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Abstract: Abstract Nearly half of heterosexually transmitted human immunodeficiency virus (HIV) infections occur among Black men in the United States. Yet Black heterosexual men (BHM) are largely ignored in HIV programming, policy implementation, and research. This study explores how masculinity, mental health, and socioeconomic factors such as income, education, and insurance (e.g., enrollment and coverage) correlate with the likelihood of BHM having important conversations surrounding HIV with their healthcare providers and family members. Conversations among social networks (e.g., peers, family, and neighbors) create an opportunity to increase comfortability while discussing HIV-related topics around condom use and testing. This study used a cross-sectional survey design and convenience sampling (N = 279) to recruit participants from a community-academic partnership involving a Federally Qualified Health Center (FQHC) in Detroit between June 1, 2020, and July 31, 2020. Descriptive statistics were used to report demographics, socioeconomic information, and sexual health-related behavior variables. Spearman’s correlation test was used to report bivariate correlations between predictor and outcome variables. 49.3% of the study participants disclosed having ever talked to a healthcare provider about HIV/acquired immune deficiency syndrome (AIDS), and 40.9% disclosed having ever talked to a family member about HIV/AIDS and sexually transmitted infections (STIs). The results from this article highlight potential barriers that may inhibit BHM from engaging in conversations about HIV with their healthcare providers and family members. It is important to include BHM in future research that focuses on HIV prevention and education to support community leaders and clinicians who work to address these disparities. PubDate: 2024-08-10
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Abstract: Background Community-based coalitions are a common strategy for community engagement efforts targeting the improvement of a variety of population health outcomes. The typical processes that coalitions follow to organize efforts include steps that are sequential, slow, and time intensive. These processes also limit local decision-making to the selection of evidence-based policies or programs. Methods We present a process control theory-based Community Action Process, Investigate-Design-Practice-Reflect (IDPR), where community hubs (i.e., coalitions) organize agile efforts in a non-sequential, rapid, and efficient manner to harness local assets and data to make decisions regarding the provision and production of population health services. Using qualitative methods, we illustrate and analyze the use of IDPR in a one community case study as part of Wellscapes, a Type 3-hybrid implementation-effectiveness community randomized controlled trial to improve children’s population health physical activity. Results We found community members followed the IDPR Community Action Process to rapidly design, organize, deliver, and receive feedback on a community-based, children’s population physical activity prototype, an afterschool Play-in-the-Park opportunity for all children. Discussion Following IDPR afforded the community coalition timely learning through feedback within a process that coordinated decisions regarding what community services met community needs (provision decisions) and how to organize the production of the population health services (production decisions). PubDate: 2024-08-07
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Abstract: Abstract Despite higher income and education, there are profound health disparities among Asian Americans. These disparities are highlighted in particular by screening behaviors for cancer. Between 1998 and 2008, cancer rates increased threefold among Indian Americans, raising concern that cancer screening in this group may be especially low. To better understand cancer screening behavior, we collected data from a total of 157 self-identifying Indian Americans residing in the greater Philadelphia area. Nearly all participants reported having health insurance (98.7%), and most had received a physical exam within a year (87.3%). Only17.4% of the participants were referred for mammography, while 30% of participants over age 30 were referred for ovarian cancer screening. Just 4 participants were recommended for pancreatic cancer screening. The findings contribute new information to the understanding of health needs of Indian Americans residing in the greater Philadelphia region and reveal a need for greater focus on preventive care. PubDate: 2024-08-07
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Abstract: Abstract Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes—namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid’s Prenatal Care Coordination (PNCC) program during 2010–2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach. PubDate: 2024-08-01
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Abstract: Abstract States have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought to estimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed to estimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and was highest for transportation among other overhead categories (65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varying from $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability. PubDate: 2024-08-01
