Archives of Public Health最新文献

{"title":"Prevalence of sexually transmitted infections and associated factors in the inmate population of the Chachapoyas correctional center, Peru.","authors":"Victor Juan Vera-Ponce, Luis M Rojas, Christian J Campos, Roxana Cubas, Jhony A De LaCruz-Vargas, Stella M Chenet, Rafael Tapia-Limonchi","doi":"10.1186/s13690-025-01676-3","DOIUrl":"10.1186/s13690-025-01676-3","url":null,"abstract":"<p><strong>Background: </strong>The objective of the study was to assess the prevalence of sexually transmitted infections (STIs) such as HIV, syphilis, viral hepatitis, and human T-lymphotropic virus types I and II (HTLV I-II) among inmates at the Chachapoyas Correctional Center. The risk factors associated with increased transmission of these infections were also determined.</p><p><strong>Methods: </strong>This study was observational, analytical, and cross-sectional. It used a non-probabilistic convenience sampling method to select inmates who consented to participate and could provide a blood sample. Samples were collected between November and December 2022. Serological tests were performed to diagnose HIV, syphilis, hepatitis B, hepatitis C, and HTLV I-II. Additionally, demographic and behavioral data were collected through surveys.</p><p><strong>Results: </strong>The prevalence of STIs in the sample was 21.31%. Significant associated factors included older age, extended duration of incarceration, and risk behaviors such as sharing personal items. There was a noted low prevalence of previous STI history and low levels of education among the studied population.</p><p><strong>Conclusions: </strong>The study emphasizes the significant prevalence of STIs among inmates at the Chachapoyas Correctional Center. It underscores the necessity of implementing specific sexual health programs and STI prevention measures in this environment. The findings highlight the importance of enhancing health services and sexual health education in prisons to minimize STI transmission and promote better conditions for public health equity.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"194"},"PeriodicalIF":3.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of decentralisation on patient and service outcomes: a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia.","authors":"Tulani Francis L Matenga, Malizgani Paul Chavula, Joseph Mumba Zulu, Adam Silumbwe, Patricia Maritim, Margarate N Munakampe, Batuli Habib, Namakando Liusha, Jeremiah Banda, Ntazana N Sinyangwe, Chris Mweemba, Angel Mubanga, Patrick Kaonga, Mwiche Musukuma, Henry Phiri, Hikabasa Halwiindi","doi":"10.1186/s13690-025-01672-7","DOIUrl":"10.1186/s13690-025-01672-7","url":null,"abstract":"<p><strong>Introduction: </strong>The Zambian government decentralised tuberculosis control programs by transferring responsibility for the care and treatment of multidrug-resistant tuberculosis (MDR-TB) patients from a two-national hospital model to provincial hospitals and other lower-level healthcare structures. Limited evidence exists on the effects of decentralisation on the quality of TB care provided through public sector decentralisation. In this paper, we explored the impact of decentralising MDR-TB on patient and service outcomes.</p><p><strong>Methods: </strong>This study used a mixed-methods approach. Quantitative data were collected through a survey of 244 MDR-TB patients, while qualitative data was collected through interviews with TB coordinators, healthcare providers, patients, and caregivers. Participants were drawn from health facilities and the Ministry of Health. Quantitative data was analysed in STATA version 16.0, while thematic analysis was used for the qualitative data.</p><p><strong>Results: </strong>Decentralisation has improved patient care and management by increasing access to essential commodities such as medication and diagnostic testing. It has led to more equitable distribution of MDR-TB healthcare services and resources across different population groups, regardless of social, economic, or demographic factors. Furthermore, the quality of life for MDR-TB patients has improved, with better adherence to medication resulting from increased family support. Due to decentralisation, tailored community and patient-centred services have been integrated resulting in reduced congestion at facilities. The study also identified challenges, including heavy workload for healthcare staff, fragmented coordination of supervisory responsibilities, and confusion over roles in patient management, which negatively impacted the decentralisation process.</p><p><strong>Conclusion: </strong>The decentralisation of MDR TB services offers significant benefits but is not a guaranteed solution, as poor planning or implementation can lead to challenges in service delivery.