Family & Community Health最新文献

Background and objectives: Though preventive measures are available to alleviate the burden of dental caries, there remain racial disparities in the utilization of preventative dental care. Our objectives were to determine whether racial disparities persisted in receiving preventive oral procedures between (1) Black children and white children; and (2) Hispanic children and white children.

Methods: We used pooled Medical Expenditure Panel Survey data in the United States from 2018 to 2021. The key outcome variable involved the use of preventive dental services (ie, examination, x-rays, cleaning, dental sealant fitting, and fluoride treatment), while the main predictor variable involved race (ie, whether they were white, Black, or Hispanic children).

Results: Controlling for covariates, there was no statistical significance in the odds of Hispanic and white children in receiving x-rays, sealants, and fluoride treatment ( P < .001). Black children had significantly lower odds of receiving oral examination, x-rays, and fluoride treatment than their white counterparts ( P < .01).

Conclusions: This study highlights the massive strides made in the utilization of preventive dental services by Hispanic children in the United States along with the persisting disparities largely present for Black children; however, further studies are needed focusing on structural, sociocultural, and factors contributing to these disparities.

Background: Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants.

Objective: This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception).

Methods: Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female.

Results: Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care.

Conclusions: Interventions that address social determinants of health can potentially promote contraceptive use.

Older adults from underserved backgrounds experience chronic pain at a rate of 60% to 75%. Pharmacological treatments have limited efficacy and involve considerable risks. Mind-body interventions hold promise to improve pain outcomes but are typically not implemented in community clinics in which they are needed most, thus contributing to health disparities in chronic pain treatment. We conducted qualitative focus groups and interviews with 20 providers (eg, primary care doctors, nurses, administrators). We sought their perspectives on barriers and facilitators to implementing an evidence based mind-body activity program for older adults with chronic pain at an underserved community health clinic in Massachusetts. Subthemes were identified within 2 superordinate domains (barriers and facilitators) using a hybrid inductive-deductive thematic analysis approach following the Framework Method. Providers discussed facilitators (partner with clinic staff to facilitate referrals and buy-in, integrate referrals through the electronic medical record, offer groups in different languages, post and tailor advertisements) and barriers (limited staff bandwidth, scheduling challenges, inconsistent patient participation). These results will directly inform tailoring and subsequent effectiveness testing and implementation of the pain management program for older underserved adults with chronic pain in this community health care setting.

Background and objectives: Physical activity (PA) environments at micro- (e.g., home) and macro-levels (e.g., built) may be associated with rural children's PA, an underrepresented population in research. A secondary data analyses of NU-HOME, a family-based childhood obesity prevention RCT, examined which environmental supports explain variation in moderate-to-vigorous PA (MVPA), vigorous PA (VPA), and total PA.

Methods: Gold standard measurement tools (geospatial analysis; accelerometry) and surveys were used to assess children's (N=105, age 7-10) PA environments and behaviors. Environmental supports were evaluated in a block-wise manner. Each variable was placed into one block (i.e., sociodemographic characteristics, physical supports, or social supports). Blocks were added in a sequential manner to multiple linear regression models, controlling for sociodemographic variables, and analyzed for their group-wise ability to explain variation in MVPA, VPA, and total PA.

Results: At micro- and macro-levels, differences in MVPA were explained by physical supports (ΔR2=0.06, p=0.03; ΔR2=0.13; p=0.04). Explained variance in VPA was improved by neither physical nor social supports at either level. Physical supports explained differences in total PA at the micro- (ΔR2=0.09, p=0.01) and macro-levels (ΔR2=0.17, p=0.01).

Conclusions: Further research is warranted to explore if expanding access to PA equipment and infrastructure supports mitigates inactivity in rural youth.

This article reports on promising pilot research which indicates that intergenerational musical practices in diverse First Nations families and communities in Vanuatu and Australia can shape cultural determinants of health (CDoH). We contend that such strength- and culture-based approaches to health promotion may help to disrupt colonial and deficit constructions of First Nations People and our health and wellbeing. The pilot study used Indigenist yarning which prioritized First Nations ideas, concepts, and knowledges during informal and relational semi-structured interviews with 9 diverse First Nations musicians in Australia and Vanuatu. The pilot study underpins an ongoing international 3-year research project examining First Nations music as a determinant of health led by Griffith University, The University of the Sunshine Coast, The University of Queensland, and Edith Cowan University. Yarning interviews were analyzed using collaborative thematic analysis and Indigenous visual art responses. Major themes emerging from the data related to intergenerational music activity and transmission. Themes include Music as an intergenerational medium of cultures; Music as a bond between older and younger generations; Intergenerational musical activism and advocacy; and Musical lineages and strengths. Intergenerational musical practices in diverse First Nations families may provide protective cultural, social, economic, educative, and professional determinants of health. The study indicates that more research and new theory may unlock the potential of First Nations musical activities as protective and agentic cultural practices in our families and communities.