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Abstract: Abstract The COVID-19 pandemic was one of the deadliest global public health events. In the United States, over 1.1 million individuals have died, and now COVID-19 is the third leading cause of death (CDC, 2023). Vaccine uptake has stalled among different demographics. Vaccine hesitancy, a delay in accepting or refusing vaccines, poses a significant challenge regardless of the availability of safe and effective COVID-19 vaccines. This study aimed to identify disparate COVID-19 vaccine uptake among individuals in Western New York. The primary objective was to identify the factors contributing to lower rates of COVID-19 vaccination within this population. Data were collected from 585 adults recruited from 20 Niagara and Erie Counties sites using a self-administered survey on vaccine hesitancy, vaccination status, and COVID-19-related characteristics. The survey included the adult Vaccine Hesitancy Scale (aVHS) and acquired information on demographic characteristics and COVID-19 impact, knowledge, and information sources. Data were analyzed using descriptive statistics, a chi-squared test, a Wilcoxon rank-sum test, and a logistic regression model. Findings suggest that unvaccinated participants (n = 35) were concerned about vaccine side effects (48.6%). For vaccinated/unboosted participants (n = 52), they (40.0%) reported clinical concerns. After adjusting for gender and age, healthcare provider guidance and family guidance remained significant predictors of vaccination status, while clinical research studies were significant predictors of booster status. Findings from this study suggest public health interventions that target vaccine education and facilitate well-informed decisions about COVID-19 vaccines lead to less vaccine hesitancy. PubDate: 2024-08-01
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Abstract: Objective Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers. Methods We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination. Results Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child’s healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child’s school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]). Conclusions For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated. Practice Implications Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement. PubDate: 2024-08-01
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Abstract: Abstract Our study assessed the characteristics of people living with HIV (PLWH) detected via opportunistic screening in Valencia (Spain) to determine diagnoses potentially missed under a more restrictive, indicator-condition diagnostic strategy. We conducted a retrospective analysis of electronic health records of 97 PLWH diagnosed between April 2019 and August 2022. The main outcomes reported were patient CD4+ T cell count, known HIV risk factors at diagnosis, and missed opportunities for diagnosis, defined as the failure of a previously untested patient to undergo HIV testing despite attending previous visits to healthcare facilities prior to diagnosis. Successful linkage to care was achieved for 95.9% of diagnosed patients. Half of the PLWH were diagnosed late, while 47.8% did not meet the criteria for indicator-condition-driven HIV diagnosis at the time of their diagnosis. Additionally, 52.2% did not receive HIV testing despite an average of 5.1 ± 6.0 healthcare visits in the 12 months prior to diagnosis. Spaniards had more missed opportunities for diagnosis than foreigners (64% vs. 40%, p = 0.02). Depending solely on an indicator-condition-driven HIV diagnosis approach could result in 47.8% of cases being missed. Including “migrants” as a testing criterion could lower missed diagnoses to 25.3% but might create inequities in prevention access. In conclusion, our findings provide valuable insights to enhance HIV testing, early diagnosis, and linkage to care. While it is crucial to uphold the indicator-condition-driven HIV diagnosis as baseline practice, improving screening strategies will decrease late diagnoses and missed opportunities, thereby effectively contributing to end the epidemic. PubDate: 2024-08-01
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Abstract: Abstract Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition. PubDate: 2024-08-01
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Abstract: Abstract To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2–18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team. PubDate: 2024-08-01
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Abstract: Abstract Approximately 2.2% of Libyans have chronic hepatitis B (CHB) and are at the highest risk of developing end-stage disease complications. Several resource-limited countries, including Libya, may be far from achieving the WHO goal of hepatitis B elimination by 2030 as a result of several testing and linkage to care (LTC) barriers. In Libya, data about the current HBV infection situation is scarce. Therefore, our study aimed to evaluate the trends of HBV in eastern Libya, Tobruk region, and try to identify the region-specific gaps and barriers that could potentially delay the WHO goal of HBV elimination. An eighteen-year retrospective review of records of the main district medical center in the region was done to estimate the trends of HBV infection and qualitative interviews with the clinical staff of the CHB registry in the region were conducted to investigate the current status of HBV management. Out of 392,952 records, 371 (0.09%) HBV-positive were recorded and declining trends of the infection were noticed over the study period. Until late 2019, there was no linkage to care or follow-up for people with HBV infection. However, a CHB registry was established in late 2019 to manage HBV infections in the region, yet there are several barriers such as the lack of diagnostic infrastructure for liver function assessment and antiviral treatment. Despite the significant decline observed in the occurrence of HBV infection and introduction of important HBV management steps such as establishment of the CHB registry, there are still several barriers that could delay the elimination of the infection. PubDate: 2024-08-01