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"193"},"PeriodicalIF":3.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-random aggregations of healthy and unhealthy lifestyles and their population characteristics - pattern recognition in a large population-based cohort.","authors":"Qian Zou, Rafael Ogaz-González, Yihui Du, Ming-Jie Duan, Gerton Lunter, Eva Corpeleijn","doi":"10.1186/s13690-025-01678-1","DOIUrl":"10.1186/s13690-025-01678-1","url":null,"abstract":"","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"192"},"PeriodicalIF":3.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of hepatitis B virus infection and its associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis of data published from 2003 to 2024.","authors":"Sintayehu Tsegaye Bitew, Yeshiwas Genanaw Mekonnen, Habtamu Belay Hailu","doi":"10.1186/s13690-025-01666-5","DOIUrl":"10.1186/s13690-025-01666-5","url":null,"abstract":"<p><strong>Background: </strong>Numerous epidemiological studies on hepatitis B virus among pregnant women in Ethiopia have been conducted, showing significant variation over time and between different geographical regions. The aim of this systematic review and Meta-analysis is to estimate the overall prevalence of hepatitis B virus infection and its associated factors among pregnant women in Ethiopia.</p><p><strong>Methods: </strong>We use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles. All observational published studies were retrieved using relevant search terms PubMed, Embase, web of science and google scholar databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments for observational studies was used for critical appraisal of the included articles. The meta-analysis was done with STATA version 18 software. The I² statistics were used to test heterogeneity whereas Begg's and Egger's tests were used to assess publication bias. The pooled prevalence was presented using the forest plot.</p><p><strong>Results: </strong>Forty -three studies with a total of 17,056 participants were included in this systematic review and meta-analysis. The pooled prevalence of the HBV infection among pregnant women was 6%(95% CI: 5.0, 7.0). a high pooled prevalence HBV infection among pregnant women was found in Tigray 7%(95% CI: 4.0, 8.0) and Somali region 7%(95% CI: 4.0, 11.0). history of surgical procedure, having multiple sexual partners, history of body tattooing, history of abortion, history of sharing sharp material, blood transfusion and family history of HBV were significant risk factors associated with HBV among pregnant women in Ethiopia.</p><p><strong>Conclusion: </strong>In conclusion, this systematic review and meta-analysis provided evidence regarding the intermediate prevalence of HBV among pregnant women in Ethiopia and also showed history of surgical procedures, multiple sexual partners, body tattooing, sharing sharp objects, abortion, blood transfusions, and family history of HBV infection were associated factors. The findings highlight the need of health education to prevent the spread of HBV infection among pregnant women.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"191"},"PeriodicalIF":3.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The roadmap for creating a novel outdoor activity space in a rehabilitation hospital setting: the OASIS program initiative.","authors":"Pazit Levinger, Jill Hall, Keith D Hill","doi":"10.1186/s13690-025-01668-3","DOIUrl":"10.1186/s13690-025-01668-3","url":null,"abstract":"<p><strong>Introduction: </strong>To meet older people's physical and mental health needs the built environment is becoming increasingly important for the health and community aged care systems. The usage of an age-friendly outdoor space as an enhancement to standard treatment for rehabilitation in hospital settings holds promise as part of patients' continuum of care. This descriptive case study described the design and development of an age-friendly outdoor rehabilitation space in a hospital setting in Sydney Australia, the OASIS (Outdoor Activity Space for Improving your Strength) program.</p><p><strong>Method: </strong>This descriptive case study reports the step-by-step process from initial concept to activation of the space. Drawing on internal planning documents, site plans, meeting records, and project materials, it outlines key phases including stakeholder consultation, site selection, design development, equipment installation, staff training, risk management, and pilot testing of a group-based exercise program.</p><p><strong>Results: </strong>The process took approximately four years which included consultation, examination and selection of suitable feature design and equipment selection. Training and upskilling staff and risk management were undertaken prior to pilot testing an exercise program. Preliminary usage testing of the space demonstrated safe usage by older people in a group setting with successful transition from supervised program into independent usage.