Public Health Approach Research Articles

Availability of community resources reduces the association among community violence exposure, negative emotionality, and substance use disorders.

Exposure to community violence is associated with increased occurrence of substance use disorders (SUD). The self-medication hypothesis states that heightened negative emotionality may underlie the link between exposure to community violence and SUD. However, it is not well-understood if access to community resources, a broader public health approach, influences the purported psychological mechanisms underlying the link between community violence exposure and SUD. We examined whether negative emotionality mediates the association between youth-onset community violence exposure and having a SUD and whether community resources (i.e., density of social services, health care services, healthy food) moderate the relationship between negative emotionality and having a SUD. Moderated mediation analyses were used to test the indirect effect of negative emotionality and the moderating role of community resources on the association between negative emotionality and having a SUD. A sample of 376 participants was collected from New Haven (ages 18-73, 45.7% Black, 44.1% White, 7.6% Hispanic). There was a significant indirect effect of negative emotionality on the association between youth-onset community violence and having a substance use disorder (indirect effect=0.22, SE=0.07, p=.001, 95% CI [0.11, 0.38]; proportion mediated=0.24). Further, increased density of community resources reduced the relationship between negative emotionality and having a substance use disorder (β=-0.23, SE=0.07, p=.001, 95% CI[-0.36, -0.10]). Increasing availability of community resources may play a role in alleviating the suffering resulting from violence exposure.

The Application of Machine Learning Algorithms to Predict HIV Testing in Repeated Adult Population-Based Surveys in South Africa: Protocol for a Multiwave Cross-Sectional Analysis.

HIV testing is the cornerstone of HIV prevention and a pivotal step in realizing the Joint United Nations Program on HIV/AIDS (UNAIDS) goal of ending AIDS by 2030. Despite the availability of relevant survey data, there exists a research gap in using machine learning (ML) to analyze and predict HIV testing among adults in South Africa. Further investigation is needed to bridge this knowledge gap and inform evidence-based interventions to improve HIV testing. This study aims to determine consistent predictors of HIV testing by applying supervised ML algorithms in repeated adult population-based surveys in South Africa. A retrospective analysis of multiwave cross-sectional survey data will be conducted to determine the predictors of HIV testing among South African adults aged 18 years and older. A supervised ML technique will be applied across the five cycles of the South African National HIV Prevalence, Incidence, Behavior, and Communication Survey (SABSSM) surveys. The Human Science Research Council (HSRC) conducted the SABSSM surveys in 2002, 2005, 2008, 2012, and 2017. The available SABSSM datasets will be imported to RStudio (version 4.3.2; Posit Software, PBC) to clean and remove outliers. A chi-square test will be conducted to select important predictors of HIV testing. Each dataset will be split into 80% training and 20% test samples. Logistic regression, support vector machines, random forests, and decision trees will be used. A cross-validation technique will be used to divide the training sample into k-folds, including a validation set, and models will be trained on each fold. The models' performance will be evaluated on the validation set using evaluation metrics such as accuracy, precision, recall, F1-score, area under curve-receiver operating characteristics, and confusion matrix. The SABSSM datasets are open access datasets available on the HSRC database. Ethics approval for this study was obtained from the University of Johannesburg Research and Ethics Committee on April 23, 2024 (REC-2725-2024). The authors were given access to all five SABSSM datasets by the HSRC on August 20, 2024. The datasets were explored to identify the independent variables likely influencing HIV testing uptake. The findings of this study will determine consistent variables predicting HIV testing uptake among the South African adult population over the course of 20 years. Furthermore, this study will evaluate and compare the performance metrics of the 4 different ML algorithms, and the best model will be used to develop an HIV testing predictive model. This study will contribute to existing knowledge and deepen understanding of factors linked to HIV testing beyond traditional methods. Consequently, the findings would inform evidence-based policy recommendations that can guide policy makers to formulate more effective and targeted public health approaches toward strengthening HIV testing. DERR1-10.2196/59916.

