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1.
Popul Health Manag ; 25(2): 254-263, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35442796

RESUMO

The National Lung Screening Trial established the benefits of low-dose computed tomography for lung cancer screening (LCS) to identify lung cancer at earlier stages. In February 2021, the US Preventive Services Task Force (USPSTF) revised the eligibility recommendations to increase the number of high-risk individuals eligible for LCS and, in effect, expand screening eligibility for vulnerable populations. One strategy for facilitating LCS is to implement targeted screening in geographic areas with the greatest need. In Philadelphia, although neighborhood smoking rates have been defined, it is not known which neighborhoods have the greatest number of people eligible for LCS. In this study, the authors estimate eligibility for LCS within Philadelphia neighborhoods using both previous and current USPSTF guidelines. They used the Public Health Management Corporation's Household Health Survey from 2010, 2012, and 2015 to identify the number of people within ever-smoker groups (current every day, current occasional, and former smokers) by neighborhood in Philadelphia. Using the 2015 National Health Interview Survey (NHIS) Cancer Supplement, they identified the percentages within ever-smoker groups that were LCS eligible using the previous and current USPSTF guidelines. Finally, they applied the percentages eligible for the ever-smoker groups from the NHIS to the numbers in these groups within Philadelphia neighborhoods. They found that the number of Philadelphians eligible for LCS increased from 41,946 to 89,231 after the revised USPSTF guidelines. The current USPSTF guidelines increased eligibility for LCS within all Philadelphia neighborhoods, with the greatest increases in the River Wards planning district. Local providers should use these results to prioritize LCS services within neighborhoods with greatest eligibility.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Detecção Precoce de Câncer/métodos , Humanos , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento , Philadelphia , Tomografia Computadorizada por Raios X/métodos
2.
Transl Behav Med ; 12(3): 489-497, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35298654

RESUMO

Colorectal cancer (CRC) is one of the most predominant cancers in the USA and ranks third among all cancers in incidence and mortality. Vietnamese Americans exhibit persistently lower screening rates compared to the general U.S. population, due to cultural, economic, and environmental barriers. The impact of environmental factors in particular is not well known, and lack of geographical access may be a significant barrier to accessing screening. This study aims to elucidate build and neighborhood environmental factors affecting CRC screening rates among Vietnamese Americans. A total of 517 Vietnamese Americans 50 years and older residing in Philadelphia County were included in the study. Surveys were collected to determine CRC screening behavior and sociodemographic characteristics. Individual neighborhood characteristics, which included the Walk Score, was obtained based on the participant's address. Neighborhood characteristics were calculated using census-tract level data for the social deprivation index, ethnic composition, and presence of hospitals or federally qualified health centers (FQHC). The generalized linear mixed model revealed that residing in an ethnically dense neighborhood was negatively associated with CRC screening (ß = -0.67, SE = 0.29, p = .01), while social deprivation (ß = 0.30, SE = 0.27, p = .27) and presence of FQHCs or hospitals (ß = 0.16, SE = 0.30, p = .58) were not. Individual neighborhood characteristics including the Walk Score (ß = 0.21, SE = 0.26, p = .43) was not associated with CRC screening behavior. Neighborhood characteristics, specifically ethnic density is associated with lower uptake of screening in this population. Future interventions should aim to target specific Vietnamese American and other Asian ethnic neighborhoods that may experience disparities in screening.


