Public Health Reports最新文献

Objectives: Immigrants in the United States are more likely than nonimmigrants to experience risk factors for intimate partner violence (IPV) and problems in getting support. The COVID-19 pandemic and recent incidents of xenophobia and anti-immigrant sentiment may have exacerbated exposure to IPV risk factors. We examined immigrant experiences of IPV before and during the COVID-19 pandemic.

Methods: This study identified changes in characteristics of abuse, services used, referrals, and barriers to services among those who contacted the National Domestic Violence Hotline (NDVH) and identified as immigrants, reported immigration status as a concern, needed immigration support, and/or identified immigration status as a barrier to accessing services (N = 49 817). We used joinpoint regressions to examine whether the rate of change differed significantly from 2016-2019 (before the pandemic) to 2019-2021 (during the pandemic).

Results: The number of immigrant contacts to NDVH peaked in 2017 (n = 9333) and declined 25% to 6946 in 2021. During 2016-2019, the percentage of contacts reporting the following increased significantly: technology-facilitated violence (+12.7 percentage points), economic/financial abuse (+10.8 percentage points), and involvement of firearms (+4.8 percentage points); during 2019-2021, these trends reversed. The percentage of contacts reporting separation or divorce was relatively flat until 2019 and then increased from 14.6% in 2019 to 19.9% in 2021 (+5.2 percentage points). Housing instability increased during 2017-2020 (+9.3 percentage points), but requests for shelters decreased (-4.5 percentage points). Immigration status and personal finances were commonly reported barriers to services; both decreased during 2016-2019 but then increased during 2019-2021.

Conclusions: This study can inform prevention and response strategies relevant for immigrants experiencing or reporting IPV.

Objective: Previous nonfatal overdose is a key risk factor for drug overdose death; however, current nonfatal overdose surveillance is limited to people who receive medical attention. We identified states that tracked nonfatal overdoses treated in prehospital and hospital care settings, assessed the effects of different surveillance methods on the magnitude of nonfatal overdose estimates, and estimated states' nonfatal-to-fatal overdose ratio.

Methods: Two analysts independently reviewed state websites to characterize states' methods of capturing nonfatal overdose events from December 2022 through February 2023. We collected information on surveillance methods in 5 states that met the inclusion criteria, including data source, measure specification, drug(s) involved, and whether states performed deduplication or published mutually exclusive measure specifications to capture unique events across care settings. We calculated nonfatal-to-fatal overdose ratios to assess the effects of different data sources on estimates of nonfatal overdoses.

Results: Illinois, Maine, North Carolina, and West Virginia used syndromic surveillance data and New Jersey used hospital discharge data to track nonfatal overdose-related emergency department visits. Illinois and West Virginia tracked nonfatal overdose-related encounters with emergency medical services. Other states tracked opioid overdoses reversed following naloxone administration by emergency medical services, law enforcement, and community members. Maine, New Jersey, and West Virginia published nonfatal overdose information by using mutually exclusive measure specifications; the number of nonfatal overdoses per fatal overdose in these states ranged from approximately 5:1 to 14:1.

Practice implications: Establishing a standard framework to combine data from existing national surveillance systems in prehospital and hospital care settings can improve nonfatal overdose estimates and enable comparisons between jurisdictions to help decision makers identify areas most in need of essential services.

Public health policy interventions are associated with many important public health achievements. To provide public health practitioners and decision makers with practical approaches for examining and employing evidence-based public health (EBPH) policy interventions, we describe the characteristics and benefits that distinguish EBPH policy interventions from programmatic interventions. These characteristics include focusing on health at a population level, focusing on upstream drivers of health, and involving less individual action than programmatic interventions. The benefits of EBPH policy interventions include more sustained effects on health than many programs and an enhanced ability to address health inequities. Early childhood education and universal preschool provide a case example that illustrates the distinction between EBPH policy and programmatic interventions. This review serves as the foundation for 3 concepts that support the effective use of public health policy interventions: applying core component thinking to understand the population health effects of EBPH policy interventions; understanding the influence of existing policies, policy supports, and the context in which a particular policy is implemented on the effectiveness of that policy; and employing a systems thinking approach to identify leverage points where policy implementation can have a meaningful effect.

Objectives: Yearly rolling aggregate trends or rates are commonly used to analyze trends in overdose deaths, but focusing on long-term trends can obscure short-term fluctuations (eg, daily spikes). We analyzed data on spikes in daily fatal overdoses and how various spike detection thresholds influence the identification of spikes.

Materials and methods: We used a spike detection algorithm to identify spikes among 16 660 drug-related overdose deaths (from any drug) reported in Massachusetts' vital statistics from 2017 through 2023. We adjusted the parameters of the algorithm to define spikes in 3 distinct scenarios: deaths exceeding 2 adjusted moving SDs above the 7-, 30-, and 90-day adjusted moving average.

Results: Our results confirmed the on-the-ground observation that there are days when many more people die of overdoses than would be expected based on fluctuations due to differences among people alone. We identified spikes on 5.8% to 20.6% of the days across the 3 scenarios, annually, constituting 11.1% to 31.6% of all overdose deaths. The absolute difference in percentage points of days identified as spikes varied from 5.2 to 11.5 between 7- and 30-day lags and from 0 to 4.6 between 30- and 90-day lags across years. When compared with the adjusted moving average across the 3 scenarios, in 2017 an average of 3.9 to 5.5 additional deaths occurred on spike days, while in 2023 the range was 3.7 to 6.0.

Practice implications: A substantial percentage of deaths occurred annually on spike days, highlighting the need for effectively monitoring short-term overdose trends. Moreover, our study serves as a foundational analysis for future research into exogenous events that may contribute to spikes in overdose deaths, aiming to prevent future deaths.