</p><p><strong>Conclusion: </strong>The OASIS approach offers an innovative adjunctive therapeutic approach to standard treatment for rehabilitation and physical activity participation of older people in out-patient settings. Future work is required to explore its provisional integration as part of the hospital in-patient and out-patient services.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"190"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sectional study examining the role of doctors' trust in patients' requests for antibiotics: a neglected perspective.","authors":"Aline Rinaldi, Serena Petrocchi, Anna Bullo, Luca Gabutti, Peter Johannes Schulz","doi":"10.1186/s13690-025-01677-2","DOIUrl":"10.1186/s13690-025-01677-2","url":null,"abstract":"<p><strong>Background: </strong>Effective interaction between patients and providers is central to understanding communication mechanisms and health-related outcomes. Antibiotic requesting behavior and its predictors are a crucial topic in the context of antimicrobial resistance, a global health challenge that increases healthcare expenditure and negatively impacts patient outcomes. A major determinant of antibiotic misuse is rooted in primary care, where patients' high expectations and requests, combined with doctors' lack of assertiveness, lead to overprescription and overconsumption. Many studies report that request, as a communicative behavior, puts great pressure on doctors affecting their decision-making process. Trust is a critical aspect of this relationship that may influence both patients' willingness to request antibiotics and doctors' responses. This study examines how trust from the doctors' perspective, trust from the patients' perspective and the interaction between the two - while controlling for covariates - impact patients' intention to ask for antibiotics, providing insights into the interpersonal dimensions that contributes to antibiotic prescribing practices.</p><p><strong>Method: </strong>A cross-sectional study with 8 family doctors and 101 patients. The data gathering was performed from May to July 2024 in the Italian-speaking region of Switzerland. Post-visit questionnaires assessed trust from both parties, patients' concerns, perceived susceptibility to illness, and symptom severity. Generalized Estimating Equations (GEE) accounted for data clustering.</p><p><strong>Results: </strong>Doctors' trust in their patients significantly reduced patients' intentions to request antibiotics (p =.02), even when controlling for covariates. Interaction effects revealed the moderating role of doctors' trust in shaping patients' antibiotics requests.</p><p><strong>Discussion: </strong>The results of this study highlighted the impact of doctors' ratings of trust on patients' intention to request antibiotics. Enhancing mutual trust in doctor-patient relationships could help reduce patient-driven antibiotic overprescription, providing a promising avenue for interventions addressing antimicrobial resistance.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"188"},"PeriodicalIF":3.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of antenatal care service utilisation in sub-Saharan Africa: an analysis of demographic and health surveys data (2015-2022).","authors":"Belete Achamyelew Ayele, Elizabeth Holliday, Catherine Chojenta","doi":"10.1186/s13690-025-01608-1","DOIUrl":"10.1186/s13690-025-01608-1","url":null,"abstract":"<p><strong>Background: </strong>Antenatal care (ANC) is crucial for maternal and neonatal health, facilitating early complication management, health education, and promoting skilled birth assistance. Despite global ANC recommendations, implementation remains suboptimal in sub-Saharan Africa, where maternal and neonatal mortality rates remain high. Assessing ANC prevalence and its determinants can help address gaps and improve health outcomes.</p><p><strong>Methods: </strong>This study utilised data from recent Demographic and Health Surveys (DHS) conducted between 2015 and 2022 across SSA countries, using a weighted sample of 196,459 women. ANC service use during pregnancy was classified as no ANC visits, one to three ANC visits, or four or more visits. Multinomial logistic regression was used to estimate explanatory variable effects, reported as relative risk ratios with 95% confidence intervals.