Background: Adolescent youth occupy a critical and complex position in refugee families who resettle in a third country.

Objectives: We examined the potential impact of health- and family-related factors on the social and behavioral adjustment outcomes of refugee adolescent youth.

Methods: Situated within an explanatory sequential mixed methods study, we used unadjusted and adjusted multinomial logistic regression to identify trauma, health, and socioecological characteristics of war-affected families associated with social and behavioral adjustment in 72 Karen adolescent youth resettled in the United States.

Results: Factors related to the health and well-being of war-affected families, including parent mental and physical health, youth-reported family function, housing, and parent employment demonstrated important associations with youth adjustment.

Conclusion: These findings, originating within the complex dynamics of resettled war-affected families, demonstrated the interconnectedness of adolescent and parent experiences and opportunities to advance resilience in youth navigating integration and supporting their families through those same processes.

Background: Over 35 000 youth experience homelessness on any given night in the United States (US). Unhoused youth experience unique physical and mental health challenges and face barriers in every social determinant of health (SDoH), which may be amplified in the LGBTQ+ population.

Objective: The objective of this study was to define characteristics of the unhoused youth population and their utilization of healthcare to inform programs to meet their needs.

Methods: Secondary analysis of data from the College of Charleston's YOUth Count survey was conducted, focusing on health-related characteristics, challenges, healthcare utilization, and SDoH of youth aged 18 to 25 experiencing homelessness in Charleston, SC.

Results: Almost three-quarters of respondents (74.6%) reported mental health challenges and 35% reported physical health challenges. A significantly higher proportion of those who engaged in survival sex were LGBTQ+ . More than half (68.4%) visited the emergency department (ED) and 29.3% were admitted to the hospital in the past 12 months. Housing status, safety, food insecurity, sexual orientation, prior foster care, and survival sex were all significantly associated with ED utilization. Housing status and survival sex were significantly associated with hospital admission.

Conclusions: Addressing SDoH is essential to improving health outcomes and healthcare utilization among unhoused youth, particularly in the LGBTQ+ population.

Background and objectives: Language-appropriate outcome measurements help to improve health equity. The purpose of this study was to translate and validate the Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) in Nepali for Bhutanese refugee utilization.

Methods: English-Nepali forward and back translations of CHIPS were completed by an official translator and evaluated by three content experts. A scaled rubric measured the following constructs: neurogenic stress response (NSR), somatic stress response (SSR), and visceral stress response (VSR). Data were analyzed using SPSS 26.0.

Results: The Nepali version of CHIPS reported good content validity, strong internal consistency (Cronbach's α  = .94), and inter-rater reliability (ICC = 0.91). Kappa statistic reported 88% to 96% agreement. Constructs of NSR (0.91), SSR (0.94), and VSR (0.94) reported strong internal consistency.

Conclusions: The Nepali translated version of CHIPS showed strong validity and reliability for utilization in the Bhutanese refugee population and improves health access to outcome measurements for a vulnerable population.

Background: Establishing healthy behaviors during a child's first 5 years is essential for healthy growth. Parents are targeted as agents of change because they serve as primary models of behavior during this period. Although parent-focused interventions often target empowerment as a driver of change, our understanding of how parents experience the process of empowerment in the context of child health promotion remains limited.

Objective: This qualitative study explored the process by which parents gain empowerment through participation in a health promotion intervention.

Methods: Semi-structured interviews were conducted with 37 low-income parents who participated in Parents Connect for Healthy Living (PConnect), a 10-week empowerment-centered obesity prevention intervention. Data were analyzed using inductive-deductive thematic analysis and guided by empowerment theories.

Results: Most parents were Hispanic/Latino (41%) and female (97%). Five themes emerged that correspond to the process by which parents gained empowerment: (1) friendships formed and relationships strengthened during PConnect, (2) parents strengthened relationships with their children and believed in their ability to parent successfully, (3) the experience of knowledge led to behavior change, (4) parents used new resources to improve family health, and (5) parents took action.

Conclusion: Empowerment theory should be a component of health promotion programs.

Background and objectives: It is recognized that development in the 0-to-5-year period is predictive of lifelong health and well-being and that early childhood development is influenced by parental mental health. Social stressors such as food insecurity can exacerbate parental mental health issues.

Methods: To improve understanding of this complex interplay, a primary care pediatric practice designed an innovative meal and grocery delivery program for families experiencing food insecurity with at least one child aged 0-5 years. As part of the program, food insecurity, parental mental health, and child development were assessed.

Results: Food insecurity was found to be correlated with increased stress in the parent-child system, and increased stress was found to be strongly correlated with delays in early childhood developmental progress.

Conclusions: These findings suggest that changes in the parent-child relationship resulting from increased parental stress due to food insecurity can play a role in influencing early childhood development.