Public Health Reports最新文献

Access to specialized health care often requires patients and caregivers to travel long distances, imposing logistical and financial burdens. Temporary lodging near hospitals is essential for health care access, yet information is fragmented, forcing patients and caregivers to search across multiple websites to see all options available. We conducted a cross-sectional review (April 2023-May 2024) of publicly available data, cataloging US organizations that offer temporary lodging near health care facilities. We geocoded and integrated data into the Healthcare Housing Navigator, an interactive map built with ArcGIS Experience Builder. Our review identified 510 lodging organizations. The tool uses geographic information systems for interactive filtering and displays key details, such as organization name, location, cost, and eligibility criteria. By centralizing fragmented information on medical lodging, the Healthcare Housing Navigator addresses an overlooked health-related social need and equips patients, caregivers, and care teams with timely, accessible information.

One Health clinics integrate human, animal, and environmental health to provide interdisciplinary health care and community resources to people experiencing homelessness (PEH). Five mobile, public health-led One Health clinics were newly implemented in Pima County, Arizona, during October 2023-February 2024. Clinic locations included parks, libraries, and homeless shelters to reduce transportation-related barriers and integrate public health, veterinary, and housing services. Originally designed for PEH and their pets, Pima County One Health clinics were open to everyone in neighborhoods where clinics were hosted to promote community engagement with clinics and strengthen relationships with public health. We evaluated the performance of these clinics by describing service patterns, client perceptions, and lessons learned to support development of clinics by other jurisdictions. During clinic visits, basic demographic information was collected for people and pets, along with data on housing status, environmental and resource concerns, use of clinic services, and perceptions of clinics. The first 5 monthly mobile community clinics served 108 clients and 93 pets; 44% of clients were unhoused or unstably housed, 36% of clients were housed, and housing status was unknown for 20% of clients. Clinics facilitated partnership among service providers and with housed and unhoused community members. Clinics supported vaccine uptake among people and their pets and identified 3 cases of sexually transmitted infections that might otherwise have remained undetected. By implementing a One Health Clinic framework, our local health department helped address gaps in human and veterinary health care services. Other public health agencies might consider implementing similar models to enhance public health engagement with local communities.

Objectives: Although wastewater monitoring for virus detection has increased in communities worldwide, public awareness, understanding, questions, and concerns about wastewater monitoring are largely unknown. We assessed awareness, knowledge, and support for wastewater monitoring for detection of viruses and bacteria among US residents and elicited questions and concerns from residents about its use.

Methods: We conducted a survey among a racially and ethnically diverse sample of residents in Colorado, Maryland, Missouri, Nebraska, and Texas to assess awareness, knowledge, and support of wastewater monitoring. We also asked an open-ended question to elicit further questions and concerns from survey participants about wastewater monitoring. Two independent reviewers coded the responses to the open-ended question.

Results: Among 516 survey participants (52% White, 31% Black, 27% Hispanic ethnicity), 289 (56%) were aware that local public health departments and federal health agencies tested sewer water yet 334 (65%) knew "little or nothing" about wastewater monitoring. After participants were exposed to a brief description of the wastewater monitoring process, 80% "supported" or "strongly supported" wastewater monitoring to detect viruses and bacteria. When we analyzed responses to the open-ended question on wastewater monitoring, 3 broad categories and 9 subcategories of questions and concerns about wastewater monitoring emerged: (1) how wastewater monitoring works (mechanics, accuracy, cost, safety), (2) what is done with the findings generated by wastewater monitoring (public accessibility, government trust, public health response), and (3) what protections were in place against misuse of findings (privacy, fairness).

Conclusions: Proactive public education is needed to increase understanding, build support, and prevent disinformation about wastewater monitoring. Local systems are needed to share findings rapidly, clearly, and simply.

Objective: COVID-19 exacerbated health inequities for American Indian/Alaska Native (AI/AN) populations. Tribal public health departments and Tribal Epidemiology Centers are critical in addressing these challenges, particularly among people on or near tribally owned land. In this study, we described an example of the value of Tribal Epidemiology Centers and tribal public health departments and estimated the prevalence of post-COVID-19 condition (PCC), defined as symptoms persisting ≥90 days postinfection, in a tribal community.

Methods: This retrospective cohort study evaluated the prevalence of PCC and functional limitations among adults diagnosed with COVID-19 on the Tule River Reservation from July 2020 through February 2023. Tule River Indian Health Center, Inc staff conducted telephone surveys to assess symptoms at 30 and 90 days postinfection and functional outcomes using the Post-COVID-19 Functional Status scale. We stratified prevalence rates by age and sex and compared functional limitations before and after infection.

Results: We estimated PCC prevalence at 21% (15 of 76). We also found that 37% (24 of 65) of survey participants reported more functional limitations after COVID-19 infection than before.

Conclusions: Our study highlights the need for further research and inclusion of AI/AN communities in PCC research and new vertical policy solutions such as those used for diabetes. AI/AN communities have had inequitably higher rates of COVID-19 and appear poised to also have inequitably higher rates of PCC.