Objectives: To improve rapid detection and response to spikes in suspected nonfatal opioid overdoses in the community, the Rhode Island Department of Health (RIDOH) sought to modify its case definition to align with newly released guidance from the Council of State and Territorial Epidemiologists (CSTE).

Methods: RIDOH used CSTE guidance to create 2 alternative criteria (CSTE-guided and RIDOH-modified CSTE) to replace one of RIDOH's original criteria. We gathered emergency medical services (EMS) records from 4 months in 2022 to determine whether they met any criteria, and we reviewed them to determine the accuracy of identifying an opioid overdose. We calculated the positive predictive value for each criterion individually and as a complete case definition (RIDOH original definition, CSTE-guided definition, and RIDOH-modified CSTE definition).

Results: The RIDOH-modified CSTE case definition was adopted because it had a positive predictive value of 91.5% in identifying nonfatal opioid overdose-related EMS incidents, similar to the original definition (91.3%) and higher than the CSTE-guided definition (82.2%). The RIDOH-modified CSTE case definition identified 624 additional nonfatal opioid overdoses in EMS data from 2018 through 2022, a 7% increase from the original definition.

Conclusions: The RIDOH-modified CSTE case definition increased RIDOH's ability to detect suspected nonfatal opioid overdoses while maintaining the accuracy of the case definition. With the new case definition, RIDOH aims to improve allocation of resources to communities experiencing increased overdose burden.

Cervical screening is crucial for early detection of and ultimately eliminating cervical cancer. Conventional methods for cervical screening that rely on clinician collection of specimens encounter barriers, including embarrassment, discomfort, accessibility, and cultural concerns. Self-collection offers a promising solution to promote cervical screening among underscreened populations. Both methods are available to screen eligible patients since changes to the Australian screening program in 2022. We surveyed Australian health care workers at medical practices in an area with low screening rates on their views about self-collection from July through November 2023. Findings revealed gaps in knowledge about appropriate test use and test accuracy. In addition, findings showed a preference for clinician collection and perceptions that their patients lack confidence in self-collection and lack the willingness to learn about self-collection for cervical screening. Lack of up-to-date information on self-collection logistics and accuracy and pessimistic views on the ability of patients to perform self-collection can hinder the use of self-collection for cervical screening. Addressing these concerns through comprehensive education, easy-to-access guidelines, and interventions designed to support self-collection as part of routine practice is essential, especially for improved participation among under- or never-screened patients.

Objectives: Massachusetts signed into law An Act Modernizing Tobacco Control (hereinafter, the Act) in 2019, which restricted retail sales of flavored tobacco products, including menthol cigarettes. This study assessed differences in advertising exposure to flavored tobacco products among adolescents in Massachusetts compared with adolescents in 4 neighboring states after passage of the Act.

Methods: We collected monthly cross-sectional survey data from April 2021 through August 2022 among a convenience sample of adolescents (aged 13-17 y) in Massachusetts and 4 control states: Connecticut, New Hampshire, Rhode Island, and Vermont. We measured self-reported past-30-day exposure to advertising for flavored electronic cigarette (e-cigarette) products and flavored cigarettes or other tobacco products across 9 channels.

Results: After implementation of the Act, adolescents in Massachusetts, compared with adolescents in the 4 control states, reported significantly lower levels of exposure to advertisements for flavored e-cigarettes (convenience store: adjusted odds ratio [AOR] = 0.80 [95% CI, 0.66-0.96]; supermarket/grocery store: AOR = 0.66 [95% CI, 0.52-0.84]; gas station: AOR = 0.61 [95% CI, 0.51-0.75]) and flavored cigarette/other tobacco products (convenience store: AOR = 0.69 [95% CI, 0.57-0.83]; supermarket/grocery store: AOR = 0.63 [95% CI, 0.49-0.79]; gas station: AOR = 0.55 [95% CI, 0.45-0.66]) in retail channels, which were the intended targets of the Act. We found no significant differences in flavored tobacco product advertising exposure for non-retail channels (television, radio, posters/billboards, newspapers/magazines, social media, and streaming services/movies in a theater).

Conclusions: Future research should further examine the effects of statewide flavored tobacco sales restrictions on the availability of and exposure to advertisements for flavored tobacco products.

Objectives: To gather perspectives on childhood vaccination and vaccine hesitancy, the Saint Louis County Department of Public Health (DPH) surveyed parents seeking nonmedical exemptions, conducted focus groups of school nurses, and interviewed pediatricians.

Methods: We distributed exemption forms and voluntary questionnaires to parents in St Louis County who were seeking nonmedical exemptions for their school-aged children at any DPH clinic from August 2019 through December 2022. We conducted and recorded four 75- to 90-minute focus groups of 11 school nurses in groups of 2 or 3 nurses in September 2022. We conducted and recorded interviews of 8 pediatricians in March 2023. We calculated descriptive statistics, transcribed focus group discussions and interviews, and performed qualitative coding.

Results: We collected 1871 exemption forms. The median age of children (n = 1854) was 6 years. Of the 10 vaccines included in the exemption list, the percentage of exclusions ranged from 91.2% for meningococcal conjugate to 88.7% for hepatitis A. We identified 4 themes in the focus groups: recent changes in vaccine compliance, hesitancy and barriers, services addressing hesitancy and barriers, and future requests for DPH. Analysis of pediatrician interviews revealed themes relating to vaccine information, community efforts, and physician decision-making.

Conclusions: This study highlights the need for a multidisciplinary approach to vaccine hesitancy in St Louis County. Future interventions need to focus on beliefs and behavioral change related to vaccines and not just the economics and accessibility of vaccines.