受访者说明某些社会关系(如家庭、企业)是否试图影响他们(1)接种或(2)避免接种 COVID-19 疫苗。我们使用 χ2 检验、Kruskal-Wallis 检验、Mantel-Haenszel χ2 检验和费舍尔精确检验来研究疫苗接种状况与调查回答之间的关联:结果:非裔美国人占多数的县的受访者接种 COVID-19 疫苗≥1 剂的可能性明显高于白人占多数的县(89.8% vs 72.3%;P P P = .001),而家人(P = .007)、朋友(P = .02)、同事(P = .003)和医疗保健提供者(P P P 结论:人际关系和人口特征与疫苗接种情况之间的关系非常密切:在阿拉巴马州农村地区,人际关系和人口特征似乎对 COVID-19 疫苗接种决策很重要。进一步的研究需要确定如何促进疫苗接种积极的人际关系,如同伴指导和可信信使干预。
{"title":"Associations Between Social Networks and COVID-19 Vaccine Uptake in 4 Rural Alabama Counties: Survey Findings.","authors":"Greer McCollum, Ashleigh Allgood, April Agne, Dave Cleveland, Cicily Gray, Eric Ford, Stefan Baral, Michael Mugavero, Allyson G Hall","doi":"10.1177/00333549241250223","DOIUrl":"10.1177/00333549241250223","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama.</p><p><strong>Methods: </strong>From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ<sup>2</sup> tests, Kruskal-Wallis tests, Mantel-Haenszel χ<sup>2</sup> tests, and Fisher exact tests to examine the associations between vaccination status and survey responses.</p><p><strong>Results: </strong>Respondents in majority-African American counties were significantly more likely than those in majority-White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; <i>P</i> < .001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; <i>P</i> < .001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose (<i>P</i> = .001), and those who were encouraged to avoid vaccination by family (<i>P</i> = .007), friends (<i>P</i> = .02), coworkers (<i>P</i> = .003), and health care providers (<i>P</i> < .001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"691-698"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241249339
Cristina A Sarmiento, Anna Furniss, Megan A Morris, Michelle L Stransky, Darcy A Thompson
Objectives: People with childhood-onset disabilities are living into adulthood, and the prevalence of smoking and illicit drug use among adults with disabilities is high. We evaluated the relationship between disability status and age of disability onset, current cigarette smoking status, and heavy alcohol drinking.
Methods: We conducted a secondary data analysis of the National Health Interview Survey (NHIS), a US survey on illness and disability. Among 2020 NHIS participants aged 22-80 years (n = 28 225), we compared self-reported prevalence of current cigarette smoking and heavy alcohol drinking among those with and without disabilities and among those with childhood- versus adult-onset disabilities. We used adjusted logistic regression analysis to calculate the adjusted odds ratios (AORs) of current smoking and heavy alcohol drinking based on disability status and age of disability onset.
Results: Compared with adults without disabilities, adults with disabilities were significantly more likely to report current smoking (23.5% vs 11.2%; P < .001) and significantly less likely to report heavy alcohol drinking (5.3% vs 7.4%; P = .001). The prevalence of these behaviors did not vary significantly by age of disability onset. In adjusted logistic regression models, adults with disabilities had significantly higher odds of current smoking (AOR = 1.76; 95% CI, 1.53-2.03) and similar odds of heavy alcohol drinking (AOR = 0.82; 95% CI, 0.65-1.04) compared with adults without disabilities. The odds of these health behaviors did not vary significantly by age of disability onset.
Conclusions: Adults with disabilities overall may be at high risk for these unhealthy behaviors, particularly smoking, regardless of age of disability onset. Routine screening and cessation counseling related to smoking and unhealthy alcohol use are important for all people with disabilities.
