Journal of Primary Care and Community Health最新文献

{"title":"Planting Seeds for Food Is Medicine: Pre-Implementation Planning Methods and Formative Evaluation Findings From a Multi-Clinic Initiative in the Midwest.","authors":"Marianna S Wetherill, Kristina M Bridges, Gabrielle E Talavera, Susan P Harvey, Brandon Skidmore, Elizabeth Stewart Burger","doi":"10.1177/21501319241241465","DOIUrl":"10.1177/21501319241241465","url":null,"abstract":"<p><p>Food is medicine (FIM) initiatives are an emerging strategy for addressing nutrition-related health disparities increasingly endorsed by providers, payers, and policymakers. However, food insecurity screening protocols and oversight of medically-tailored food assistance programs are novel for many healthcare settings. Here, we describe the pre-implementation planning processes used to successfully engage federally-qualified health centers (FQHCs) across Kansas to develop new FIM initiatives. A Kansas-based philanthropic foundation facilitated pre-implementation planning for FQHCs over 17 months across 3 stages: 1) Community inquiry, 2) FIM learning event with invitation for FQHC attendees to request pre-implementation funding, and 3) Pre-implementation planning workshops and application assignments for FQHC grantees to develop a FIM implementation grant proposal. We evaluated satisfaction and perceived utility of these pre-implementation planning activities via post-workshop surveys and qualitative comparisons of FIM design components from pre-implementation and implementation grant applications. All 7 FQHCs attending the learning event applied for and were awarded pre-implementation planning grants; 6 submitted an implementation grant application following workshop completion. FQHCs rated pre-implementation support activities favorably; however, most clinics cited limited staff as a barrier to effective planning. As compared to pre-implementation planning grant proposals, all FQHCs elected to narrow their priority population to people with pre-diabetes or diabetes with better articulation of evidence-based nutrition prescriptions and intervention models in their final program designs. In the midst of a nationwide FIM groundswell, we recommend that funders, clinic stakeholders, and evaluators work together to devise and financially support appropriate pre-implementation planning activities prior to launching new FIM initiatives.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241241465"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal Colorectal Cancer Test Follow-Up: A Quality Improvement Initiative at a Federally Qualified Health Center.","authors":"Faizah Shareef, Balambal Bharti, Felipe Garcia-Bigley, Monica Hernandez, Jesse Nodora, Jie Liu, Christian Ramers, Jill Dumbauld Nery, Jessica Marquez, Karina Moyano, Sarah Rojas, Elva Arredondo, Samir Gupta","doi":"10.1177/21501319241242571","DOIUrl":"10.1177/21501319241242571","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Colonoscopy completion rates after an abnormal fecal immunochemical test (FIT) are suboptimal, resulting in missed opportunities for early detection and prevention of colorectal cancer. Patient navigation and structured follow-up may improve colonoscopy completion, but implementation of these strategies is not widespread.</p><p><strong>Methods: </strong>We conducted a quality improvement study using a Plan-Do-Study-Act (PDSA) Model to increase colonoscopy completion after abnormal FIT in a large federally qualified health center serving a diverse and low-income population. Intervention components included patient navigation, and a checklist to promote completion of key steps required for abnormal FIT follow-up. Primary outcome was proportion of patients achieving colonoscopy completion within 6 months of abnormal FIT, assessed at baseline for 156 patients pre-intervention, and compared to 208 patients during the intervention period from April 2017 to December 2019. Drop offs at each step in the follow-up process were assessed.</p><p><strong>Results: </strong>Colonoscopy completion improved from 21% among 156 patients with abnormal FIT pre-intervention, to 38% among 208 patients with abnormal FIT during the intervention (<i>P</i> < .001; absolute increase: 17%, 95% CI: 6.9%-25.2%). Among the 130 non-completers during the intervention period, lack of completion was attributable to absence of colonoscopy referral for 7.7%; inability to schedule a pre-colonoscopy specialist visit for 71.5%; failure to complete a pre-colonoscopy visit for 2.3%; the absence of colonoscopy scheduling for 9.2%; failure to show for a scheduled colonoscopy for 9.2%.</p><p><strong>Conclusions: </strong>Patient navigation and structured follow-up appear to improve colonoscopy completion after abnormal FIT. Additional strategies are needed to achieve optimal rates of completion.