Critical Steps To Address Climate, Health, And Equity.

Climate change poses an unprecedented threat to human health and well-being in the United States. In this article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, we outline key strategies to address climate change, health, and equity, using a public health approach. We focus on three critical areas: transitioning to clean energy sources, upgrading health infrastructure, and scaling public health and health care resilience. Priorities for action must be coupled with further research to ensure the equitable implementation of climate solutions, create effective communication strategies, and build public support and momentum. Addressing the climate crisis requires urgent, coordinated action across sectors. With concerted effort, the health sector can play a vital role in mitigating climate change and protecting the population's health.

Evaluating the synergy: anxiety prevalence and alcohol consumption patterns in high-income countries using Granger causality analysis

BackgroundAlcohol consumption frequently experiences episodes of severe anxiety. This study set out to explore the long-term effects of alcohol consumption on anxiety, revealing insights into how alcohol consumption uniquely impact anxiety, aiming to inform mental health and public health approaches. This research paper explores the complex relationship between the prevalence of anxiety and the consumption patterns of wine, beer, and spirits across fifty-two high-income countries with a continental analysis.MethodBy employing significant secondary data taken from the World Health Organization and Our World in Data online databases and covering the period from 1990 to 2019, this study seeks to explore various causality relationships over this period. Its primary objective is to fill the empirical gap in existing research by using Granger causality analysis to reveal the dynamic relationships between the consumption of alcohol and the prevalence of anxiety. This study endeavours to provide a continental analysis of the high-income countries, which allows for including a comprehensive viewpoint in the context of a single investigation.ResultsThe findings demonstrate a variety of patterns of causality in alcohol consumption and anxiety prevalence in a one-way causal relationship across specific continents, a bidirectional relationship in others, and no apparent causal relationship in several countries.ConclusionThe inference made from the study’s results goes beyond scholarly curiosity; it establishes the foundation for further investigations and the development of customised policies aimed at reducing the mutually reinforcing dangers of alcohol consumption and anxiety disorders.

Reimagining psychosis prevention: responding to the accessibility issues of At-Risk Mental State (ARMS) services through a selective public health approach.

At-Risk Mental State (ARMS) services aim to prevent the onset of first-episode psychosis (FEP) in those with specific clinical or genetic risk markers. In England, ARMS services are currently expanding, but the accessibility of this preventative approach remains questionable, especially for a subgroup of FEP patients and those from specific ethnic minority communities. This commentary outlines the key debates about why a complimentary approach to psychosis prevention is necessary, and gives details for an innovative public health strategy, drawing on existing research and health prevention theory.

Venoms and Extracellular Vesicles: A New Frontier in Venom Biology.

Extracellular vesicles (EVs) are nanoparticle-sized vesicles secreted by nearly all cell types under normal physiological conditions. In toxicological research, EVs have emerged as a crucial link between public health and multi-omics approaches, offering insights into cellular responses to disease-causing injury agents such as environmental and biological toxins, contaminants, and drugs. Notably, EVs present a unique opportunity to deepen our understanding of the pathophysiology of envenomation by natural toxins. Recent advancements in isolating and purifying EV cargo, mass spectrometry techniques, and bioinformatics have positioned EVs as potential biomarkers that could elucidate biological signaling pathways and provide valuable information on the relationship between venomous toxins, their mechanisms of action, and the effectiveness of antivenoms. Additionally, EVs hold promise as proxies for various aspects of envenomation, including the toxin dosage, biological characterization, injury progression, and prognosis during therapeutic interventions. These aspects can be explored through multi-omics technology applied to EV contents from the plasma, saliva, or urine samples of envenomated individuals, offering a comprehensive integrative approach to understanding and managing envenomation cases.

