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1.
Front Public Health ; 10: 882421, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937263

RESUMO

Background: Exacerbated by the COVID-19 pandemic and the proliferation of fentanyl and fentanyl analogs, overdose deaths have surged in the United States, making it important to understand how individuals who use drugs experience and perceive the risks of fentanyl use and how it has changed during the COVID-19 pandemic. Methods: Twenty clients from a Philadelphia syringe services program completed a questionnaire and in-depth interview about their fentanyl experiences from January to March 2021. These interviews were transcribed and analyzed using thematic analysis methods. Results: Sixty percent of participants were female and racial/ethnic minority. Participants indicated they believed fentanyl use accounted for most Philadelphia opioid-related overdoses and understood that fentanyl was different from other opioids. Fentanyl use was characterized as "all-consuming" by taking over lives and inescapable. While most perceived their risk of fentanyl overdose as high, there was low interest in and reported use of harm reduction strategies such as fentanyl test strips. The COVID-19 pandemic was noted to have negative effects on fentanyl availability, use and overdose risk, as well as mental health effects that increase drug use. Conclusions: The divide between perceived risk and uptake of protective strategies could be driven by diminished self-efficacy as it relates to acting on and engaging with resources available at the syringe services program and represents a potential intervention target for harm reduction intervention uptake. But the COVID-19 pandemic has exacerbated risks due to fentanyl use, making an effective, accessible, and well-timed intervention important to address the disconnect between perceived overdose risk and use of preventive behaviors.


Assuntos
COVID-19 , Overdose de Drogas , COVID-19/epidemiologia , Overdose de Drogas/prevenção & controle , Overdose de Drogas/psicologia , Etnicidade , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Grupos Minoritários , Philadelphia/epidemiologia , Seringas , Estados Unidos
3.
J Acquir Immune Defic Syndr ; 90(S1): S90-S97, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35703760

RESUMO

BACKGROUND: Strengthening HIV prevention services is a key priority of the Ending the HIV Epidemic plan. Informed by the Consolidated Framework for Implementation Research, we examined HIV testers' perceived barriers and facilitators to implementing HIV prevention services, including testers' strengths and weaknesses; enabling factors within the inner and outer settings; and willingness to adopt potential implementation strategies. METHODS: In 2019, the Penn Center for AIDS Research (CFAR) partnered with the Philadelphia Department of Public Health (PDPH) to examine system-level challenges and opportunities experienced by PDPH-funded HIV testers (individuals conducting HIV testing) in Philadelphia. We recruited HIV testers to complete 2 web surveys (n ≈ 40 each) and in-depth interviews (n = 11). RESULTS: Testers self-reported high HIV testing self-efficacy and competence, despite identifying gaps in their knowledge of STI testing, reporting moderate willingness to recommend pre-exposure prophylaxis, and having insufficient cultural competency when working with priority populations. Testers indicated that educational materials and policies within their agencies might require realignment to affirm sexual and gender minority clients. In qualitative interviews, testers noted challenges to implementing PDPH priorities because limited funding fueled competition between local agencies, deterred interagency partnerships, and limited their ability to serve key populations locally. DISCUSSION: HIV testers are critical partners in addressing agency-level barriers to HIV prevention service provision through multilevel implementation strategies. In partnership with PDPH, we will create and implement a train-the-trainers program consisting of skill-building activities, technical assistance, and capacity-building for all agency personnel to address missed opportunities in HIV prevention. These activities will reinforce scalability and sustainability of PDPH-supported HIV prevention programs.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Profilaxia Pré-Exposição , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Ciência da Implementação , Philadelphia
4.
JAMA Netw Open ; 5(6): e2216649, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35696165