目标:儿童时期致残的人一直活到成年,而成年残疾人中吸烟和使用非法药物的比例很高。我们评估了残疾状况与残疾发病年龄、当前吸烟状况和大量饮酒之间的关系:我们对美国国家健康访谈调查(National Health Interview Survey,NHIS)进行了二次数据分析,这是一项关于疾病和残疾的调查。在 2020 名年龄在 22-80 岁之间的 NHIS 参与者(n = 28 225)中,我们比较了有残疾和无残疾者以及儿童期残疾和成年期残疾者自我报告的当前吸烟率和酗酒率。我们使用调整后的逻辑回归分析法,计算了基于残疾状况和残疾发病年龄的当前吸烟和大量饮酒的调整后几率比(AORs):与非残疾成年人相比,残疾成年人报告当前吸烟的可能性明显更高(23.5% vs 11.2%; P P = .001)。这些行为的发生率并不因残疾发生年龄的不同而有显著差异。在调整后的逻辑回归模型中,与非残疾成年人相比,残疾成年人当前吸烟的几率明显更高(AOR = 1.76;95% CI,1.53-2.03),大量饮酒的几率也与非残疾成年人相似(AOR = 0.82;95% CI,0.65-1.04)。这些健康行为的发生几率并不因残疾发生年龄的不同而有显著差异:结论:总体而言,残疾成年人可能是这些不健康行为的高危人群,尤其是吸烟,与残疾发病年龄无关。与吸烟和不健康饮酒有关的常规筛查和戒酒咨询对所有残疾人都很重要。
{"title":"Disparities in Smoking and Heavy Drinking Behaviors by Disability Status and Age of Disability Onset: Secondary Analysis of National Health Interview Survey Data.","authors":"Cristina A Sarmiento, Anna Furniss, Megan A Morris, Michelle L Stransky, Darcy A Thompson","doi":"10.1177/00333549241249339","DOIUrl":"10.1177/00333549241249339","url":null,"abstract":"<p><strong>Objectives: </strong>People with childhood-onset disabilities are living into adulthood, and the prevalence of smoking and illicit drug use among adults with disabilities is high. We evaluated the relationship between disability status and age of disability onset, current cigarette smoking status, and heavy alcohol drinking.</p><p><strong>Methods: </strong>We conducted a secondary data analysis of the National Health Interview Survey (NHIS), a US survey on illness and disability. Among 2020 NHIS participants aged 22-80 years (n = 28 225), we compared self-reported prevalence of current cigarette smoking and heavy alcohol drinking among those with and without disabilities and among those with childhood- versus adult-onset disabilities. We used adjusted logistic regression analysis to calculate the adjusted odds ratios (AORs) of current smoking and heavy alcohol drinking based on disability status and age of disability onset.</p><p><strong>Results: </strong>Compared with adults without disabilities, adults with disabilities were significantly more likely to report current smoking (23.5% vs 11.2%; <i>P</i> < .001) and significantly less likely to report heavy alcohol drinking (5.3% vs 7.4%; <i>P</i> = .001). The prevalence of these behaviors did not vary significantly by age of disability onset. In adjusted logistic regression models, adults with disabilities had significantly higher odds of current smoking (AOR = 1.76; 95% CI, 1.53-2.03) and similar odds of heavy alcohol drinking (AOR = 0.82; 95% CI, 0.65-1.04) compared with adults without disabilities. The odds of these health behaviors did not vary significantly by age of disability onset.</p><p><strong>Conclusions: </strong>Adults with disabilities overall may be at high risk for these unhealthy behaviors, particularly smoking, regardless of age of disability onset. Routine screening and cessation counseling related to smoking and unhealthy alcohol use are important for all people with disabilities.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"724-733"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241249922
Kyle Rosenblum, Christopher Dunphy, Jing Wang, Kessa Frantz, Rachel Hulkower, Sharon Wong
Objectives: Youth suicide is an urgent public health problem. Gatekeeper training aims to prevent suicide by training people to identify warning signs and make referrals to appropriate services. Many states in the United States have enacted gatekeeper training laws (GTLs) to train school staff in suicide prevention. The objectives of this study were to describe the development of a dataset on GTLs and use the dataset to summarize trends in uptake of GTLs from 2002 through 2022 as well as differences in characteristics (eg, frequency and duration of training) of GTLs.