From trusted intruder to real collaborator: Mapping the ecosystem of stakeholders and community assets in a coastal region in England, with a focus on end-of-life care and bereavement support

While policy efforts to promote health through integration across sectors are not new, the 2022 UK Health and Care Act formalised Integrated Care Systems (ICSs) as legal entities with statutory powers in England. This includes a legal responsibility to commission adequate palliative and end-of-life care services, including bereavement support, for the communities they serve. Cross-sector partnerships that leverage community assets are recommended to tackle inequities towards the end of life and in bereavement. However, the nature of effective, equitable partnership remains unclear, and asset-based approaches have been criticised for neglecting issues of power and potentially transferring the responsibility for solving social and health injustices to communities. Aware of these debates, we critically explore the conditions that enable inclusive collaborative relationships and integration across sectors, as well as the barriers that prevent this, within the ecosystem of one coastal region in England. We conducted a system mapping study, drawing on theories of death systems, social capital, and service ecosystems, understood via Service-Dominant Logic (S-D L).Our three-phase participatory, qualitative study involved three community network meetings (attended by 35–55 stakeholders across sectors), a participatory digital mapping workshop (n = 19), and semi-structured interviews analysed using inductive thematic analysis (n = 15 stakeholders across sectors). Digital mapping showed weak or unstable bridging capital between sectors. Interviews highlighted that attending to the relational foundations of integration is essential but often omitted: opportunities and time to understand each other and co-create a shared vision, understanding differences and deepening connections, and, fundamentally, addressing power differentials. Failed attempts at generating bridging capital were linked to extractive relationships, widespread staff shortages and inadequate funding and resources, particularly in the VCSE. Understanding the nature of collaboration and social capital in a locality can support public health approaches which go beyond naïve calls for cross-sector collaboration to engender meaningful change.

Predicting the Effect of Temperature Changes on Phlebotomus papatasi Activity, as the Main Vector of Zoonotic Cutaneous Leishmaniasis in Iran

Cutaneous leishmaniasis (CL) represents a significant vector‐borne disease in Iran. Our study examined the status of zoonotic CL (ZCL) in the country and forecasted the influence of global climate change on the monthly activity of Phlebotomus papatasi, the main vector of ZCL in the country. To predict the impact of climate change on the monthly activity of Ph. papatasi, we obtained the monthly average minimum and maximum temperatures for both the reference and future periods, using the MIROC6 model and two different shared socioeconomic pathway (SSP) scenarios. Based on our analysis, we found that Ph. papatasi can be active in Iran from March to November, although this may vary depending on the region. Our predictions suggest that the duration of Ph. papatasi’s activity may change following future changes in weather patterns. In different scenarios, the duration of the active season in various regions of the country extends by at least 1–2 months. This extension is likely more pronounced in the southern provinces. Additionally, our findings indicate a notable correlation between ZCL incidence, the presence of Ph. papatasi, and environmental factors in Ardestan, Esfahan Province. This study focuses on the impact of temperature on the activity and distribution of Ph. papatasi in Iran, which is a significant vector for transmitting ZCL. The study predicts that with future climate scenarios, especially SSP5‐8.5, the activity of this vector will start earlier, last longer, and might even occur throughout the year by the 2050s, thereby increasing the risk of ZCL transmission. Although temperature plays a dominant role in shaping the activity of Ph. papatasi, its influence is not consistent across Iran. The variation in different regions emphasizes the importance of implementing targeted public health approaches to address the changing risks of ZCL transmission due to evolving climate conditions. However, it acknowledges that certain factors such as land use and humidity have not been taken into account and requests additional research in these areas. It also calls for enhanced environmental monitoring and public health interventions.

A Systematic Review of the Existing Evidence on Early Year Interventions for Trauma and Violence Prevention.