</p><p><strong>Results: </strong>Among participants, 11.2% received no ANC, 30.5% had one to three visits, and 58.4% attended four or more visits. ANC utilisation varied by region, with 54.7% of women in East Africa and 60.3% in West Africa receiving four or more visits. Having health insurance showed one of the strongest positive associations with ANC attendance for both one to three visits (RRR = 2.81, 95% CI: 2.37, 3.34; p < 0.001) and four or more visits (RRR = 2.95, 95% CI: 2.48, 3.51; p < 0.001). Women who did not consider obtaining permission to visit a health facility as a problem also had a higher likelihood of attending one-three visits (RRR = 1.66, 95% CI: 1.53, 1.81; p < 0.001) or ≥ four visits (RRR = 1.92, 95% CI: 1.77, 2.09; p < 0.001). Higher maternal education, longer preceding birth intervals, and an improved wealth index were significantly associated with a greater probability of attending ≥ four ANC visits (p < 0.001). In contrast, living in a rural area was associated with lower odds of attending ≥ four visits (RRR = 0.65, 95% CI: 0.58, 0.72; p < 0.001).</p><p><strong>Conclusion and recommendations: </strong>This study highlights disparities in ANC utilisation in SSA, with many women receiving insufficient or no ANC visits. Individual, household, and community-level factors, such as education, health insurance, income, geographic access, and others, strongly influence ANC service use. Strengthening maternal health insurance schemes can alleviate financial barriers, and community-based outreach programs and educational campaigns can enhance access and awareness, and improve access and continuity of care, particularly in rural or remote areas. Integrating these strategies into broader health policies and fostering collaboration between healthcare providers, policymakers, and local communities allows for narrowing existing gaps in ANC utilisation and ultimately improving maternal and neonatal outcomes across the region.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"189"},"PeriodicalIF":3.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The independent and joint role of socioeconomic status and family relationships on mortality risk in China: cultural differences and health inequalities in the context of intergenerational cohabitation.","authors":"Zhixi Zhu, Yiying Wang, Xin Wang, Fuyan Zhang, Lisha Yu, Tao Liu","doi":"10.1186/s13690-025-01669-2","DOIUrl":"10.1186/s13690-025-01669-2","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES) and family relationships are critical social determinants of health disparities. The mechanisms underlying their interactions remain insufficiently understood in Asian cultures with prevalent intergenerational cohabitation. This study investigates the independent and combined effects of SES and family relationships on all-cause mortality in China.</p><p><strong>Methods: </strong>A baseline survey was conducted in 2010 involving 9280 adult permanent residents from 12 counties (districts) in Guizhou Province, using stratified cluster random sampling. Two follow-ups (2016-2020, 2023) were conducted. SES was assessed using a composite score comprising household income, education, and occupation, while family relationships were classified as either \"good\" or \"mediocre.\" The Cox proportional hazards model was employed to evaluate the independent and combined effects of SES and family relationships on all-cause mortality.</p><p><strong>Results: </strong>Among 5949 participants were included, and the cumulative mortality rate was 6.4% over a median follow-up of 12 years. With a decrease in mortality risk as SES increased (P < 0.001). Compared with SES ≤ 6, mortality risk with SES scores of 7, 8, and ≥ 9 decreased by 36.9% (HR = 0.631, 95% CI = 0.473-0.842), 36.6% (HR = 0.644, 95% CI = 0.469-0.886), and 73% (HR = 0.270, 95% CI = 0.183-0.397), respectively. The independent effect of family relationship on the risk of death was not statistically significant (HR = 0.847, 95% CI = 0.0.670- 1.070). The joint analysis showed the compensatory effect was significant when SES exceeded a threshold (SES ≥ 9), alleviating the mortality risk associated with family relationships (HR = 0.2197, 95% CI = 0.073-0.652).</p><p><strong>Conclusion: </strong>Findings demonstrate SES independently reduces mortality in Chinese populations, while the effect of family relationships is modulated by cultural background. The resource substitution hypothesis is valid at specific SES thresholds. Intervention efforts should prioritize the vulnerable group characterized by \"low SES and weak family support\".</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"187"},"PeriodicalIF":3.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic lung diseases (Asthma and COPD) among middle-aged and older populations in India: social, individual, and household determinants and their associations with geriatric syndromes.","authors":"Aditi Chakraborty, Suryakant Yadav, A H Sruthi Anil Kumar","doi":"10.1186/s13690-025-01675-4","DOIUrl":"10.1186/s13690-025-01675-4","url":null,"abstract":"<p><strong>Background: </strong>India's ageing population presents new health challenges, particularly the rising burden of lung diseases like Asthma and COPD among middle-aged and older adults. These conditions weaken individuals and heighten the risk of geriatric complications. Understanding their interplay with socio-economic, demographic, and household factors is essential for informed public health interventions.