In the United States, rates of fatal and nonfatal firearm injuries differ substantially by race and sex, with Black men being more likely than any other group to be shot. Many people who survive a gunshot wound have complex physical, psychological, and social challenges during their recovery. Public health programs, including hospital-based violence intervention programs (HVIPs), have been designed to reduce the likelihood of reinjury for their participants and to support their well-being. However, little is known about how Black men who survive a gunshot wound and receive care from these programs conceptualize the best ways to support their healing and the barriers they experience in achieving their health-related goals. This case study, drawing from ethnographic research conducted during 2013-2023 at the second busiest HVIP in Maryland, examines the experiences of 6 Black men who were treated with a colostomy after surviving a gunshot wound. Emergent themes included increased psychological stress from being treated with a colostomy and wearing a waste collection pouch, disruptions to everyday life, and insufficient access to colostomy care and education. The findings from this case study highlight the importance of providing access to psychological services, colostomy education, and health care supplies to meet the needs of HVIP participants and improve health outcomes for this population.

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: People with disabilities face many challenges in accessing dental care. We compared disparities in dental care patterns (ie, dental visits for preventive care or treatment) between adults with and without hearing, seeing, mobility, self-care, cognition, or independent living disabilities.

Methods: We analyzed data from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES). For outcome variables, we included self-reported dental visit (yes/no) and preventive dental visit (yes/no) within the past year. NHANES asked participants whether they had serious difficulty in conducting any of the following 6 activities: hearing, seeing, mobility, self-care, cognition, or independent living; participants who answered yes to any of these activities were classified as disabled. Our analytic sample included 11 288 adult respondents aged ≥20 years. We used multiple logistic regression to assess the association between disability status-measured by any disability (yes/no), the 6 types of disabilities (yes/no), and the number of disabilities-and the outcome variables, with P ≤ .05 indicating significance.

Results: Respondents with disabilities were less likely than those without a disability to have a preventive dental visit (adjusted odds ratio = 0.67; 95% CI, 0.59-0.77). Respondents with disabilities in mobility, self-care, or independent living were significantly less likely than those without any disability to have a dental visit. In addition, adults with more disabilities were significantly less likely than those without a disability to have a dental visit.

Conclusions: Access to preventive dental care was limited among people with disabilities. Further assistance, including providing dental insurance coverage, is needed to increase access to dental care among people with disabilities, especially those with mobility, self-care, and independent living disabilities.

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.

In response to the COVID-19 pandemic, a multidisciplinary team at the University of Kentucky developed an interdisciplinary science, technology, engineering, and mathematics and environmental health unit-the Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology (WACKIEST) Unit-for high school students in summer 2022. This case study outlines the WACKIEST Unit, which focused on wastewater surveillance and COVID-19, the obstacles faced during development and recruitment, and implementation of the WACKIEST Unit in conjunction with a rural wastewater surveillance initiative. The unit was implemented in spring 2023 at a rural high school in Kentucky, spanning 12 days and engaging 190 students. Lessons emphasized the importance of wastewater testing in public health decision-making, particularly in the context of COVID-19. A mobile laboratory provided students with hands-on experience in conducting preliminary analyses of wastewater, and a field trip to the local wastewater treatment plant allowed them to observe real-world wastewater management practices. At the unit's conclusion, students created a public health report aligned with the Evidence-Informed Decision Making in Public Health model, reinforcing the goal of fostering community health resilience. The initiative's success-measured by the unit's completion and positive feedback from students and teachers-supports the creation of online modules for broader dissemination. This case study demonstrates how adaptable interdisciplinary approaches can integrate real-world scientific issues into secondary education, offering valuable insights for future efforts in public health education.

Objectives: US community pharmacies are a unique and underused health service setting for identifying and potentially intervening with patients at risk of opioid overdose or opioid use disorder with evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT). The aim of our study was to assess the feasibility of implementing SBIRT in community pharmacies in an urban county in terms of engagement, reach, and equity across the cascade of pharmacy screening and care.

Methods: Patients aged 18 years or older receiving a schedule II or III opioid prescription at 1 of 17 participating community pharmacies in Allegheny County, Pennsylvania, were invited to engage in SBIRT as part of Project Lifeline-II from June 2020 through January 2023. Participants completed a prescreen and/or a full screen. We calculated the percentage of patients who participated across the cascade of pharmacy screening and care, overall and by sex (male and female) and race (Black and White).

Results: During the study period, 1952 unique adults (79.6%) were screened at least once (52.1% female; 58.0% White, 30.7% Black). Patients who identified as male (vs female) and Black (vs White) were more likely to have a positive prescreen (14.7% male vs 9.8% female; 16.4% Black vs 9.5% White), receive and complete a full screen (82.7% male vs 80.0% female; 83.6% Black vs 78.4% White), and score positively on the full screen (26.6% male vs 20.4% female; 26.8% Black vs 21.9% White).

Conclusion: Although additional research is needed to characterize the full effect of Project Lifeline-II on patient outcomes, our findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the substance use disorder crisis in the United States.