Family & Community Health最新文献

Key nutritional behaviors during the first 1000 days of development (pregnancy to age 2) can affect a child's risks for obesity and related negative health conditions. Because social disadvantage can pose substantial barriers to engaging in healthy lifestyle behaviors and increase obesity risk, it's particularly important to help families facing such circumstances support optimal early nutrition. Although some studies have found relevant health messaging to be effective, little previous research has focused on the mechanisms underlying successful messaging. The current study involved semi-structured interviews with pregnant women (n = 8) and mothers of children aged 0-24 months (n = 27) who were members of minoritized socio-economic or racial or ethnic groups with relatively high rates of childhood obesity. Study goals included developing an enhanced understanding of caregiver decision-making and potential obstacles to engaging in recommended behaviors to support optimal early nutrition, as well as identifying likely mechanisms underlying caregiver responses. Thematic analysis identified multiple determinants of caregiver responses related to internal or psychological factors, environmental obstacles, and individual needs. Findings may have implications for future health-focused messaging campaigns aimed at pregnant women and caregivers of young children, particularly for groups at greatest risk for childhood obesity.

Background and objectives: Vasectomy is a highly effective outpatient procedure for permanent contraception that is allowable as a contraceptive method with Title X funds. However, there is limited published knowledge on vasectomies in publicly funded agencies. We sought to understand and document vasectomy services in Title X-funded health centers, including barriers and facilitators to providing those services.

Study design: The study team held qualitative interviews with 22 organizations who received Title X funding. Through an iterative thematic analysis, our team coded the data to produce findings illustrating the landscape of vasectomy service provision in Title X family planning health centers.

Results: Our analysis revealed barriers and facilitators to providing vasectomy services in Title X settings centered on 5 areas: provision of care, finance, supplies, training, and marketing.

Conclusions: These findings highlight some common barriers experienced by clinics and organizations funded by Title X, as well as the facilitators and ways in which barriers are mitigated. By adopting successful strategies to facilitate vasectomy services and mitigate barriers, Title X-funded clinics can meet potential increases in demand for vasectomy services and ensure equitable access to uninsured and underinsured individuals.

Purpose: Combining the Integrated Behavioral Model (IBM) and Social Network Analysis (SNA), this study explored individual and interpersonal-level factors related to adults meeting physical activity (PA) recommendations.

Methods: 250 adults (66.8% women, 70.1% non-Hispanic white, age = 38.65 ± 12.93) recruited through local events and social media completed online surveys. Logistic regression analysis assessed factors related to meeting PA recommendations, including demographic characteristics, barriers to PA, injunctive norms, perceived behavioral control, intention, and descriptive norms measured via SNA.

Results: 40.6% (n = 99) of participants met minimum PA recommendations. Higher perceived behavioral control (OR = 1.47, P < .001), intention (OR = 1.16, P = .01), having more female network members (OR = 1.02, P = .04) and more network members who were active with the participant (OR = 1.03, P < .001) were associated with increased odds of meeting PA recommendations. Network density scores (OR = .04, P < .01), decreased the odds of meeting PA recommendations.

Conclusions: Our findings highlight the importance of a person's immediate social context, more so than global social norms, on their PA behavior. In addition to increasing individual-level perceived behavioral control and intentions, efforts aimed at promoting PA should focus on leveraging aspects of social networks that translate to direct social influence on individual behavior. This study affirms SNA as a useful way to assess descriptive norms defined in the IBM.

Background and objective: Internet-based patient engagement (PE) can empower rural individuals in essential health services. This study investigated predisposing, need, and enabling factors associated with major online PE activities in the rural populations of the United States Pacific Northwest region.

Method: A cross-sectional survey of 250 adults aged 45 to 75 residing in rural parts of Alaska, Idaho, Oregon, and Washington was conducted. Three domains of predictors (predisposing, need, and enabling factors) were assessed. The outcomes were 3 major online PE activities (online access to care, information seeking and sharing, and self-management support).

Result: Online health engagement was associated with multiple chronic diseases, perceived need for colorectal cancer screening, difficulty finding providers, and lower mistrust. Younger age, higher awareness of colorectal cancer risk, better health status, difficulty finding providers, frequent internet use, and misunderstanding between patients and providers were associated with increased online information seeking and sharing. Female gender, more cancer knowledge, lower income, and higher information search difficulty were associated with increased online self-management support. Health information literacy was associated with all PE activities.

Conclusion: Different factors influence online PE activities among rural populations. Optimizing diverse PE activities should assess different predisposing, need, and enabling factors in rural health care.

Background and objectives: Nearly 24 million adults in the United States identify as LGBTQIA+, facing significant health disparities due to discrimination, structural barriers, and lack of culturally competent health care. This study explores health care disparities, barriers, facilitators, and the association of perceived discrimination on LGBTQIA+ health care.

Methods: Participants were recruited from June 2023 to January 2024 using convenience sampling methods via LGBTQIA+ organizations and social media platforms. A total of 501 participants completed a REDCap survey, with 255 providing complete data. The survey queried demographics, physical and mental health, and health care utilization. Data analysis included descriptive statistics and CHERRIES guidelines.

Results: Participants reported significant barriers to care, including being uninsured (22%), geographic distance (33%), fear of negative reactions (26%), and past trauma (23%). Discrimination in health care settings was reported by 83%, impacting access. High rates of homelessness (26%), food insecurity (73%), and chronic medical conditions (92%) were reported. Approximately 55% reported head trauma, 26% experienced intimate partner violence-related head injuries, and only 44% sought care for head injuries. Moderate depressive and anxiety symptoms were common, and 49% screened positive for possible PTSD.