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Abstract: Abstract Food insecurity, a critical social determinant of health, has been measured nationwide in the United States for years. This analysis focuses on food insufficiency, a more severe form of food insecurity, in New York City (NYC) and its association with self-reported physical and mental health conditions. Data from the 2017–2018 NYC Community Health Survey were used to estimate the prevalence of food insufficiency citywide, by neighborhood, and across selected socioeconomic characteristics. Multivariable logistic regression was used to explore the associations between food insufficiency and hypertension, diabetes obesity, and depression, adjusting for selected sociodemographic characteristics. Approximately 9.4% (95% CI:8.8-10.0%]) of adult New Yorkers aged 18 + reported food insufficiency, with neighborhood variation from 1.7% (95% CI:0.5-6.2%) to 19.4% (95% CI:14.2-25.8%). Food insufficiency was more prevalent among Latinos/as (16.9%, 95% CI:15.5-18.3%, p < 0.001), Black (10.1%, 95% CI:8.8-11.5%, p < 0.001) and Asian/Pacific Islanders (6.6%, 95% CI:5.4-8.1%, p = 0.002) compared to White New Yorkers (4.2%, 95% CI:3.5-5.1%). Prevalence of food insufficiency was higher among NYC adults with less than a high school education, (19.6%, 95% CI:17.7-21.6%), compared to college graduates (3.8%, 95% CI:3.2-4.4%, p < 0.001). In the adjusted logistic regression model, food insufficiency was associated with diabetes (OR = 1.36; 95% CI:1.12–1.65), hypertension (OR = 1.58; 95% CI:1.32–1.89]) and depression (OR = 2.98; 95% CI:2.45–3.59), but not with obesity (OR = 0.99; 95% CI:0.84–1.21). Our findings highlight food insufficiency at an important intersection of inequity and disease burden which is critical to informing public health interventions in the context of a large, densely populated metropolis like NYC. PubDate: 2024-08-01
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Abstract: Abstract Safe and effective vaccines have been developed that protect against high-risk strains of HPV, but uptake is relatively low. We previously identified factors such as sexual attitudes and HPV knowledge that impact the intent of Christian parents to vaccinate their children against HPV. We hypothesized that culturally specific interventions in the form of short videos would be effective at improving HPV vaccine intentions and attitudes. We made three short educational videos, one with a Christian focus, one informational about HPV, and one control. Videos were distributed electronically with accompanying surveys, and responses were measured before and after watching a randomly selected video. The religious-focused and educational interventions significantly (p < 0.0001, p = 0.0015) improved intentions towards HPV vaccination. The religiously-focused video also significantly diminished the belief that the HPV vaccine is unnecessary because of a family’s values (p = 0.014). Parents significantly credited both interventions with improving their intent to vaccinate their children against HPV (p < 0.001 for both). These results suggest that culturally focused educational interventions are effective at influencing vaccine intentions and attitudes, even when those are based on religious or cultural feelings. Highly specific interventions are likely to be necessary for optimal improvement in vaccine hesitancy. PubDate: 2024-08-01
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Abstract: Background During the COVID-19 pandemic, public health institutions, particularly the Centers for Disease Control and Prevention (CDC), were frequently attacked by politicians. Popular trust in these institutions declined, particularly among self-identified Republicans. Therefore, the effectiveness of public health institutions as vaccination messengers might have been weakened in the post-COVID-19 period. We conducted a survey experiment examining the effectiveness of messaging from the CDC in shaping people’s attitudes toward mandatory MMR (measles-mumps-rubella) vaccination for schoolchildren. Methods The experiment was embedded in a survey fielded in South Dakota, a “red state” with a population predisposed to distrust the CDC. Using registration-sampling, we received 747 responses. We used difference-in-means tests and multivariate regression to analyze the data. Results We found that participants who received a message from the CDC were more likely to support MMR vaccine mandate for schoolchildren than participants who received the same prompt from a state agency. Further analyses showed that messaging from the CDC was particularly effective among Republicans. Discussion Overall, our study showed that although the CDC was caught up in the political skirmishes during the COVID-19 pandemic, it remains an authoritative source of public health information. Conclusions Public health officials at the local and state levels should not shy away from referring to the CDC in their vaccination messaging. PubDate: 2024-08-01
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Abstract: Abstract The COVID-19 pandemic brought a mental health crisis, with depression symptoms increasing nearly three-fold compared to pre-pandemic levels. To explain this surge and to outline related novel treatment targets for post-pandemic psychiatric interventions, the current study examined cognitive, emotional, and behavioral predictors of depression (in the context of the recent pandemic). Participants completed measures assessing perceived danger, perceived infectiousness, and fear of the coronavirus (COVID-19). Participants also reported symptoms of depression and behavioral tendencies: pandemic-related compulsive checking, cleaning, and avoidance (of activities, situations, places, and people). A multiple mediation model revealed that the relationship between perceived infectiousness of the virus and depression was atemporally mediated by fear of the virus and pandemic-related avoidance of activities, situations, places, and people. Furthermore, avoidance played a uniquely important role in the mediation model. First, it directly mediated the relationship between perceived infectiousness and depression, even when omitting fear from the model. Second, avoidance was a discriminant predictor of depression, as neither pandemic-related checking and reassurance-seeking nor cleaning behavior mediated the relationship between cognition and depressive symptoms. Clinical implications are discussed, including how addressing the relationship between anxiety about viral infections and depression can prospectively increase treatment success as we move beyond the pandemic. PubDate: 2024-08-01