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241242571"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Care, Depression, and Anxiety Among Family Caregivers of People With Dementia.","authors":"Doaa S Abdelhalim, Marwa M Ahmed, Hoda A Hussein, Ola O Khalaf, Mai D Sarhan","doi":"10.1177/21501319241288029","DOIUrl":"10.1177/21501319241288029","url":null,"abstract":"<p><strong>Background: </strong>There are many challenges that entail caring for an individual with dementia, affecting not only the individual with the condition but also their caregivers. This can lead to increased burden, frustration, and depression among those taking care of them. A research gap exists concerning the care of people with dementia in Egypt, particularly regarding the mental health of caregivers. Limited studies have been conducted in Egypt, particularly focusing on the mental health of caregivers. This lack highlights the need to understand the prevalence and impact of caregiver burden in this population.</p><p><strong>Objectives: </strong>The research aimed to evaluate the burden of dementia, levels of depression, and anxiety among family caregivers of individuals with dementia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at a geriatric unit clinic of a psychiatric hospital in Cairo University, Egypt. Caregiver burden, anxiety, and depression were assessed using questionnaires. These questionnaires included the Zarit Burden Interview (ZBI), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), together with demographic data on the patients and caregivers.</p><p><strong>Results: </strong>The majority of the 141 participants (73% (n = 103)) were female, mostly daughters, with an average age of 40 years. Approximately 50% (n = 71) of the subjects exhibited mild to moderate burden, whereas 30% (n = 43) showed moderate to severe burden. About 31% (n = 44) of the subjects exhibited symptoms of moderate depression, whereas 9% (n = 13) had symptoms of severe depression. Furthermore, almost 43% (n = 60) of caregivers exhibited a moderate level of anxiety. Furthermore, a significant association was seen between caregiver burden and the presence of anxiety and depression.</p><p><strong>Conclusion: </strong>This study showed a substantial burden in providing care, elevated levels of despair, and anxiety among caregivers of PWD. The findings highlight how important it is to develop targeted therapies and support systems in order to lessen the load on caregivers, advance their mental health, and improve overall care for both caregivers and their patients in Egypt. Policy-makers should prioritize investing in dementia-related support systems and services to empower caregivers and improve the quality of life for both caregivers and their patients.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241288029"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Family Structure on Adolescent Depression Outcomes in a Collaborative Care Program.","authors":"Brian A Lynch, Charles P Lewis, Jennifer L Vande Voort, Aiswarya L Nandakumar, RoxAnne M Brennan, Kristin C Cole, Sandra J Rackley, Chung-Ii Wi, Paul E Croarkin, Magdalena Romanowicz","doi":"10.1177/21501319241291790","DOIUrl":"10.1177/21501319241291790","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>We aimed to investigate the effect of family structure on depression program outcomes for adolescents enrolled in a depression-focused, primary care-based collaborative care program.</p><p><strong>Methods: </strong>This was a retrospective study of primary care patients ages 12 to 18 years seen at a Midwestern academic center with data obtained by medical record review. We used logistic regression models to assess the effect of family structure on program graduation and achievement of a single Patient Health Questionnaire 9-Modified for Adolescents (PHQ-9M) score <5 at any time while enrolled.</p><p><strong>Results: </strong>Adolescents were divided into 2 groups, Both Parents in Household (n = 179) and Parents Not Together (n = 161). The Both Parents in Household group had higher rates of graduation (38.0% vs 23.6%, <i>P</i> = .005) and achieving single PHQ-9M scores <5 (64.1% vs 46.2%, <i>P</i> = .002) than the Parents Not Together group.</p><p><strong>Discussion: </strong>Youth residing with both parents had higher rates of successful outcomes in a depression-focused collaborative care program.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241291790"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of the COVID-19 Vaccination Within a Convenience Sample of Sudanese Americans.","authors":"Jonathan Freese, Fatima Abuzaid, Harlan Sayles, Mujtaba Abdellatif, Nada Fadul","doi":"10.1177/21501319241234868","DOIUrl":"10.1177/21501319241234868","url":null,"abstract":"<p><strong>Introduction: </strong>Sudanese American and other immigrant and refugee communities are at greater risk for exposure to COVID-19. This survey sought to better characterize COVID-19 vaccination practices, motivators, and drivers for hesitancy among Sudanese Americans.