Methods: We used publicly available legal databases from all 50 states and the District of Columbia to conduct a policy surveillance assessment of GTLs. We cross-checked data with the American Foundation for Suicide Prevention's 2022 Suicide Prevention in Schools (K-12) issue brief and used Westlaw Edge to conduct a sensitivity analysis. We included the following data in the full dataset: type of laws (encouraged, mandatory, or conditional mandatory), date passed, effective date, frequency of training, and length of training.
Results: In 2022, 49 states and the District of Columbia had GTLs, 31 of which were mandatory laws. In 2002, only 6 states had such laws, and none were mandatory.
Conclusion: The growing proliferation of laws on suicide prevention training for school staff warrants evaluation of the laws' effectiveness. Our policy surveillance data may be used to better understand the role of these laws in a school-based approach to youth suicide prevention.
{"title":"Changes in State Laws on Suicide Prevention Training for School Staff, 2002-2022.","authors":"Kyle Rosenblum, Christopher Dunphy, Jing Wang, Kessa Frantz, Rachel Hulkower, Sharon Wong","doi":"10.1177/00333549241249922","DOIUrl":"10.1177/00333549241249922","url":null,"abstract":"<p><strong>Objectives: </strong>Youth suicide is an urgent public health problem. Gatekeeper training aims to prevent suicide by training people to identify warning signs and make referrals to appropriate services. Many states in the United States have enacted gatekeeper training laws (GTLs) to train school staff in suicide prevention. The objectives of this study were to describe the development of a dataset on GTLs and use the dataset to summarize trends in uptake of GTLs from 2002 through 2022 as well as differences in characteristics (eg, frequency and duration of training) of GTLs.</p><p><strong>Methods: </strong>We used publicly available legal databases from all 50 states and the District of Columbia to conduct a policy surveillance assessment of GTLs. We cross-checked data with the American Foundation for Suicide Prevention's <i>2022 Suicide Prevention in Schools (K-12)</i> issue brief and used Westlaw Edge to conduct a sensitivity analysis. We included the following data in the full dataset: type of laws (encouraged, mandatory, or conditional mandatory), date passed, effective date, frequency of training, and length of training.</p><p><strong>Results: </strong>In 2022, 49 states and the District of Columbia had GTLs, 31 of which were mandatory laws. In 2002, only 6 states had such laws, and none were mandatory.</p><p><strong>Conclusion: </strong>The growing proliferation of laws on suicide prevention training for school staff warrants evaluation of the laws' effectiveness. Our policy surveillance data may be used to better understand the role of these laws in a school-based approach to youth suicide prevention.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"750-759"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241249675
Briana Moreland, Tessa Clemens, Nimi Idaikkadar
Objectives: To improve national drowning surveillance efforts, we developed and evaluated a definition for unintentional drowning for use in the National Syndromic Surveillance Program's ESSENCE platform (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) and described drowning-related emergency department (ED) visits from 2019 through 2022 using the new definition.
Methods: We adapted an unintentional drowning definition from a previous version, which included all drowning-related ED visits regardless of intent (including drowning related to assault and suicide, as well as unintentional drowning). We reviewed a random sample of 1000 visits captured by the new definition of unintentional drowning and categorized visits as likely, possibly, and unlikely to be related to unintentional drowning. We compared monthly drowning-related ED visits from 2020, 2021, and 2022 with monthly drowning ED visits from 2019, overall and by sex and age group.
Results: A total of 35 431 ED visits related to unintentional drowning (10.71 per 100 000 ED visits) occurred from 2019 through 2022. Most visits (86%) captured by the new definition and manually reviewed were likely related to unintentional drowning. Rates were highest among males (14.04 per 100 000 ED visits) and children aged <1 to 4 years (65.61 per 100 000 ED visits). The number of drowning-related ED visits was higher in May and August 2020, May and June 2021, and May 2022 as compared with the same months in 2019 among people aged 18 to 44 years.