Colorectal cancer (CRC) is one of the most common cancers in the USA and ranks third among all cancers as the leading cause of death. CRC screening is key for early detection and better patient outcomes and is recommended for individuals between ages 50 and 75. Vietnamese Americans are an Asian ethnic group that engages in low levels of colorectal cancer screening. This study aimed to determine how the environment plays a role in being able to obtain CRC screenings. A total of 517 Vietnamese Americans aged 50 years and older residing in Philadelphia County were included in the study. This study found that individuals who live in a neighborhood with greater composition of Asians were less likely to have been screened. Other neighborhood characteristics such as neighborhood walkability, social deprivation, and the presence of Federally Qualified Health Centers and Hospitals in one's neighborhood were not linked to screening. Future interventions should aim to target specific Asian neighborhoods that experience disparities in screening.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Americanos Asiáticos , Neoplasias Colorretais/prevenção & controle , Humanos , Philadelphia , Características de Residência , Fatores Socioeconômicos , Estados Unidos
3.
JAMA Netw Open ; 5(3): e223986, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35323949

RESUMO

Importance: A central tenet of harm reduction and prevention of opioid overdose deaths is the distribution and use of naloxone. Patient-centered methods that investigate naloxone acquisition and carrying can guide opioid overdose education and naloxone distribution efforts. Objective: To assess patients' self-reported naloxone acquisition and carrying after an emergency department (ED) encounter using automated text messaging. Design, Setting, and Participants: This cohort study investigated self-reported patient behaviors involving naloxone after ED discharge in a large, urban academic health system in Philadelphia, Pennsylvania. Adult patients who were prescribed or dispensed naloxone and who had a mobile phone number listed in the electronic health record provided informed consent after ED discharge, and data were collected prospectively using text messaging from October 10, 2020, to March 19, 2021. Patients who did not respond to the survey or who opted out were excluded. Exposure: Automated text message-based survey after ED discharge for patients who were prescribed or dispensed naloxone. Main Outcomes and Measures: The primary outcome was patient-reported naloxone acquisition, carrying, and use. Descriptive statistics were used to summarize patient demographic characteristics. Results: Of 205 eligible patients, 41 (20.0%) completed the survey; of those patients, the mean (SD) age was 39.5 (13.7) years, and 21 (51.2%) were women. Fifteen (36.6%) had a personal history of being given naloxone after an overdose. As indicated by the ED record, 27 participants (65.9%) had naloxone dispensed in the ED, and 36 (87.8%) self-reported acquiring naloxone during or after their ED visit. Twenty-four participants (58.5%) were not carrying naloxone in the week before their ED visit. Twenty participants (48.8%) were carrying naloxone after the ED visit, and 27 (65.9%) reported planning to continue carrying naloxone in the future. Of the 24 individuals (58.5%) not carrying naloxone before their ED encounter, 13 (54.2%) reported planning to continue carrying naloxone in the future. Conclusions and Relevance: In this cohort study of adult patients dispensed or prescribed naloxone from the ED, most reported acquiring naloxone on or after discharge. The ED remains a key point of access to naloxone for individuals at high risk of opioid use and overdose, and text messaging could be a method to engage and motivate patient-reported behaviors in enhancing naloxone acquisition and carrying.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Envio de Mensagens de Texto , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Naloxona/uso terapêutico , Alta do Paciente , Medidas de Resultados Relatados pelo Paciente , Philadelphia/epidemiologia
4.
Med Anthropol ; 41(3): 329-341, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35244500

RESUMO

Interviews with close kin of those who died from opioid overdose in Philadelphia in 2017 reveal myriad strategies that families employ to minimize overdose risk, secure treatment options, and mitigate everyday precarity that can result from heroin addiction. Their efforts to keep kin alive - at times contradictory, conflicted, desperate and, in the end, ineffectual - reveal deeply situated structural vulnerabilities. When understood as "resistance" to death, however, kin strategies return us to a vital tenet of harm reduction - the imperative to develop programs in collaboration with those most impacted, in this case families at risk of overdose fatality.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Analgésicos Opioides/uso terapêutico , Antropologia Médica , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/prevenção & controle , Humanos , Philadelphia
5.
Prev Med ; 158: 107020, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35301043