</p><p><strong>Methods: </strong>We developed an online, cross-sectional survey in English and Arabic distributed by Sudanese American community leaders in April 2022 with data stored anonymously in REDCap. Inclusion criteria were self-reporting being born within Sudan and living in the US within the last 2 years. Descriptive analysis tested survey responses for possible associations between the primary outcome, self-reported vaccination status, and questions regarding vaccination history, perspectives on vaccination, and demographic characteristics using Fishers Exact and Chi Squared Tests.</p><p><strong>Results: </strong>Of 111 survey responses received, 107 met inclusion criteria. 93% of respondents reported COVID-19 vaccine uptake with the primary motivation to protect oneself from disease. The most cited reason for vaccine hesitancy was belief it had not been studied enough. The group that reported vaccination had higher levels of education (.032) and were more likely to perceive that COVID-19 vaccinations were able to reduce spread (.001), decrease severe outcomes (.004), and benefits outweighing their risks (.004).</p><p><strong>Discussion and conclusions: </strong>This survey population of Sudanese Americans demonstrated high levels of vaccine uptake (93%), far greater than either the corresponding US (78%) or Sudanese population (15%). It is likely that high levels of educational attainment moderated vaccine uptake, though our survey may not have had the power to fully evaluate vaccine hesitancy.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241234868"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Member Adherence to a Health Insurer-Sponsored Gap Closure Program Using Multi-Target Stool DNA Test for Colorectal Cancer Screening.","authors":"Mallik Greene, Timo Pew, Quang Le, Alisdair Philp, William K Johnson, A Burak Ozbay, John Kisiel, Michael Dore, Derek Ebner, A Mark Fendrick, Paul Limburg","doi":"10.1177/21501319241305958","DOIUrl":"10.1177/21501319241305958","url":null,"abstract":"<p><strong>Objectives: </strong>To describe member adherence to a mail-based, health insurer-sponsored gap closure program for colorectal cancer (CRC) screening using multi-target stool DNA (mt-sDNA; Cologuard^®) tests.</p><p><strong>Methods: </strong>Combined patient data from Exact Sciences Laboratories LLC and data from mass-mailed mt-sDNA orders placed by a large Medicare Advantage Insurance Plan were analyzed (03/01/2023-06/30/2023). Adherence and time to test return were the primary and secondary outcomes, respectively. Their association with patient characteristics was evaluated using multivariable regression.</p><p><strong>Results: </strong>Among the 3201 member-patients included (86.6% aged 65-75 years; 58.7% female), adherence rate was 49.4%, and mean time to test return was 25.5 days. After multivariable adjustment, the odds of test return were significantly higher among 65- to 75-year-olds (odds ratio [OR] = 1.59 relative to 45- to 64-year-olds), those living in small towns (OR = 1.43 relative to metropolitan-located individuals), and with digital outreach via both SMS and email (OR = 4.31 relative to no digital outreach). Time to test return was shorter in 65- to 75-year-olds than in 45- to 64-year-olds and was not associated with other patient characteristics.</p><p><strong>Conclusions: </strong>Mass-mailed mt-sDNA tests for CRC screening were associated with an overall adherence rate of about 50% in this Medicare Advantage population, with higher likelihood of test return among patients receiving digital outreach.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241305958"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the Introduction of the Additional Roles Reimbursement Scheme on the General Practice Nursing Workforce in England.","authors":"Alison Leary, Geoffrey Punshon, Angie Hack, Dave Bushe, Crystal Oldman","doi":"10.1177/21501319241298759","DOIUrl":"10.1177/21501319241298759","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>To understand the impact of introducing Additional Roles Reimbursement Scheme (ARRS) on the General Practice Nurse (GPN) workforce. A workforce/people impact assessment designed as a cross-sectional survey of a stratified sample of 900 GPN on the Queen's Nursing Institute mailing list.</p><p><strong>Method: </strong>A workforce/people impact assessment was designed based on the UKCS 2014 piloted and distributed as a cross-sectional survey via a survey platform. This included questions on level of impact, kind of impact and perception of prior engagement. Data were analyzed using descriptive statistics and content analysis.