Conclusions: The definition for unintentional drowning is available in the National Syndromic Surveillance Program's ESSENCE platform for state and local jurisdictions to use to monitor unintentional drowning-related ED visits in near-real time to inform prevention strategies.
{"title":"Syndromic Surveillance of Emergency Department Visits Related to Unintentional Drowning, United States, 2019-2022.","authors":"Briana Moreland, Tessa Clemens, Nimi Idaikkadar","doi":"10.1177/00333549241249675","DOIUrl":"10.1177/00333549241249675","url":null,"abstract":"<p><strong>Objectives: </strong>To improve national drowning surveillance efforts, we developed and evaluated a definition for unintentional drowning for use in the National Syndromic Surveillance Program's ESSENCE platform (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) and described drowning-related emergency department (ED) visits from 2019 through 2022 using the new definition.</p><p><strong>Methods: </strong>We adapted an unintentional drowning definition from a previous version, which included all drowning-related ED visits regardless of intent (including drowning related to assault and suicide, as well as unintentional drowning). We reviewed a random sample of 1000 visits captured by the new definition of unintentional drowning and categorized visits as likely, possibly, and unlikely to be related to unintentional drowning. We compared monthly drowning-related ED visits from 2020, 2021, and 2022 with monthly drowning ED visits from 2019, overall and by sex and age group.</p><p><strong>Results: </strong>A total of 35 431 ED visits related to unintentional drowning (10.71 per 100 000 ED visits) occurred from 2019 through 2022. Most visits (86%) captured by the new definition and manually reviewed were likely related to unintentional drowning. Rates were highest among males (14.04 per 100 000 ED visits) and children aged <1 to 4 years (65.61 per 100 000 ED visits). The number of drowning-related ED visits was higher in May and August 2020, May and June 2021, and May 2022 as compared with the same months in 2019 among people aged 18 to 44 years.</p><p><strong>Conclusions: </strong>The definition for unintentional drowning is available in the National Syndromic Surveillance Program's ESSENCE platform for state and local jurisdictions to use to monitor unintentional drowning-related ED visits in near-real time to inform prevention strategies.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"717-723"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241247708
Richard W Puddy, Megan A Kelly, Christopher Nelson, Alexandra H Ntazinda, Sameer Siddiqi, Diane Hall, Christian T Murray, James E Kucik
A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary "black boxes," interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts.
{"title":"Advancing Evidence-Based Public Health Policy: How Core Component Thinking Can Illuminate the Multilevel Nature of Public Health Policy.","authors":"Richard W Puddy, Megan A Kelly, Christopher Nelson, Alexandra H Ntazinda, Sameer Siddiqi, Diane Hall, Christian T Murray, James E Kucik","doi":"10.1177/00333549241247708","DOIUrl":"10.1177/00333549241247708","url":null,"abstract":"<p><p>A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary \"black boxes,\" interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"675-683"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241251982
Nazish Masud, Whitney Hamilton, Yelena Tarasenko
Objectives: Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States.
Methods: This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse.
Results: During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics.
Conclusions: Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months.
{"title":"Prevalence of Cigarette Smoking, E-cigarette Use, and Dual Use Among Urban and Rural Women During the Peripartum Period, PRAMS 2015-2020.","authors":"Nazish Masud, Whitney Hamilton, Yelena Tarasenko","doi":"10.1177/00333549241251982","DOIUrl":"10.1177/00333549241251982","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States.</p><p><strong>Methods: </strong>This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse.</p><p><strong>Results: </strong>During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (<i>P</i> < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics.</p><p><strong>Conclusions: </strong>Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"708-716"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-28DOI: 10.1177/00333549241253419
Victoria M Nielsen, W W Sanouri Ursprung, Glory Song, Gail Hirsch, Theresa Mason, Claire Santarelli, Erica Guimaraes, Erica Marshall, Caitlin G Allen, Pei-Pei Lei, Diane Brown, Bittie Behl-Chadha
Objectives: The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy.
