Sarah B. Maness

Menstruation is a normal biological process experienced by approximately half the global population for a substantial portion of their lives. The average length of a menstrual cycle is 28 days, wit...

In a climate where fear of on campus shootings is high, universities often provide active shooter training. However, these trainings are often inherently ableist and largely ignore the needs of disabled people. Many universities offer these trainings under the umbrella of "Run, Hide, Fight." The foundational steps of the training imply elements of individual physical ability and does not directly indicate actions to be taken by disabled individuals. The purpose of this commentary is to describe current active shooter training practices in higher education and call for revised protocols that are inclusive of disabled people.

Ethnic and minority groups throughout the United States experience higher rates of sickness and death across a wide range of health conditions. The purpose of this study was to assess social determinants of healthcare access in the Charleston area by race/ethnicity. This study utilized a secondary data set from the 2019 Trident United Way Community Health Needs Assessment. Variables included self-reported reasons for limited healthcare access and race/ethnicity. Results indicated significant differences by race/ethnicity based on not knowing how to access health services (p=.034); not knowing when to see a doctor (p=.006); fear (p=.015); and lack of trust of doctors (p=.014). Additional significant differences were found for cultural/religious beliefs; health insurance related barriers; lack of transportation; and lack of knowledge (all p<.00l). Findings indicate that disparities exist by race/ethnicity related to reasons for limited healthcare access in the Charleston Tri-County area.

Introduction: Vaccination has led to significant decreases in mortality over the last century but requires high levels of uptake to be successful in reducing a wide range of infectious diseases in communities. Vaccine hesitancy is on the rise in the United States with most adults not receiving all recommended vaccinations, and childhood vaccinations are declining. Living in a rural community with a lack of access to resources may further limit uptake of vaccines. Identifying strategies to enhance vaccine confidence and access may assist in increasing vaccine uptake. The purpose of this study was to describe the landscape of existing community-based vaccination efforts and assess the components of a successful community-based vaccination program in rural eastern North Carolina. To reach this purpose, we conducted qualitative interviews with those involved in running community-based vaccine education and navigation programming in rural eastern North Carolina.” Methods: Researchers conducted 25 semi-structured interviews with participants involved in vaccination efforts in three rural counties in Eastern North Carolina. Interviews were transcribed, coded in NVivo version 14, and analyzed using thematic analysis to synthesize insights from participants. Results: Study participants held manager or coordinator roles in area health agencies, clinics, and pharmacies. Reported strengths of current vaccine efforts in Eastern North Carolina included patient education, strong partnerships between organizations providing vaccines, and ability to engage community members. Successful vaccine efforts have engaged participants through social media, flyers, trusted leaders, and the provision of convenient vaccine appointments. Areas for improvement in vaccine efforts included engaging a wider audience at vaccine events, building trust in vaccines among community members, and expanding vaccine education for hard-to-reach populations. Participants supported the development of a proposed community-based education and navigation program and felt that community members would be interested. Identified challenges included low participation due to vaccine hesitancy which could be overcome through incentives and delivery from trusted individuals. Conclusions: We found that there is still a need for trust building, education, and patient engagement within the landscape of existing community-based vaccination efforts for vulnerable populations in rural eastern North Carolina. Study participants indicated support for the development of a vaccine education program and researchers determined the project to be feasible. Based on the results of this study, researchers developed and implemented an integrated vaccine education and navigation program in Eastern North Carolina.

The purpose of this study was to gain consensus on Social Determinants of Health indicators among researchers actively publishing on SDH. We used a modified Delphi Method, an approach to gather expert opinions and gain consensus. We recruited participants in February 2024 via email from a PubMed search of researchers who had published on SDH in the last year. Participants (n = 22) completed 3 rounds of surveys. In each survey participants ranked the importance of each indicator. Fourteen participants completed all 3 surveys. Participants agreed to add indicators of Income (n = 14), Transportation (n = 14), Access to Quality Education (n = 13), Experiences of Racism and Discrimination (n = 12), Type of Healthcare Coverage (n = 11), Adverse Childhood Events (n = 9), Access to Higher Education (n = 8), Costs of Care (n = 8), and Provider Cultural and Linguistic Competency (n = 8). Participants agreed on significant modifications to an existing SDH framework, including adding more nuanced indicators on education, insurance coverage, transportation, and social context. However, the low response rate and over-representation of early career researchers indicate that further study is needed. Future research may also include a qualitative interview component to more fully understand participant rationale for responses. Our future goal is to develop a SDH instrument for use in population level public health surveillance based on the consensus of SDH indicators. To achieve this goal, additional research is needed to include a broader range of SDH researchers.