RESUMO

Importance: COVID-19 vaccine uptake among urban populations remains low. Objective: To evaluate whether text messaging with outbound or inbound scheduling and behaviorally informed content might increase COVID-19 vaccine uptake. Design, Setting, and Participants: This randomized clinical trial with a factorial design was conducted from April 29 to July 6, 2021, in an urban academic health system. The trial comprised 16 045 patients at least 18 years of age in Philadelphia, Pennsylvania, with at least 1 primary care visit in the past 5 years, or a future scheduled primary care visit within the next 3 months, who were unresponsive to prior outreach. The study was prespecified in the trial protocol, and data were obtained from the intent-to-treat population. Interventions: Eligible patients were randomly assigned in a 1:20:20 ratio to (1) outbound telephone call only by call center, (2) text message and outbound telephone call by call center to those who respond, or (3) text message, with patients instructed to make an inbound telephone call to a hotline. Patients in groups 2 and 3 were concurrently randomly assigned in a 1:1:1:1 ratio to receive different content: standard messaging, clinician endorsement (eg, "Dr. XXX recommends"), scarcity ("limited supply available"), or endowment framing ("We have reserved a COVID-19 vaccine appointment for you"). Main Outcomes and Measures: The primary outcome was the proportion of patients who completed the first dose of the COVID-19 vaccine within 1 month, according to the electronic health record. Secondary outcomes were the completion of the first dose within 2 months and completion of the vaccination series within 2 months of initial outreach. Additional outcomes included the percentage of patients with invalid cell phone numbers (wrong number or nontextable), no response to text messaging, the percentage of patients scheduled for the vaccine, text message responses, and the number of telephone calls made by the access center. Analysis was on an intention-to-treat basis. Results: Among the 16 045 patients included, the mean (SD) age was 36.9 (11.1) years; 9418 (58.7%) were women; 12 869 (80.2%) had commercial insurance, and 2283 (14.2%) were insured by Medicaid; 8345 (52.0%) were White, 4706 (29.3%) were Black, and 967 (6.0%) were Hispanic or Latino. At 1 month, 14 of 390 patients (3.6% [95% CI, 1.7%-5.4%]) in the outbound telephone call-only group completed 1 vaccine dose, as did 243 of 7890 patients (3.1% [95% CI, 2.7%-3.5%]) in the text plus outbound call group (absolute difference, -0.5% [95% CI, -2.4% to 1.4%]; P = .57) and 253 of 7765 patients (3.3% [95% CI, 2.9%-3.7%]) in the text plus inbound call group (absolute difference, -0.3% [95% CI, -2.2% to 1.6%]; P = .72). Among the 15 655 patients receiving text messaging, 118 of 3889 patients (3.0% [95% CI, 2.5%-3.6%]) in the standard messaging group completed 1 vaccine dose, as did 135 of 3920 patients (3.4% [95% CI, 2.9%-4.0%]) in the clinician endorsement group (absolute difference, 0.4% [95% CI, -0.4% to 1.2%]; P = .31), 100 of 3911 patients (2.6% [95% CI, 2.1%-3.1%]) in the scarcity group (absolute difference, -0.5% [95% CI, -1.2% to 0.3%]; P = .20), and 143 of 3935 patients (3.6% [95% CI, 3.0%-4.2%]) in the endowment group (absolute difference, 0.6% [95% CI, -0.2% to 1.4%]; P = .14). Conclusions and Relevance: There was no detectable increase in vaccination uptake among patients receiving text messaging compared with telephone calls only or behaviorally informed message content. Trial Registration: ClinicalTrials.gov Identifier: NCT04834726.


Assuntos
COVID-19 , Envio de Mensagens de Texto , Adulto , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Feminino , Humanos , Masculino , Philadelphia , Sistemas de Alerta , Vacinação
5.
Obstet Gynecol ; 139(6): 1018-1026, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35675599

RESUMO

OBJECTIVE: To quantify the extent to which neighborhood characteristics contribute to racial and ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity in pregnancy. METHODS: This cohort study included pregnant patients who presented for childbirth at two hospitals in Philadelphia, Pennsylvania from April 13 to December 31, 2020. Seropositivity for SARS-CoV-2 was determined by measuring immunoglobulin G and immunoglobulin M antibodies by enzyme-linked immunosorbent assay in discarded maternal serum samples obtained for clinical purposes. Race and ethnicity were self-reported and abstracted from medical records. Patients' residential addresses were geocoded to obtain three Census tract variables: community deprivation, racial segregation (Index of Concentration at the Extremes), and crowding. Multivariable mixed effects logistic regression models and causal mediation analyses were used to quantify the extent to which neighborhood variables may explain racial and ethnic disparities in seropositivity. RESULTS: Among 5,991 pregnant patients, 562 (9.4%) were seropositive for SARS-CoV-2. Higher seropositivity rates were observed among Hispanic (19.3%, 104/538) and Black (14.0%, 373/2,658) patients, compared with Asian (3.2%, 13/406) patients, White (2.7%, 57/2,133) patients, and patients of another race or ethnicity (5.9%, 15/256) (P<.001). In adjusted models, per SD increase, deprivation (adjusted odds ratio [aOR] 1.16, 95% CI 1.02-1.32) and crowding (aOR 1.15, 95% CI 1.05-1.26) were associated with seropositivity, but segregation was not (aOR 0.90, 95% CI 0.78-1.04). Mediation analyses revealed that crowded housing may explain 6.7% (95% CI 2.0-14.7%) of the Hispanic-White disparity and that neighborhood deprivation may explain 10.2% (95% CI 0.5-21.1%) of the Black-White disparity. CONCLUSION: Neighborhood deprivation and crowding were associated with SARS-CoV-2 seropositivity in pregnancy in the prevaccination era and may partially explain high rates of SARS-CoV-2 seropositivity among Black and Hispanic patients. Investing in structural neighborhood improvements may reduce inequities in viral transmission.