Methods: We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch?
Results: Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations.
Conclusions: Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce.
{"title":"The Launch of Massachusetts Community Health Worker Certification: Findings From the Massachusetts Community Health Worker Workforce Surveys.","authors":"Victoria M Nielsen, W W Sanouri Ursprung, Glory Song, Gail Hirsch, Theresa Mason, Claire Santarelli, Erica Guimaraes, Erica Marshall, Caitlin G Allen, Pei-Pei Lei, Diane Brown, Bittie Behl-Chadha","doi":"10.1177/00333549241253419","DOIUrl":"10.1177/00333549241253419","url":null,"abstract":"<p><strong>Objectives: </strong>The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy.</p><p><strong>Methods: </strong>We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch?</p><p><strong>Results: </strong>Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations.</p><p><strong>Conclusions: </strong>Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"760-767"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Linkage to HIV medical care is important in the continuum of HIV care and health outcomes for people with HIV. The objective of this analysis was to identify how the community-based organization (CBO) program contributes to linkage to HIV medical care among people with newly diagnosed HIV in the Centers for Disease Control and Prevention's (CDC's) HIV testing program.
Methods: We analyzed HIV linkage-to-care data submitted to CDC from 2019 through 2021. Linkage was defined as confirmation that an individual attended their first HIV medical care appointment within 30 days of their HIV test date. We included in the analysis data submitted from the health department (HD) program that included 61 state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and the CBO program that included 150 CBOs.
Results: The CBO program linked a higher proportion of people to HIV medical care within 30 days of diagnosis (86.7%) than the HD program (73.7%). By population group, the proportion linked in the CBO program was higher than the proportion linked in the HD program among men who have sex with men (prevalence ratio [PR] = 1.13; P < .001), men who have sex with men/people who inject drugs (PR = 1.29; P < .001), transgender people (PR = 1.28; P < .001), and those reporting no sexual contact or injection drug use (PR = 1.34; P < .001). In the Cox proportional hazards model, time to linkage in the CBO program was significantly shorter than in the HD program (hazard ratio = 0.63; P < .001).
Conclusion: This analysis shows that the CBO program fills a vital need in linking newly diagnosed HIV-positive people to HIV medical care, which is important in the HIV care continuum and for viral suppression.
目的:与 HIV 医疗护理的衔接对于 HIV 护理的连续性和 HIV 感染者的健康结果非常重要。本分析旨在确定社区组织(CBO)计划如何促进美国疾病控制和预防中心(CDC)HIV 检测计划中新确诊的 HIV 感染者与 HIV 医疗护理的联系:我们分析了从 2019 年到 2021 年提交给疾病预防控制中心的 HIV 链接到护理数据。联系被定义为确认患者在 HIV 检测日期后 30 天内参加了首次 HIV 医疗护理预约。我们在分析中纳入了卫生部门(HD)计划(包括美国、波多黎各和美属维尔京群岛的 61 个州和地方卫生部门)和 CBO 计划(包括 150 个 CBO)提交的数据:结果:CBO 计划在确诊后 30 天内为艾滋病患者提供医疗服务的比例(86.7%)高于 HD 计划(73.7%)。按人群划分,在男男性行为者中,CBO 计划的联系比例高于 HD 计划的联系比例(流行率 [PR] = 1.13;P P P P P 结论:这项分析表明,CBO 计划满足了将新诊断出的 HIV 阳性者与 HIV 医疗护理联系起来的重要需求,这对于 HIV 护理的连续性和病毒抑制非常重要。
{"title":"Contributions of the Community-Based Organization Program Funded by the Centers for Disease Control and Prevention to Linkage to HIV Medical Care.","authors":"Mariette Marano-Lee, Weston Williams, Songli Xu, Jonny Andia, Ekaterine Shapatava","doi":"10.1177/00333549241252579","DOIUrl":"10.1177/00333549241252579","url":null,"abstract":"<p><strong>Objective: </strong>Linkage to HIV medical care is important in the continuum of HIV care and health outcomes for people with HIV. The objective of this analysis was to identify how the community-based organization (CBO) program contributes to linkage to HIV medical care among people with newly diagnosed HIV in the Centers for Disease Control and Prevention's (CDC's) HIV testing program.