Exposure to violence in early childhood is considered a public health issue and is a significant predictor of becoming a victim or perpetrator of violence later in life. There has been a significant increase in violence intervention and prevention programs that are available for children and young people; however, there are few evidence-based interventions for younger children. This review systematically explores the existing impact evidence for available intervention and prevention programs targeted at young children (ages 3-8) across the United States and United Kingdom. It also explores the feasibility and methodological issues faced with school-based prevention work. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were systematically searched. Of the initial 766 articles, 13 met the final inclusion criteria. The findings showed that early intervention programs for vulnerable children can promote prosocial behaviors and protective factors. Outcomes included improved academic achievement, implementation of Social Emotional Learning-based learning, decrease in violence and criminal justice-related outcomes, and increased resiliency and emotional development among children. Evidence also showed that trauma-informed training for staff and teachers can increase teacher awareness of trauma and the importance of trauma-informed practices. Most programs showed a positive change in children as a result of early intervention programs. We discuss important issues for policy and practice in early years teaching, particularly for high-risk populations, and the importance of trauma-informed practices in the long-term, public health approach to violence prevention and reduction. We also highlight important areas for future research on violence prevention programs.

Unraveling the Multifactorial Determinants of Miscarriage: Insights from SEM Analysis of Maternal Characteristics, Lifestyle Factors, and Antenatal Care

Background: This paper establishes that miscarriage is still a major determinant of maternal health, with the implication that factors such as maternal age, lifestyle factors, socioeconomic status and antenatal care visits affect the condition. This knowledge of factors involved can help in designing ways of ensuring they do not lead to miscarriages. Objective: The purpose of this work was to examine the relationship between a range of maternal lifestyle behaviors, education, visits to the antenatal care facility, and miscarriage rates by using structural equation modelling (SEM). Methods: Assuming a female population of 2000, data was generated on Maternal Age, education, Smoking, alcohol, exercise, Antenatal Care visits and an outcome variable representing miscarriage. SEM was employed to test the hypothesized relationships of these variables with Latent Lifestyle Risks captured under the observed behavior (smoking, alcohol use, exercise). To check the model fit, the following fit measure was used; Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR). Results: Consequently, the assumption of good model fit in the current SEM was obtained with CFI = 0.984, TLI = 0.971, RMSEA = 0.033, and SRMR = 0.021. Hence in this study maternal age was significantly related to miscarriage risk (Estimate = 0.028, p < 0.001), while higher level of education was inversely inclined to miscarriage (Estimate = -0.042, p < 0.001). Latent Lifestyle Risks were identified to have a positive relationship with miscarriages (Estimate = 0.200, p < 0.001 while antenatal care visits have a negative association with miscarriage risks (Estimate = -0.022, p < 0.001). Conclusions: Descriptive findings also reveal that maternal age, specific lifestyle patterns, educational attainment and utilization of antenatal care services are potential determinants of miscarriage. We found that offering changes to lifestyle behaviors and increasing the accessibility of antenatal care could lower miscarriage risk, and hence there can be great potential in public health approaches which address such factors to enhance the quality of maternal health.

The Need for a Public Health Approach to Childbirth Rate: A Critical Study from Japan

The Article Abstract is not available.

Mold remediation in homes after flooding.

Flooding events, particularly those caused by hurricanes and other large storm events, are increasingly fueled by climate change. Stormwater intrusion into homes creates ideal conditions for mold growth. Homes inundated by floodwaters become vulnerable to production of mold spores, particulate matter, and volatile organic compounds, all of which trigger a variety of poor health outcomes. Disadvantaged communities often bear the brunt of these hazards and face additional challenges due to limited resources for effective remediation. Moisture control is the cornerstone of effective mold remediation. Removal of porous material and rapid initiation of dehumidification reduce potentially harmful exposures. During cleanup, protective measures, especially the use of N95 respirators, reduce the inhalation of particulate matter from mold and from the remediation process itself. Individuals with immunodeficiency or respiratory conditions should be excluded from damp environments and remediation activities. Public health approaches are needed after flooding events, including prioritization of remediation in resource-limited communities and communication on effective, ineffective, and potentially harmful strategies in addressing mold exposure.