RESUMO

Recent increases in firearm violence in U.S. cities are well-documented, however dynamic changes in the people, places and intensity of this public health threat during the COVID-19 pandemic are relatively unexplored. This descriptive epidemiologic study spanning from January 1, 2015 - March 31, 2021 utilizes the Philadelphia Police Department's registry of shooting victims, a database which includes all individuals shot and/or killed due to interpersonal firearm violence in the city of Philadelphia. We compared victim and event characteristics prior to the pandemic with those following implementation of pandemic containment measures. In this study, containment began on March 16, 2020, when non-essential businesses were ordered to close in Philadelphia. There were 331 (SE = 13.9) individuals shot/quarter pre-containment vs. 545 (SE = 66.4) individuals shot/quarter post-containment (p = 0.031). Post-containment, the proportion of women shot increased by 39% (95% CI: 1.21, 1.59), and the proportion of children shot increased by 17% (95% CI: 1.00, 1.35). Black women and children were more likely to be shot post-containment (RR 1.11, 95% CI: 1.02, 1.20 and RR 1.08, 95% CI: 1.03, 1.14, respectively). The proportion of mass shootings (≥4 individuals shot within 100 m within 1 h) increased by 53% post-containment (95% CI: 1.25, 1.88). Geographic analysis revealed relative increases in all shootings and mass shootings in specific city locations post-containment. The observed changes in firearm injury epidemiology following COVID-19 containment in Philadelphia demonstrate an intensification in firearm violence, which is increasingly impacting people who are likely made more vulnerable by existing social and structural disadvantage. These findings support existing knowledge about structural causes of interpersonal firearm violence and suggest structural solutions are required to address this public health threat.


Assuntos
COVID-19 , Armas de Fogo , Ferimentos por Arma de Fogo , COVID-19/epidemiologia , Criança , Feminino , Humanos , Pandemias , Philadelphia/epidemiologia , Violência , Ferimentos por Arma de Fogo/epidemiologia
6.
Occup Environ Med ; 79(5): 326-332, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35246484

RESUMO

OBJECTIVES: High ambient temperatures may contribute to acute asthma exacerbation, a leading cause of morbidity in children. We quantified associations between hot-season ambient temperatures and asthma exacerbation in children ages 0-18 years in Philadelphia, PA. METHODS: We created a time series of daily counts of clinical encounters for asthma exacerbation at the Children's Hospital of Philadelphia linked with daily meteorological data, June-August of 2011-2016. We estimated associations between mean daily temperature (up to a 5-day lag) and asthma exacerbation using generalised quasi-Poisson distributed models, adjusted for seasonal and long-term trends, day of the week, mean relative humidity,and US holiday. In secondary analyses, we ran models with adjustment for aeroallergens, air pollutants and respiratory virus counts. We quantified overall associations, and estimates stratified by encounter location (outpatient, emergency department, inpatient), sociodemographics and comorbidities. RESULTS: The analysis included 7637 asthma exacerbation events. High mean daily temperatures that occurred 5 days before the index date were associated with higher rates of exacerbation (rate ratio (RR) comparing 33°C-13.1°C days: 1.37, 95% CI 1.04 to 1.82). Associations were most substantial for children ages 2 to <5 years and for Hispanic and non-Hispanic black children. Adjustment for air pollutants, aeroallergens and respiratory virus counts did not substantially change RR estimates. CONCLUSIONS: This research contributes to evidence that ambient heat is associated with higher rates of asthma exacerbation in children. Further work is needed to explore the mechanisms underlying these associations.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Adolescente , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Alérgenos/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Criança , Pré-Escolar , Temperatura Alta , Humanos , Lactente , Recém-Nascido , Philadelphia/epidemiologia , Temperatura , Fatores de Tempo
7.
Subst Use Misuse ; 57(6): 999-1006, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35277115

RESUMO

Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016-2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/psicologia , Estudos Transversais , Feminino , Redução do Dano , Humanos , Recém-Nascido , Philadelphia/epidemiologia , Gravidez
8.
JAMA Netw Open ; 5(3): e222117, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35285918