</p><p><strong>Methods: </strong>We analyzed HIV linkage-to-care data submitted to CDC from 2019 through 2021. Linkage was defined as confirmation that an individual attended their first HIV medical care appointment within 30 days of their HIV test date. We included in the analysis data submitted from the health department (HD) program that included 61 state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and the CBO program that included 150 CBOs.</p><p><strong>Results: </strong>The CBO program linked a higher proportion of people to HIV medical care within 30 days of diagnosis (86.7%) than the HD program (73.7%). By population group, the proportion linked in the CBO program was higher than the proportion linked in the HD program among men who have sex with men (prevalence ratio [PR] = 1.13; <i>P</i> < .001), men who have sex with men/people who inject drugs (PR = 1.29; <i>P</i> < .001), transgender people (PR = 1.28; <i>P</i> < .001), and those reporting no sexual contact or injection drug use (PR = 1.34; <i>P</i> < .001). In the Cox proportional hazards model, time to linkage in the CBO program was significantly shorter than in the HD program (hazard ratio = 0.63; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>This analysis shows that the CBO program fills a vital need in linking newly diagnosed HIV-positive people to HIV medical care, which is important in the HIV care continuum and for viral suppression.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"662-668"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-06-01DOI: 10.1177/00333549241253092
Anna Satcher Johnson, Anne Peruski, Alexandra M Oster, Alexandra Balaji, Azfar-E-Alam Siddiqi, Patricia Sweeney, Angela L Hernandez
HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services' Ending the HIV Epidemic in the United States initiative, the White House's National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains.
通过全国艾滋病监测系统 (NHSS) 对艾滋病病毒感染情况进行监测,以帮助改善艾滋病病毒感染者的健康状况并减少传播。NHSS 数据在联邦、州和地方各级被常规用于监测 HIV 的分布和传播情况,规划和评估预防和护理计划,分配资源,为政策制定提供信息,以及识别和应对美国的快速传播。我们介绍了自 2013 年 NHSS 状态更新以来扩大使用 HIV 监测数据的情况,在此期间,美国疾病控制和预防中心 (CDC) 进行了协调,修订了 HIV 监测病例定义,以支持早期感染的检测和实验室数据的报告,扩大了数据收集范围,纳入了有关性取向和性别认同的信息,加强了重复数据删除流程以提高质量,并扩大了报告范围,纳入了健康的社会决定因素和健康公平措施。疾病预防控制中心通过将艾滋病毒预防和监测的资金整合为一个单一的计划,最大限度地发挥了联邦资金的作用;计划资金的整合扩大了艾滋病毒监测数据的使用范围,加强了监测工作,从而提高了群集响应能力,强化了数据到护理的活动,以确保持续的病毒抑制。NHSS 数据是监测艾滋病毒趋势和实现国家倡议进展情况的主要来源,这些倡议包括美国卫生与公众服务部的 "结束美国艾滋病毒流行 "倡议、白宫的 "国家艾滋病毒/艾滋病战略(2022-2025 年)"和 "2030 年健康人群"。随着对高质量艾滋病监测数据需求的持续增长,国家艾滋病监测系统将继续进行现代化改造、调整并扩大其范围。
{"title":"Enhancements to the National HIV Surveillance System, United States, 2013-2023.","authors":"Anna Satcher Johnson, Anne Peruski, Alexandra M Oster, Alexandra Balaji, Azfar-E-Alam Siddiqi, Patricia Sweeney, Angela L Hernandez","doi":"10.1177/00333549241253092","DOIUrl":"10.1177/00333549241253092","url":null,"abstract":"<p><p>HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services' Ending the HIV Epidemic in the United States initiative, the White House's National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"654-661"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-05-23DOI: 10.1177/00333549241239556
Colleen Staatz, Penny S Loosier, Ruth Hsu, Michelle Fiscus, Reena Gupta, E Rain Sabin, Divya Vohra, Holly Matulewicz, Melanie M Taylor, Elise C Caruso, Nickolas DeLuca, Patrick K Moonan, John E Oeltmann, Phoebe Thorpe
Objective: Case investigation and contact tracing (CI/CT) are fundamental public health efforts widely used during the COVID-19 pandemic to mitigate transmission. This study investigated how state, local, and tribal public health departments used CI/CT during the COVID-19 pandemic, including CI/CT methodology, staffing models, training and support, and efforts to identify or prioritize populations disproportionately affected by COVID-19.