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Abstract: Abstract Few studies have examined the role of perceived neighborhood characteristics such as neighborhood safety, social cohesion, and contentedness on sedentary behavior (SB) and physical activity (PA) among adolescents. Furthermore, no studies have investigated how these associations are moderated by gender and race. This study aimed to examine the associations of the perceived neighborhood social environment with (SB) and moderate-to-vigorous physical activity (MVPA). Data from 6504 adolescents (aged 15.4 ± 0.03 years) who participated in the National Longitudinal Study of Adolescent Health was used. SB and PA were considered continuously and dichotomously. PNSE variables include safety, social cohesion, and contentedness, where higher values of PNSE indicate a more favorable neighborhood perception. Weighted linear and logistic regression models were used to examine the association of PNSE with continuous total SB (hours/week) and MVPA (bouts/week), and binary excessive SB (14 h/week) and meeting MVPA guidelines (≥ 5 bouts/week), respectively. Associations were stratified by gender and race to test moderation effects. Models were adjusted for demographic, health, parental, and neighborhood covariates. This study found that neighborhood safety and contentedness were negatively associated with SB, whereas neighborhood social cohesion and contentedness were positively associated with PA. Gender-specific and race-specific results remained somewhat consistent with overall findings; however, neighborhood safety was not associated with SB among female and non-White adolescents, respectively. Similarly, neighborhood safety and contentedness were not associated with MVPA for non-White adolescents. Findings suggest that an adolescent’s neighborhood environment, gender, and race should be considered when implementing strategies to reduce SB and increase PA. PubDate: 2024-08-01
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Abstract: Background Conflict profoundly impacts community health and well-being. While post-conflict research exists, little is known about initial effects during active hostilities. Objective To assess self-reported changes in health behaviors, distress, and care access within one month of regional warfare onset in a conflict-affected community. Methods An online survey was conducted in November 2023 among 501 residents (mean age 40.5 years) of a community where war began October 7th. Measures evaluated physical health, mental health, diet, substance use, sleep, weight changes, and healthcare access before and after the declaration of war. Results Relative to pre-war, respondents reported significantly increased rates of tobacco (56%) and alcohol (15%) consumption, worsening sleep quality (63%), elevated distress (18% sought help; 14% needed but didn’t receive it), and postponed medical care (36%). Over a third reported weight changes. Distress was higher among females and those endorsing maladaptive coping. Conclusion Within one month, substantial impacts on community psychosocial and behavioral health emerged. Unmet mental health needs and risk-taking behaviors were early indicators of conflict’s health consequences. Continuous monitoring of conflict-affected communities is needed to inform tailored interventions promoting resilience and prevent entrenchment of harms over time. PubDate: 2024-08-01
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Abstract: Abstract As the opioid epidemic continues, availability of evidence-based strategies for harm reduction and treatment in communities is critical to reduce overdose and other consequences of opioid use disorder. Community members’ support of harm reduction and treatment services is needed for new programs and to maintain existent programs. This study sought to understand beliefs and attitudes associated with support for three community-based strategies to address opioid misuse and addiction: naloxone, needle exchange, and medication-assisted treatment. We conducted a cross-sectional online survey with 545 adults. Results of the survey showed that participants supported all three strategies, with the strongest support for medication-assisted treatment. Multiple regression showed that stigma and perceived stigma were significant predictors for all three strategies, with inverse relationships. Stigmatizing beliefs predicted less support while perceiving stigma among others was associated with greater support for the strategies. Normative beliefs also significantly predicted support for all three strategies, such that stronger belief that others were supportive of each strategy was associated with greater support for that strategy. Other predictors varied across the three strategies. Support for harm reduction and treatment programs in communities affected by the opioid epidemic may be bolstered by reducing stigma and increasing normative beliefs. Stronger support for medication-assisted treatment may be leveraged and extended to harm reduction strategies. Results of our study contribute insights for bolstering community support for harm reduction and treatment, which is vital for adoption and maintenance of these important programs. PubDate: 2024-08-01
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Abstract: Abstract Within a small geographic area, Marion County contains a stark spectrum of health outcomes and socioeconomic statuses. The Indiana University Student Outreach Clinic (IUSOC) serves as a safety net provider, offering free health and social services in the Near Eastside neighborhood of Indianapolis. The aim of this study was to characterize the demographics and geographic distribution of the IUSOC’s patient population. From January to September 2023, 612 patients visited the IUSOC, and 460 self-identified as Marion County residents. 63.9% of patients were between 45 and 64 years old. 66.8% were Non-Hispanic (NH) Black, and 23.3% were Hispanic. 18.9% spoke Spanish and had limited English proficiency. Based on the Distressed Communities Index (DCI), 58.7% lived in “Distressed” zip codes, indicating economic vulnerability and disparities. The zip code with the greatest number of IUSOC patients had the highest rate of uninsured adults in Marion County. IUSOC patients are primarily middle-aged minorities who live in zip codes with low socioeconomic rankings by DCI. This information can be used to improve community resource referral pathways in the clinic. PubDate: 2024-08-01
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