RESUMO

Importance: Penicillin allergy labels influence clinical decision-making, yet most children who are labeled do not have type 1 hypersensitivity allergic reactions and instead have a history of predictable adverse reactions or unspecified illness symptoms while receiving penicillin for viral infections. Studies describing penicillin allergy labeling in the pediatric outpatient setting are lacking. Objective: To describe the epidemiology and factors associated with penicillin allergy labels across 2 large US pediatric primary care networks. Design, Setting, and Participants: This retrospective, longitudinal birth cohort study was conducted in 90 primary care pediatric practices serving a diverse population of children across Houston, Texas, Austin, Texas, Philadelphia, Pennsylvania, and parts of New Jersey. Participants were children born between January 2010 and June 2020 who had a health care visit in the first 14 days of life and at least 2 additional visits in the first year of life at one of 90 primary care pediatric practices. Censoring criteria were additionally applied to exclude data from children no longer seeking health care in the 90 clinics over time. Statistical analysis was performed from February to May 2021. Exposures: Basic patient demographics, health care utilization, penicillin exposure, and primary clinic location. Main Outcomes and Measures: Addition of penicillin allergy label in the electronic medical record. Results: Among 334 465 children in the birth cohort, 164 173 (49.1%) were female; 72 831 (21.8%) were Hispanic, 59 598 (17.8%) were non-Hispanic Black, and 148 534 (44.4%) were non-Hispanic White; the median (IQR) age at censoring was 3.8 (1.7-6.6) years; 18 015 (5.4%) were labeled as penicillin allergic, but the prevalence of penicillin allergy labeling ranged from 0.9% to 10.2% across practices. Children were labeled at a median (IQR) age of 1.3 (0.9-2.3) years. Non-Hispanic White children were more likely to be labeled compared with non-Hispanic Black children after controlling for potential confounders (adjusted odds ratio, 1.7 [95% CI, 1.6-1.8]). There were 6797 allergic children (37.7%) labeled after receiving 1 penicillin prescription and 1423 (7.9%) labeled after receiving 0 penicillin prescriptions. Conclusions and Relevance: In this cohort study of more than 330 000 children, penicillin allergy labeling was common and varied widely across practices. Children were labeled early in life, and almost half were labeled after receiving 1 or 0 penicillin prescriptions. These findings raise questions regarding the validity of penicillin allergy labels. Future work exploring the fidelity of and outcomes associated with penicillin allergy-labeling in children is warranted.


Assuntos
Hipersensibilidade a Drogas , Registros Eletrônicos de Saúde , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Estudos de Coortes , Hipersensibilidade a Drogas/epidemiologia , Feminino , Humanos , Lactente , Masculino , Penicilinas/efeitos adversos , Philadelphia , Atenção Primária à Saúde , Estudos Retrospectivos
9.
Health Promot Pract ; 23(2): 338-344, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35285327

RESUMO

Photovoice is a participatory action research method that was founded on mobilizing communities toward action. However, there is limited research detailing the action stages of photovoice that are meant to follow the initial research. In this article, we describe the action stage of a youth photovoice project conducted at the planning phase of a Community Health Needs Assessment of the Latino community in North Philadelphia. In collaboration with local leaders, we utilized photovoice to prioritize the health needs identified in the assessment. We announced a request for proposals and launched twelve, 1-year, community catalyst grants in the amount of US$50,000 each. While grants were funded and implemented, the participants continued to exhibit their findings in Philadelphia City Hall and engage with city policymakers. We developed a health policy workshop where Philadelphia youth beyond the original photovoice participants could learn advocacy skills and policy research to develop a proposal addressing a priority health need identified through photovoice. This workshop was expanded into a year-round program where participants can be matched with a career mentor, engage in professional development sessions, and continue to refine and advocate for their policy proposal. We found that successful action planning stemmed from setting goals several steps ahead of the current stage of action while enhancing the ability to center community voice in guiding action forward. Photovoice influenced decision-making throughout each of the steps taken toward action. Future research should recognize and describe action planning as a central tenet of photovoice methodologies.