</p><p><strong>Objectives and methods: </strong>This study investigates the growing burden of Asthma and COPD among Indian individuals aged 45 years and above using LASI Wave 1 data. Unadjusted prevalence was calculated across predictor variables. Poisson regression identified factors associated with Asthma and COPD, while logistic regression examined their unadjusted and adjusted associations with geriatric syndromes.</p><p><strong>Results: </strong>The study reveals that the prevalence of Asthma and COPD among individuals aged 45 years and above is 4.38% and 2.1%. It reveals distinct yet overlapping risk patterns for both Asthma and COPD. For both diseases, the risk increases significantly with age, particularly for those aged 60 years and above, and is higher among wealthier individuals and those belonging to SC, OBC, or non-classified social groups. Women are less likely to suffer from both diseases, while discontinued smoking elevates the risk for both. Employment status influences both conditions differently, those currently working are less likely to have COPD and Asthma. Household factors such as the absence of a separate kitchen increase the risk for both diseases. Cooking on open fires and exposure to passive smoking significantly heighten the risk of COPD. Regional variations persist, with lower risk in the North-East and elevated risks in the South. Both diseases show significant association with geriatric syndromes such as ADL (1.418 for Asthma and 1.424 for COPD), IADL (1.587 for Asthma and 1.542 for COPD), and Falls ((1.172 for Asthma and 1.320 for COPD)), after adjusting for various individual and household determinants.</p><p><strong>Conclusion: </strong>The study reveals complex relationships between social, individual and household factors, chronic lung diseases (Asthma and COPD), and age-related complications in India's older population.It highlights the need for targeted treatments addressing both lung diseases and geriatric complications, guiding policymakers in framing healthcare policies to promote healthy aging in India's diverse older population.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"186"},"PeriodicalIF":3.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating county-level dental care utilization among adults in California using multilevel modeling with raking approach.","authors":"Yilan Huang, Honghu Liu","doi":"10.1186/s13690-025-01673-6","DOIUrl":"10.1186/s13690-025-01673-6","url":null,"abstract":"<p><strong>Background: </strong>Regular dental visits are essential for oral health, yet disparities between regions exist due to socioeconomic and geographic factors. While national surveys provide valuable data on dental care utilization, they generally lack sufficient sample sizes at the local level to generate reliable county-level estimates. Small area estimation techniques, such as multilevel regression and post-stratification (MRP), can help address this gap by producing robust estimates for smaller geographic areas. However, the MRP approach relies on detailed population data in the form of joint distributions and cannot be applied when only marginal distributions are available.</p><p><strong>Methods: </strong>This paper introduces a hybrid approach combining multilevel modeling with the raking procedure. We used individual-level data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and census data from American Community Survey to estimate county-level dental care utilization among adults in California.</p><p><strong>Results: </strong>The county-level dental care utilization in California ranged from 52.5 to 73.1%, with a median of 63.1%. Our model-based estimates matched direct BRFSS estimates at metropolitan and micropolitan statistical area levels. Furthermore, we found significantly positive correlations between our model-based estimates and direct estimates from the California Health Interview Survey for 41 counties (Pearson coefficient: 0.801, P < 0.001).</p><p><strong>Conclusions: </strong>The proposed approach accounts for individual- and area-level factors while overcoming data constraints that limit the application of MRP. The findings demonstrate the feasibility of this approach in generating county-level estimates, supporting public health planning and targeted interventions to reduce disparities in dental care utilization.</p>","PeriodicalId":48578,"journal":{"name":"Archives of Public Health","volume":"83 1","pages":"183"},"PeriodicalIF":3.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}