Conclusions: This study highlights barriers to care reported by LGBTQIA+ individuals, emphasizing the need for culturally informed services. Addressing these disparities requires education, cultural humility, and systemic reforms to reduce disparities in health care for LGBTQIA+ individuals.

Background and objectives: Social determinants of health (SDOH) can have profound impacts on children, though many lack access to SDOH programs. Our objective was to determine feasibility and outcomes of a SDOH program for families of children seen in an emergency department (ED) serving an under-resourced rural population.

Methods: This prospective cohort study assessed for 11 domains of SDOH among families of pediatric ED patients. Families with positive screens were contacted following their ED visit and provided resources. Fisher exact and Chi-square tests were used to identify sociodemographic factors associated with SDOH and resource requests.

Results: Of the 95 surveys administered, 42% were positive for ≥1 SDOH, most frequently food scarcity (27%). Forty percent of families with positive SDOH needs screens requested services, of which remote resource assistance was performed successfully with 75%. Families with an unemployed primary caregiver ( P = .04) and Medicaid insurance ( P < .001) were more likely to screen positive for SDOH needs. Forty percent of respondents were from surrounding rural counties and were less likely to request resources ( P = .01).

Conclusions: SDOH needs are common among families utilizing EDs for their children's health care. EDs serving under-resourced rural communities can be leveraged to address SDOH needs, and further research is needed to evaluate their impacts on rural families.

Background: Some maternity leave practices are associated with postpartum depressive (PPD) symptoms which in turn are linked with increased risk of poor maternal and infant outcomes. Mothers of color disproportionately experience poor maternity leave policies and elevated PPD symptoms.

Methods: This cross-sectional study employed data collected at baseline of the Baby's First Year study. Participants were 153 American mothers living below the poverty line. They were interviewed (2018-2019) in the days following birth regarding their race, maternity leave, and PPD symptoms.

Results: Findings indicated that alone race and maternity leave practices were not associated with PPD symptoms. However, the interaction between the two accounted for significant variability in PPD symptoms. Black/African American mothers who reported that they used unpaid maternity leave (n=41, M=8.146, SD=0.708) and mothers in the "Other" race category who reported not taking maternity leave (n=7, M=8.857, SD=1.715) had higher than expected rates of PPD.

Conclusion: These findings show that on the whole, poor maternity leave practices have a disproportionate impact on mothers of color. When women of color are exposed to either no maternity leave or unpaid maternity leave, they are at elevated risk of developing PPD.

Background: In the United States, 30.7% of children aged 10-17 are overweight/obese, increasing their risk of experiencing negative health outcomes. Clinical guidelines urge for frequent visits for preventative weight management. Limited research examines the intersection of primary care patterns and families' perspectives of pediatric primary care in rural South Carolina (SC).

Objectives: 1) Examine rural/non-rural differences in pediatric primary care patterns among Medicaid-insured children, and 2) contextualize differences from families' perspectives.

Methods: SC Medicaid claims were analyzed among patients who had a weight-related diagnostic code and ≥1 primary care visit in northeastern SC from 2018 to 2022 (N = 22,084). Logistic regression examined associations between patient characteristics and traveling for primary care. Additionally, in-depth interviews (N = 12) were conducted to explore families' perspectives in rural primary care access.

Results: Overall, 40.54% of children were diagnosed as overweight/obese. Children living in rural counties, younger, non-Hispanic white, and had a healthy weight were most likely to travel for primary care. Rurality influenced the relationship between traveling for care, race/ethnicity, and weight status. Families express limited trust and perceive poor healthcare quality in their community, motivating their willingness to travel for healthcare.

Conclusion: Findings may inform tailored public health efforts to optimize child and family health across rural SC.

Background: Research suggests that physical activity policy is emerging as an avenue to target physical activity behaviors. Shared use has been identified as a policy strategy to increase access to physical activity opportunities. Still, few studies have examined the shared use process and the partnerships at the policy and environmental levels within the local context.

Objectives: This study examined the influential factors of shared use initiatives and the community-school partnership.

Methods: A multiple case study method was utilized to investigate shared use policies and procedures. Seven interviews were conducted with nine combined participants from three schools. The qualitative data were analyzed using thematic analysis.

Results: Cross-case analysis revealed three salient themes: (1) the need for coordinated communication, (2) variation in partnership collaboration, and (3) fluctuation in the use of established policy.

Implications for policy: This study revealed gaps in communication from upper-level education administration, and having diverse partners can enhance shared use implementation efforts. Additionally, having a specific shared use policy was a nominal factor in schools participating in shared use.

Conclusion: The findings suggest that policy dissemination and education should be considered for local school administration and the community. Multifaceted partnerships are needed to implement robust shared use initiatives.

Background: Residents of historically Black low-income neighborhoods experience disproportionately poorer health. Public infrastructure redevelopment projects (eg, multi-use trails, parks, and public transportation) may improve quality of life and health outcomes in these neighborhoods.

Objectives: The current study draws from communication infrastructure theory to examine the role of interpersonal discussion and civic engagement (belonging, collective efficacy) in intentions to use newly built trails and parks for physical activity.

Methods: Community-based survey data from 398 randomly selected households in historically Black low-income neighborhoods impacted by health inequities were used to identify factors associated with intention to use multi-use trails being developed in the neighborhoods.

Results: Interpersonal discussion, belonging, and collective efficacy were positively and independently associated with intentions to use parks and trails. Additionally, the civic engagement factors (belonging and collective efficacy) mediate the relationship between interpersonal discussion and intentions to use parks and trails.

Conclusion: Interpersonal discussions and civic engagement can promote new parks and trails in low-income neighborhoods, which in turn may increase physical activity and improve overall health of community members.