Assuntos
Fotografação , Saúde Pública , Adolescente , Pesquisa Participativa Baseada na Comunidade , Política de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , Philadelphia
10.
J Adolesc Health ; 70(5): 829-832, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35165029

RESUMO

PURPOSE: We surveyed healthcare providers to determine the extent to which they discuss transition-to-adulthood topics with autistic patients without intellectual disabilities. METHODS: Seventy-four healthcare providers in the Philadelphia area reported on the patient age at which they begin transition conversations, topics covered, and provider comfort. We calculated the proportion of providers who endorsed each transition topic, overall and by clinical setting. RESULTS: Providers initiated transition-related conversations at a median age of 16 years (IQR: 14, 18), with over half reporting they were "somewhat" or "a little" comfortable with discussions. Nearly all providers discussed at least one healthcare, well-being, and mental health topic, while basic need-related discussions were limited. DISCUSSION: Results suggest providers may delay and feel poorly prepared to provide anticipatory guidance to autistic patients for transition to adulthood. Future efforts to enhance the available resources and preparation available to providers are essential to meet autistic patients' needs.


Assuntos
Transtorno Autístico , Adolescente , Adulto , Atenção à Saúde , Pessoal de Saúde , Humanos , Philadelphia
11.
PLoS One ; 17(2): e0263777, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35196358

RESUMO

This study examines changes in gun violence at the census tract level in Philadelphia, PA before and after the onset of the COVID-19 pandemic. Piecewise generalized linear mixed effects models are used to test the relative impacts of social-structural and demographic factors, police activity, the presence of and proximity to drug markets, and physical incivilities on shooting changes between 2017 and June, 2021. Model results revealed that neighborhood structural characteristics like concentrated disadvantage and racial makeup, as well as proximity to drug markets and police activity were associated with higher shooting rates. Neighborhood drug market activity and police activity significantly predicted changes in shooting rates over time after the onset of COVID-19. This work demonstrates the importance of understanding whether there are unique factors that impact the susceptibility to exogenous shocks like the COVID-19 pandemic. The increasing risk of being in a neighborhood with an active drug market during the pandemic suggests efforts related to disrupting drug organizations, or otherwise curbing violence stemming from drug markets, may go a long way towards quelling citywide increases in gun violence.


Assuntos
COVID-19/epidemiologia , Violência com Arma de Fogo/estatística & dados numéricos , COVID-19/virologia , Bases de Dados Factuais , Tráfico de Drogas/estatística & dados numéricos , Humanos , Pandemias , Philadelphia/epidemiologia , Polícia , Racismo , Características de Residência , SARS-CoV-2/isolamento & purificação
12.
Am J Public Health ; 112(3): 408-416, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35196028

RESUMO

Objectives. To evaluate the occurrence of HIV and COVID-19 infections in Philadelphia, Pennsylvania, through July 2020 and identify ecological correlates driving racial disparities in infection incidence. Methods. For each zip code tabulation area, we created citywide comparison Z-score measures of COVID-19 cases, new cases of HIV, and the difference between the scores. Choropleth maps were used to identify areas that were similar or dissimilar in terms of disease patterning, and weighted linear regression models helped identify independent ecological predictors of these patterns. Results. Relative to COVID-19, HIV represented a greater burden in Center City Philadelphia, whereas COVID-19 was more apparent in Northeast Philadelphia. Areas with a greater proportion of Black or African American residents were overrepresented in terms of both diseases. Conclusions. Although race is a shared nominal upstream factor that conveys increased risk for both infections, an understanding of separate structural, demographic, and economic risk factors that drive the overrepresentation of COVID-19 cases in racial/ethnic communities across Philadelphia is critical. Public Health Implications. Difference-based measures are useful in identifying areas that are underrepresented or overrepresented with respect to disease occurrence and may be able to elucidate effective or ineffective mitigation strategies. (Am J Public Health. 2022;112(3):408-416. https://doi.org/10.2105/AJPH.2021.306538).