Assuntos
COVID-19 , SARS-CoV-2 , Estudos de Coortes , Feminino , Humanos , Características da Vizinhança , Philadelphia/epidemiologia , Gravidez , Brancos
6.
J Health Care Poor Underserved ; 33(2): 726-736, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35574872

RESUMO

Sex workers face many occupation-specific health challenges, including facing stigma in health care settings. There is a lack of both quantitative and qualitative research regarding sex workers in the United States. METHODS: Hermeneutic phenomenology and Harding's feminist theory guided the qualitative portion of this mixed-methods study that also included a quantitative health needs assessment. Private interviews were conducted with a purposive sample of sex workers recruited from a drop-in support center for cis- and transgender individuals identifying as women. RESULTS: Issues of homelessness, food insecurity, and personal safety were among the women's top health-related concerns (n=29). Seven themes emerged from qualitative data after transcripts were reviewed, reflected upon, and validated with a focus group at the center. Extraordinary emphasis was given to the theme, "I am a person." CONCLUSION: This study helps to illuminate the lived experience and health risks of being a woman-identified sex worker in Philadelphia.


Assuntos
Profissionais do Sexo , Pessoas Transgênero , Feminino , Humanos , Philadelphia , Pesquisa Qualitativa , Estigma Social
7.
JAMA Netw Open ; 5(5): e2211900, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35552724

RESUMO

Importance: The burden of chronic kidney disease (CKD) and end-stage kidney disease falls disproportionately on Black individuals in the US, with Black veterans experiencing substantial consequences, and only a portion of the disparities in health conditions and health care can be explained by nonbiological factors. Among Black individuals, racism is likely one of those factors, suggesting the need to examine the consequences of racism and the resulting social structures that establish and perpetuate these racial disparities. Objective: To investigate the health care experiences of Black veterans with CKD and identify and explore the racial discrimination encountered by this vulnerable population. Design, Setting, and Participants: This qualitative study used semistructured interview guides to investigate the health care experiences of 36 Black veterans with CKD who received care at the Corporal Michael Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania, from October 2018 to September 2019. Interview transcripts were analyzed using applied thematic analysis. Results: Among 36 Black veterans with CKD who characterized racism in the context of their care at a Veterans Affairs medical center, the mean (SD) age was 66.0 (7.8) years; 35 participants (97.2%) were male, 1 participant (2.8%) was female, and 19 participants (52.8%) were married. The mean (SD) duration of military service was 8.0 (7.0) years. Overall, 15 participants (41.7%) were not dependent on dialysis, and hypertension was the most common comorbidity (9 participants [25.0%]). Veterans described the ways in which racism produced emotional and physical stress, including psychological symptoms (eg, anger and hurt) and physiological symptoms (eg, headaches). Veterans described a strong sense of distrust in the health care system coupled with a need to be hypervigilant during clinical encounters. When encountering racism, veterans described bottling up their feelings, which sometimes led to maladaptive behavior (eg, substance use). Veterans also described individual and collective positive strategies (eg, faith) for coping with the stress of racism. Conclusions and Relevance: In this study, Black veterans with CKD experienced racism in the clinical setting that produced physical and emotional stress and a strong sense of distrust in the health care system. These findings highlight an important opportunity for education and training of health care professionals in the implementation of trauma-informed approaches to care as a means of addressing race-based stress and trauma.