Introduction: South Carolina ranks ninth in the USA for its firearm death rates and black non-Hispanic residents are most impacted. The purpose of this research was to learn more from community members in the Charleston, South Carolina Tri-County area regarding steps to achieve a reduction in local gun violence. Methods: Researchers conducted an online survey of community members (n=153) using a community-based participatory research approach. The research questions were developed in collaboration with the Tri-County Gun Violence Coordinating Council. Community members were trained in research methods and involved in the design, recruitment and conduct of the study. Results: Participants ranked the most important approach to focus on as offering youth at risk for gun violence social resources and mentor services. The ranked order of approaches participants would like to see started first began with a public campaign to lock cars to reduce gun theft, followed by youth mentoring and building a database on gun crime. We identified significant differences in rating of importance and feasibility by demographic variables. Conclusions: Community members prioritised strategies that align with reducing community gun violence using a social determinants of health approach, yet demographic differences in preferences exist.

Introduction: In the United States, vaccine hesitancy is higher among rural and racially and ethnically diverse communities, and messaging from trusted individuals may increase vaccine acceptance. The purpose of this study is to understand vaccine hesitancy, messaging from trusted individuals, and vaccine acceptance strategies among racially and ethnically diverse, medically underserved rural populations. Methods: The researchers conducted 12 in-person focus groups, each consisting of 5 to 12 participants, with community members and trusted leaders from three rural counties in Eastern North Carolina (n = 119). Thematic analysis was used to synthesize insights from the discussions, allowing for the identification of recurring patterns and community-specific considerations regarding vaccine perceptions and messaging. Results: The researchers identified seven key themes within the primary focus areas of the study: factors influencing vaccine hesitancy, messaging from trusted individuals, and strategies to improve vaccine acceptance. Participants reported differences in trust based on how long a vaccine has been available, concerns about becoming sick after a vaccine, seeing the symptoms of vaccine-preventable diseases, and misinformation on social media. Overall, participants reported trust in messages from medical providers. Trusted leaders advised people to conduct their own research on vaccines when determining whether to receive vaccinations. Lastly, social determinants such as cost, education, and transportation were identified as key barriers to vaccination. Conclusions: Our findings indicate that medical providers are trusted messengers for vaccine information and the promotion of vaccine uptake. However, distrust linked to fear, misinformation, and structural barriers persist. Public health efforts to increase vaccination confidence among rural, racially and ethnically diverse populations in the United States Southeast should address these factors in future vaccine interventions and educational efforts.

Background/Objectives: Human papillomavirus (HPV) causes multiple types of cancer, and demographic-based inequities in HPV-related cancers persist. Behavioral interventions have increased HPV vaccination uptake, yet it is unclear how intervention effects vary by demographics. The purpose of this study was to examine whether existing HPV vaccine interventions for adolescents have unequal effects on HPV vaccine uptake. Methods: We searched MEDLINE via PubMed, PsycINFO, CINAHL, Scopus, and Cochrane CENTRAL in October 2023. The search strategy combined keywords and subject terms for HPV vaccine, interventions/health promotion, and adolescents. Studies were included in final analyses if they were peer-reviewed, published in the US between 2006 and 2023, included outcome measures from an evidence-based HPV vaccination intervention, included adolescents aged 9–17, and demographic variables for age, race/ethnicity, income/SES, or geographic region. Studies were excluded if they were review articles, abstract-only, dissertations or theses, non-English language, non-US-based, or outside the age range of 9–17. Studies were also excluded if they did not include an intervention, outcome evaluation measures, or demographic measures. The screening and extraction processes were independently performed by multiple reviewers using Covidence software. Results: Ultimately, 74 articles were included for full extraction. Sex was the most common demographic variable analyzed by the HPV vaccine (n = 38), followed by race/ethnicity (n = 15), income/SES (n = 6), and geographic region (n = 6). Conclusions: Few interventions assess whether intervention results differ by demographics, making it unclear whether these interventions reduce health inequities. This review included a wide variation in study designs, limiting our ability to uniformly assess study conclusions.