Assuntos
COVID-19/epidemiologia , Infecções por HIV/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , COVID-19/etnologia , Criança , Estudos Transversais , Feminino , Infecções por HIV/etnologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Características de Residência , SARS-CoV-2 , Análise Espacial , Adulto Jovem
13.
Pediatrics ; 149(2)2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35102416

RESUMO

BACKGROUND AND OBJECTIVES: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS: We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS: There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of -25.2 prescriptions per 1000 patients; 95% CI: -32.9 to -17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS: Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.


Assuntos
Antibacterianos/uso terapêutico , COVID-19/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde , Criança , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pandemias , Pediatria , Philadelphia/epidemiologia , Estudos Retrospectivos
14.
J Prim Care Community Health ; 13: 21501327211037894, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35120417

RESUMO

IMPORTANCE: Tobacco use remains the leading cause of preventable deaths and is susceptible to social influence. Yet, we know little about the characteristics of primary care social networks and how they influence tobacco use. OBJECTIVE: To determine what primary care patient social network characteristics are associated with individual smoking behavior. DESIGN: Cross-sectional. SETTING: Two primary care practices in West Philadelphia, Pennsylvania (PA), USA. PARTICIPANTS: A random sample of 53 primary care patients and 155 of their nominated social ties. MAIN OUTCOME AND MEASURES: We examined the association between social network characteristics (degree, communicated weighted social ties, and presence of social reinforcement) and tobacco use history (never smoker, successful quitter, or current smoker). Other covariates included age, race/ethnicity, sex, education, income, and employment status, self-efficacy, depression status, provider-patient relationship. RESULTS: Of those enrolled in our study (n = 208), 101 identified as never smokers, 59 as successfully quitters, and 48 as current smokers. Social reinforcements from connected alter pairs that never-smoked (OR = 1.20, 95% CI: 1.08, 1.34) was significantly associated with a participant being a never smoker. Participants with stronger ties with successful quitters were significantly more likely to identify as successfully quitting (OR = 1.37, 95% CI: 1.11, 1.69) and conversely had a negative association with stronger ties to unsuccessful quitters (OR = 0.59, 95% CI: 0.44, 0.80) or current smokers who had not tried to quit in the last year (OR = 0.82, 95% CI: 0.68, 0.98). Social reinforcement from connected pairs of alters that were unsuccessful quitters was significantly associated with the participant being a current smoker (OR = 1.26, 95% CI: 1.10, 1.45). CONCLUSIONS: Our study suggests that smoking behaviors do not occur in isolation, nor because of 1 or 2 prominent social network members. Rather, our findings suggest that both strong ties and social reinforcement from clusters of similarly-behaving persons influence smoking behavior. Primary care practices have an opportunity to leverage these insights on patient networks to improve cancer prevention.


Assuntos
Abandono do Hábito de Fumar , Estudos Transversais , Humanos , Philadelphia/epidemiologia , Atenção Primária à Saúde , Rede Social , Uso de Tabaco
15.
Artigo em Inglês | MEDLINE | ID: mdl-35206224