Methods: During March and April 2022, we conducted key informant interviews with up to 3 public health officials from 43 state, local, and tribal public health departments. From audio-recorded and transcribed interviews, we used the framework method to analyze key themes.
Results: Major adjustments to CI/CT protocols during the pandemic included (1) prioritizing populations for outreach; (2) implementing automated outreach for nonprioritized groups, particularly during COVID-19 surges; (3) discontinuing contact tracing and focusing exclusively on case investigation; and (4) adding innovations to provide additional support. Key informants also discussed the utility of having backup staffing to support overwhelmed public health departments and spoke to the difficulty in "right-sizing" the public health workforce, with COVID-19 surges leaving public health departments understaffed as case rates rose and overstaffed as case rates fell.
Conclusions: When addressing future epidemics or outbreaks, public health officials should consider strategies that improve the effectiveness of CI/CT efforts over time, such as prioritizing populations based on disproportionate risk, implementing automated outreach, developing models that provide flexible additional staffing resources as cases rise and fall among local public health departments, incorporating demographic data in laboratory reporting, providing community connections and support, and having a system of self-notification of contacts.
{"title":"Experience of Public Health Departments in Implementation of COVID-19 Case Investigation and Contact Tracing Programs.","authors":"Colleen Staatz, Penny S Loosier, Ruth Hsu, Michelle Fiscus, Reena Gupta, E Rain Sabin, Divya Vohra, Holly Matulewicz, Melanie M Taylor, Elise C Caruso, Nickolas DeLuca, Patrick K Moonan, John E Oeltmann, Phoebe Thorpe","doi":"10.1177/00333549241239556","DOIUrl":"10.1177/00333549241239556","url":null,"abstract":"<p><strong>Objective: </strong>Case investigation and contact tracing (CI/CT) are fundamental public health efforts widely used during the COVID-19 pandemic to mitigate transmission. This study investigated how state, local, and tribal public health departments used CI/CT during the COVID-19 pandemic, including CI/CT methodology, staffing models, training and support, and efforts to identify or prioritize populations disproportionately affected by COVID-19.</p><p><strong>Methods: </strong>During March and April 2022, we conducted key informant interviews with up to 3 public health officials from 43 state, local, and tribal public health departments. From audio-recorded and transcribed interviews, we used the framework method to analyze key themes.</p><p><strong>Results: </strong>Major adjustments to CI/CT protocols during the pandemic included (1) prioritizing populations for outreach; (2) implementing automated outreach for nonprioritized groups, particularly during COVID-19 surges; (3) discontinuing contact tracing and focusing exclusively on case investigation; and (4) adding innovations to provide additional support. Key informants also discussed the utility of having backup staffing to support overwhelmed public health departments and spoke to the difficulty in \"right-sizing\" the public health workforce, with COVID-19 surges leaving public health departments understaffed as case rates rose and overstaffed as case rates fell.</p><p><strong>Conclusions: </strong>When addressing future epidemics or outbreaks, public health officials should consider strategies that improve the effectiveness of CI/CT efforts over time, such as prioritizing populations based on disproportionate risk, implementing automated outreach, developing models that provide flexible additional staffing resources as cases rise and fall among local public health departments, incorporating demographic data in laboratory reporting, providing community connections and support, and having a system of self-notification of contacts.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"734-743"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}