</p><p><strong>Results: </strong>The survey consisted of 21 questions (531 responses, response rate of 60%). ARRS deployment appears to have impacted the GPN workforce in several ways. There was positive impact on workloads from ARRS roles working in original scope, for example pharmacists medicine reviews. However, any benefit was offset by the increased workloads created by those new to general practice and/or working outside of traditional scope. This ranged from a lack of resources to provide the support those new to primary care require to practice safely, the expectations of others-that GPN will fill the gap in support and teaching to GPN directly safety netting the work of others. There was a lack of consultation regarding a major workforce change, leading to feelings of devaluation. There are some significant equity issues highlighted particularly around pay and opportunity.</p><p><strong>Conclusion: </strong>The introduction of ARRS has had some positive but mostly negative impact on the workload and introduced pay inequity issues on GPN.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241298759"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Cancer Equity by Improving Health Insurance Access for All Latinos.","authors":"Nathalie Huguet, Heather Holderness, Cirila Estela Vasquez Guzman, Miguel Marino, John Heintzman","doi":"10.1177/21501319241278874","DOIUrl":"10.1177/21501319241278874","url":null,"abstract":"<p><p>Cancer is the top leading cause of death among Latino people. Lack of health insurance is a significant contributor to inadequate cancer detection and treatment. Despite healthcare policy expansions such as the Affordable Care Act, Latino people persistently maintain the highest uninsured rate among any ethnic and racial group in the US, especially among Latino individuals who are immigrants or part of a mixed immigration status household. Recognizing that immigration status is a critical factor in the ability of Latino community members to seek health insurance and access healthcare services, a few US states and the District of Columbia have implemented policies that have expanded coverage to children and adults regardless of immigration status. Expansion of Medicaid eligibility regardless of immigration status may significantly benefit Latino communities, however the facilitators and barriers to enrolling in these programs need to be evaluated to ensure reach and achieve health equity across the cancer control continuum for all Latinos.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241278874"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Family Medicine in Addressing the Maternal Health Crisis in the United States.","authors":"Saskia Spiess, Robert Owens, Elizabeth Charron, Mario DeMarco, Mirela Feurdean, Karen Gold, Kathryn Murray, Nicholas Schenk, Kirsten Stoesser, Pauline Thomas, Emmanuel Adediran, Elena Gardner, Katherine Fortenberry, Thomas Carl Whittaker, Dominik Ose","doi":"10.1177/21501319241274308","DOIUrl":"10.1177/21501319241274308","url":null,"abstract":"<p><p>The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241274308"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Association Between State Laws Limiting Local Control and Community Smoke-Free Indoor Air in the United States.","authors":"Sunday Azagba, Todd Ebling, Alperen Korkmaz, Jessica King Jensen, Fares Qeadan, Mark Hall","doi":"10.1177/21501319241280905","DOIUrl":"https://doi.org/10.1177/21501319241280905","url":null,"abstract":"<p><p>This study examines the association between state laws limiting local control (preemption laws) and local smoke-free policies. We utilized policy data from the American Nonsmokers' Rights Foundation. The primary outcome variable is the presence of a \"100% smoke-free policy,\" across any of 4 indoor settings: workplaces, restaurants, bars, and gaming venues. We employed generalized structural equation modeling to investigate the relationship between state laws pre-empting smoke-free indoor air regulation and local adoption of policies requiring smoke-free air in any public venues, or for specific venues, adjusting for sociodemographic characteristics. Our findings reveal a significant association between state preemption laws and the presence of a local 100% smoke-free indoor policy as of 2023. In states with preemption laws, cities were less likely to have a 100% smoke-free indoor policy at any venue than cities in states without preemption laws (OR = 0.07, 95% CI = 0.05-0.10). When considering specific smoke-free venues, cities in states with preemption laws were less likely to have a 100% smoke-free indoor policy covering workplaces (OR = 0.05, 95% CI = 0.03-0.09), restaurants (OR = 0.04, 95% CI = 0.02-0.07), bars (OR = 0.04, 95% CI = 0.03-0.08), and gaming venues (OR = 0.03, 95% CI = 0.01-0.09) compared to cities in states without preemption laws. Our study suggests that state preemption laws limit local decision-making and the implementation of public health policies focused on tobacco harms.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"15 ","pages":"21501319241280905"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}