RESUMO

Green spaces have been proposed as equigenic factors, potentially mitigating health disparities. We used data from the 3887 participants residing in Philadelphia who participated in the Public Health Management Corporation's Southeastern Pennsylvania Household Health Survey in 2014-2015 to assess whether socioeconomic disparities in hypertension are modified by availability of neighborhood-level green spaces. Socioeconomic status (SES) was measured using individual-level education and neighborhood-level median household income. Green space availability was measured using surrounding percent tree canopy cover, mean normalized difference vegetation index (NDVI), and proximity to nearest park. Using logistic regression models adjusted for age, sex, and race/ethnicity, we found that adults with higher educational attainment had significantly lower levels of hypertension (OR = 0.63, 0.57, and 0.36 for high school, some college, and college graduates, respectively, as compared to those with less than high school education), and this pattern was similar for median household income (higher prevalence in lower income areas). We found no significant interaction between education and percent tree canopy cover (p = 0.83), meaning that educational disparities in hypertension were similar across all levels of green space availability. These results held when using mean NDVI or distance to nearest park as availability measures, or when considering neighborhood-level median household income as the socioeconomic measure, although the specific patterns and significance of interactions varied by exposure and modifier. While socioeconomic disparities in hypertension are strong for adults residing in Philadelphia, green spaces did not seem to modify them.


Assuntos
Hipertensão , Parques Recreativos , Adulto , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Philadelphia/epidemiologia , Características de Residência , Fatores Socioeconômicos
16.
J Urban Health ; 99(1): 134-145, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35076872

RESUMO

Historical, institutional racism within the housing market may have impacted present-day disparities in heat vulnerability. We quantified associations between historically redlined areas with present-day property and housing characteristics that may enhance heat vulnerability in Philadelphia, PA. We used color-coded Home Owners Loan Corporation (HOLC) maps and tax assessment data to randomly select 100 present-day (2018-2019) residential properties in each HOLC grade area (A = Best; B, C, and D = Most hazardous; N = 400 total). We conducted virtual inventories of the properties using aerial and streetview imagery for land cover and housing characteristics (dark roof color, flat roof shape, low or no mature tree canopy, no recently planted street trees) that may enhance heat vulnerability. We used modified Poisson regression models to estimate associations of HOLC grades with the property characteristics, unadjusted and adjusted for historical and contemporary measures of the neighborhood sociodemographic environment. Compared to grade A areas, higher proportions of properties in grade B, C, and D areas had dark roofs, low/no mature tree canopy, and no street trees. Adjusting for historical sociodemographics attenuated associations, with only associations with low or no tree canopy remaining elevated. Adjusting for present-day concentrated racial and socioeconomic deprivation did not substantially impact overall findings. In Philadelphia, PA, HOLC maps serve as spatial representations of present-day housing and land cover heat vulnerability characteristics. Further analyses incorporating longitudinal data on urban redevelopment, reinvestment, and neighborhood change are needed to more fully represent complex relationships among historical racism, residential segregation, and heat vulnerability.


Assuntos
Habitação , Segregação Social , Temperatura Alta , Humanos , Philadelphia , Características de Residência
17.
PLoS One ; 17(1): e0261398, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35020749

RESUMO

OBJECTIVES: To quantify changes in adherence to mask and distancing guidelines in outdoor settings in Philadelphia, PA before and after President Trump announced he was infected with COVID-19. METHODS: We used Systematic Observation of Masking Adherence and Distancing (SOMAD) to assess mask adherence in parks, playgrounds, and commercial streets in the 10 City Council districts in Philadelphia PA. We compared adherence rates between August and September 2020 and after October 2, 2020. RESULTS: Disparities in mask adherence existed by age group, gender, and race/ethnicity, with females wearing masks correctly more often than males, seniors having higher mask use than other age groups, and Asians having higher adherence than other race/ethnicities. Correct mask use did not increase after the City released additional mask guidance in September but did after Oct 2. Incorrect mask use also decreased, but the percentage not having masks at all was unchanged. CONCLUSIONS: Vulnerability of leadership appears to influence population behavior. Public health departments likely need more resources to effectively and persuasively communicate critical safety messages related to COVID-19 transmission.