Proposing an Individual-in-Contexts Model for Reimagining Suicide Screening, Assessment, and Intervention in Black Communities

Suicidality affects millions of people in the United States every year. Despite its pervasiveness, suicidality often impacts minoritized communities disproportionately. For example, Black communities, with historically low suicidality rates, have experienced significant increases in deaths by suicide in the last two decades. Such increases have occurred in unique and complex individual and contextual relationships such as historical trauma, racialized ecological injustices, structural and institutional racism, resource-deprived communities, forced family separation through over-incarceration, interpersonal discrimination, and internalized shame. While traditional psychiatric, psychological, and public health approaches have undoubtedly prevented some suicides, these fields of study often overlook or obscure the interconnections between upstream, oppressive systemic dynamics and downstream, individual-level factors that uniquely contribute to suicidality in Black communities. To address these oversights and limitations, and to re-imagine human services professionals’ suicide screening, assessment, and intervention with Black communities, The Individual-in-Contexts Model (ICM) is offered. This model integrates critical, ecological, contextual, and Black feminist scholarship frameworks, and provides rationale for specific human services research, practice, and policy recommendations.

Interpersonal, Community, and Institutional Influences on Sexual Consent Among Fraternity and Sorority Students in the Context of a Hookup: A Qualitative Analysis

ABSTRACT College sexual assault is a persistent public health problem in the United States. A public health approach to develop effective prevention strategies must take into account the social ecology of college campuses, including interpersonal-, community-, and institutional-level factors that may influence sexual assault. To maximize effectiveness, prevention strategies should be tailored to reflect contextual factors of specific college communities and situations where sexual assault is more likely to occur. Using one-on-one semi-structured interviews, this qualitative study of fraternity and sorority students examined interpersonal, community, and institutional factors influencing consent within the context of a hookup. Participants included 42 sexually active, predominantly heterosexual undergraduate fraternity and sorority members. From interviews, eight modifiable factors emerged that influence student consent behavior: (a) Awkwardness and fear of rejection; (b) Traditional heterosexual sexual scripts; (c) Coercion; (d) Men’s fear of being accused of sexual assault; (e) Peers and the sexual double standard; (f) Sex and the Greek social hierarchy; (g) Drunk sex; and (h) Greek environments. College sexual assault prevention efforts should be tailored to the fraternity and sorority community and aim to address these eight factors to prevent sexual assault within the high-risk context of hookups.

Bullets as Pathogen—The Need for Public Health and Policy Approaches

This JAMA Viewpoint explores how public health principles related to communicable diseases and bullet-specific regulations could be applied in the US to prevent further injury and death due to gun violence.

Empowering Communities and Enhancing Public Safety: Stakeholders' Perspectives on Opioid Overdose Prevention Strategies in Boston.

The opioid crisis in Boston necessitated multifaceted prevention strategies. This qualitative descriptive study engaged stakeholders' perspectives to explore the role of community empowerment and educational strategies in opioid overdose prevention. Fifteen officials from law enforcement, healthcare, policy, and community organizations participated in semi-structured interviews conducted from January to March 2024. Thematic analysis using Braun and Clarke's approach, facilitated by MAXQDA software, revealed three themes: Perceived Role of Community Empowerment in Opioid Overdose Prevention, highlighting the importance of local leadership, personal recovery, and grassroots initiatives; Effectiveness of Educational Strategies in Opioid Overdose Prevention, focusing on awareness, harm reduction, and bridging gaps post-incarceration; and Challenges and Innovations in Empowering Communities and Enhancing Public Safety, emphasizing the integration of law enforcement with technological solutions and community collaboration. The study underscores the importance of integrating public health approaches with enhanced law enforcement strategies and community-driven solutions to balance immediate intervention with long-term community resilience.