Assuntos
Racismo , Insuficiência Renal Crônica , Veteranos , Idoso , Atenção à Saúde , Feminino , Humanos , Masculino , Philadelphia , Racismo/psicologia , Insuficiência Renal Crônica/terapia
8.
BMC Public Health ; 22(1): 1044, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35614426

RESUMO

BACKGROUND: COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. METHODS: We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 - May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. RESULTS: Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together - low college education AND low/medium concentrated racial privilege - identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege - medium/high college education OR high concentrated racial privilege - were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). CONCLUSIONS: Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.


Assuntos
COVID-19 , Segregação Social , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Philadelphia/epidemiologia , Características de Residência , Vacinação
9.
Popul Health Manag ; 25(2): 254-263, 2022 04.
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
10.
Am J Prev Med ; 63(1): 60-67, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35365396

RESUMO

INTRODUCTION: This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern. METHODS: This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021. RESULTS: A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03). CONCLUSIONS: From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.


Assuntos
Cannabis , Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Adolescente , Humanos , Nicotina , Philadelphia/epidemiologia , Estudos Prospectivos , Vaping/epidemiologia
11.
Am J Health Promot ; 36(6): 1019-1024, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35382562

RESUMO

PURPOSE: Feeling connected to nature, or nature relatedness (NR), can positively impact physical and psychological well-being. However, the relationship between NR and dietary behaviors has not been studied. This research examined the relationship between NR and dietary behaviors, including dietary diversity and fruit and vegetable intake. DESIGN: Cross-sectional online survey study. SETTING: Philadelphia, Pennsylvania. SUBJECTS: Adults (n = 317) over 18 years who resided in Philadelphia, PA. MEASURES: The NR Scale was used to measure participants' connection to nature. It includes 21 items across three subscales: self, experience, and perspective (total and subscales range from 1 to 5). Dietary Diversity was assessed using the FAO's standardized tool (scores range from 0 to 9). To calculate dietary diversity, food groups reported were aggregated into nine food categories: starchy staples; dark green leafy vegetables; vitamin A rich fruits/vegetables; other fruits/vegetables; organ meat; meat/fish; eggs; legumes, nuts/seeds; and milk products. The NCI's 2-item CUP Fruit and Vegetable Screener was used to estimate daily fruit and vegetable intake (cups/day), and socio-demographic questions were asked. ANALYSIS: Simple and multivariable regression models were used to examine associations between NR Total and subscale scores with dietary diversity scores and fruit and vegetable intake with NR Total scores and subscale scores. The multivariable models were adjusted for age, race, gender, and income. RESULTS: People with higher NR Total (P < .001), NR Self (P < .001), NR Perspective (P = .002), and NR Experience (P = .002) were more likely to report greater dietary diversity. Those with higher NR Total (P < .001), NR Self (P < .001), and NR Experience (P < .001) reported greater fruit and vegetable intake. Associations remained significant after adjusting for covariates. CONCLUSION: NR was associated with better dietary intake after accounting for socio-demographic indicators. These findings highlight the need for health promotion interventions that enhance NR, such as nature prescription initiatives, urban gardening and greening, and immersion in urban green spaces.


Assuntos
Frutas , Verduras , Animais , Estudos Transversais , Dieta , Humanos , Philadelphia , População Urbana
12.
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
13.
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
14.
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
15.
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
16.
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
17.
Prev Med ; 158: 107020, 2022 05.
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
18.
Occup Environ Med ; 79(5): 326-332, 2022 05.
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
19.
Am Psychol ; 77(4): 626, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35238588

RESUMO

Memorializes David S. Festinger (1962-2021). He was best known for the impacts of his research contributions in the area of substance abuse treatment-particularly around issues of law and ethics. His interest in researching and promoting ethical principles for research participants was strongly influenced by the experiences of his parents, who were both Holocaust survivors. He served as principal or co-investigator on over 20 National Institutes of Health-funded grants and numerous contracts and grants from other funding agencies. Most of Dr. Festinger's career was spent with the Treatment Research Institute in Philadelphia. His final affiliation was with the Philadelphia College of Osteopathic Medicine, where he conducted research, taught students, and provided clinical supervision to trainees and early career practitioners. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Organização do Financiamento , National Institutes of Health (U.S.) , Humanos , Masculino , Philadelphia , Estados Unidos
20.
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
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