Assuntos
COVID-19/epidemiologia , Máscaras/tendências , Adolescente , Adulto , Idoso , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Fidelidade a Diretrizes/tendências , Humanos , Masculino , Máscaras/estatística & dados numéricos , Pessoa de Meia-Idade , Philadelphia , Distanciamento Físico , Saúde Pública , SARS-CoV-2/isolamento & purificação , Adulto Jovem
18.
Health Commun ; 37(4): 515-524, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-33345602

RESUMO

The underrepresentation of African American (AA) participants in medical research perpetuates racial health disparities in the United States. Open-ended phone interviews were conducted with 50 AA adults from Philadelphia who had previously participated in a genetic study of glaucoma that included complimentary ophthalmic screenings. Recruitment for the genetic study was done in partnership with a Black-owned radio station. Thematic analysis of interview transcripts, guided by the integrated behavior model (IBM), identified self-reported motivations for participating in this care-focused and community-promoted research program. Findings revealed that decisions to enroll were influenced by strong instrumental attitudes regarding learning more about personal health and contributing to future care options for others. Notable normative influences that factored into participants' decisions to enroll in the study included hearing about the study from a respected community media outlet, friends, and family. About one-third of respondents discussed past and current racial discrimination in medical research as an important sociocultural frame within which they thought about participation, suggesting that experiential attitudes play a continuing role in AA's decisions to enroll in medical research studies. Medical researchers seeking to recruit AA participants should collaborate with community partners, combine enrollment opportunities with access to health services, and emphasize the potential for new research to mitigate racial inequalities.


Assuntos
Pesquisa Biomédica , Glaucoma , Adulto , Afro-Americanos , Glaucoma/genética , Humanos , Philadelphia , Estados Unidos
19.
Sex Transm Dis ; 49(5): e64-e66, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34694276

RESUMO

ABSTRACT: The impact of preexposure prophylaxis uptake on sexual and injection-related behaviors among women who inject drugs is poorly understood. Over 24 weeks, preexposure prophylaxis uptake among women who inject drugs was associated with increased sharing of injection equipment but not syringes and no changes in condomless sex, providing limited evidence of risk compensation in this vulnerable population.


Assuntos
Infecções por HIV , Equidade em Saúde , Profilaxia Pré-Exposição , Abuso de Substâncias por Via Intravenosa , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Philadelphia/epidemiologia , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia
20.
Int J Drug Policy ; 100: 103521, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34826788

RESUMO

BACKGROUND: The U.S. relies far too heavily on punitive criminal justice strategies to address problems that are better prevented and resolved through social and health services. The resulting harms are especially large and longstanding for people trapped in the failed War on Drugs. Philadelphia launched a Police Assisted Diversion (PAD) program to address the highest rates of poverty, incarceration, and fatal overdose among large cities in the U.S. PAD enables police officers to connect people with supportive services in many instances that would otherwise result in arrest or through outreach when no crime is suspected. METHODS: We conducted semi-structured interviews with 30 clients, 15 police officers, and 12 other personnel involved with the program. Data were gathered in 2019 and 2020 and analyzed using standard qualitative methods. RESULTS: PAD represents a new less-punitive model for responding to illegal purchasing of drugs, possession of drugs, prostitution, and retail theft in Philadelphia. Clients reported mostly positive experiences with the program, identifying the primary benefits as avoided arrest and relational support from affiliated service providers. Police officers expressed support for the program in principle but skepticism about its effects in practice, questioning the quality of available services. Program personnel and police officers described multi-sectoral collaboration as essential to addressing frequent and diverse logistical challenges, including overly restrictive eligibility criteria, mistrust between police and service providers, and coordination across different neighborhoods. Finally, all three groups suggested that people can only benefit from service linkages when they are ready to engage and that inadequate access to resources like housing limits program effectiveness. CONCLUSIONS: The PAD program is a promising public health intervention for diverting people away from punishment and towards services to address unmet social and health needs. But increasing investments in training and in other supportive services is essential to sustainable and transformational change.


Assuntos
Aplicação da Lei , Polícia , Direito Penal , Humanos , Philadelphia , Pesquisa Qualitativa
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