Evaluating a targeted selective speech, language, and communication intervention at scale – Protocol for the Happy Talk cluster randomised controlled trial.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Moving from indifference to reparative action: a public health approach to racial health inequities in life expectancy in cities in the USA

Moving from indifference to reparative action: a public health approach to racial health inequities in life expectancy in cities in the USA

Implementation of the advanced HIV disease package of care using a public health approach: lessons from Nigeria

BackgroundNigeria adapted the WHO package of care for Advanced HIV Disease (AHD) in 2020. The package includes CD4 + cell count testing to identify People Living with HIV (PLHIV) with AHD, screening and treatment of opportunistic infections, rapid antiretrovirals (ART) initiation, and intensive adherence follow-up. The national program adopted a phased approach in the rollout of the AHD package of care to learn lessons from a few representative health facilities before scaling up across the country. This study describes the process and lessons learned from the first phase of implementation.MethodsThis was a prospective observational study, and participants were enrolled between February and September 2021. Healthcare-worker (HCW) capacity was built to implement the AHD package of care. The study population included newly diagnosed PLHIV ≥ 10 years presenting to care in 28 selected facilities across 4 states in Nigeria. Eligible participants received CD4 + cell testing at baseline. Those with CD4 + cell count < 200 cells/mm3 were subjected to a blood cryptococcal antigen (CrAg) test and urine TB lateral flow lipoarabinomannan (LF-LAM). Those with positive CrAg tests had a cerebrospinal fluid (CSF) test to confirm cryptococcal meningitis. Those negative for both blood CrAg and TB LF-LAM were rapidly initiated on ART and underwent intensive follow-up. Participants were followed up for 12 months.ResultsA total of 6,781 patients were enrolled; 71% (4,812) received CD4 + cell count test, of which 41% (1,969 of 4812) had a CD4 + count < 200 cells/mm3. Approximately 81% (1,492 of 1,850) of those with CD4 + count < 200 cells/mm3 had TB LF-LAM test results documented; 25% were positive, of which 47% started TB treatment. Blood CrAg screening coverage among those with CD4 + count < 200 cells/mm3 was 88% (1,634 of 1,850), of which 5% (85 of 1,634) were positive. Cotrimoxazole preventive therapy was initiated for 65% (1,198 of 1,850) of the participants with CD4 + count < 200 cells/mm3, and 70% (966 of 1,375) of AHD patients with a negative TB LF-LAM and blood CrAg results were initiated on ART on the day of enrolment. Approximately 91% (421 of 461) of those who received viral load results at month 12 post-enrollment were virally suppressed. The retention rate and the Kaplan Meier survival probability estimate at month 12 were 65% (1,204 of 1,850) and 0.93 (CI, 0.91–0.94), respectively, for the enrolled participants.ConclusionImplementation of the AHD package of care in Nigeria has improved the diagnosis of TB and CM, and will potentially enhance the quality of care for PLHIV if sustained. Findings from this implementation were used to guide national scale-up.

Developing and implementing whole systems approaches to reduce inequalities in childhood obesity: A mixed methods study in Dundee, Scotland.

UK local authorities are developing and implementing Whole Systems Approaches to childhood obesity to tackle persistent and complex health inequalities. However, there is a lack of research on the practical application of these approaches. This paper reports on findings of a study into the initial implementation of this approach in Dundee, Scotland. We applied a mixed methods research design: 1) semi-structured interviews (n=9) with partnership members; 2) training members as peer researchers to interview their wider networks; n=17); 3) an online survey among wider stakeholders (n=27); and 4) two action learning sets with decision makers. Interview data was analysed using thematic framework analysis and survey data was analysed using descriptive statistics. Dundee stakeholders stated that they had good knowledge of childhood obesity prevention efforts, but their engagement with working groups around identified priority themes was still limited, due to a lack of awareness about existing structures and knowledge about sustainable, impactful strategies, which were not always well-aligned between key organisations. Our findings extend current literature on facilitators for Whole Systems Approaches in public health by highlighting that understanding of strategies and wider structures are crucial to build capacity and maintain engagement to address inequalities. We identified an ongoing need for targeted communication and diverse involvement opportunities for different stakeholder groups.