@Article{info:doi/10.2196/27061,
author="Melendez-Torres, GJ
and Meiksin, Rebecca
and Witzel, Charles T.
and Weatherburn, Peter
and Falconer, Jane
and Bonell, Chris",
title="eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e27061",
keywords="men who have sex with men",
keywords="HIV and sexually transmitted infections",
keywords="mental health",
keywords="substance use",
keywords="mobile apps",
keywords="HIV",
keywords="eHealth",
keywords="electronic media",
keywords="mobile phone apps",
keywords="sexual risk",
abstract="Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95\% CI --0.18 to 0.52; I2=0\%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=--0.14, 95\% CI --0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=--0.12, 95\% CI --0.19 to --0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. ",
doi="10.2196/27061",
url="https://publichealth.jmir.org/2022/4/e27061",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384845"
}


@Article{info:doi/10.2196/33733,
author="R{\"o}bbelen, Alice
and Schmieding, L. Malte
and Kopka, Marvin
and Balzer, Felix
and Feufel, A. Markus",
title="Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="15",
volume="8",
number="4",
pages="e33733",
keywords="clinical decision support",
keywords="usability",
keywords="COVID-19",
keywords="consumer health",
keywords="medical informatic",
keywords="symptom checker",
keywords="decision support",
keywords="symptom",
keywords="support",
keywords="decision making",
keywords="algorithm",
keywords="flowchart",
keywords="agent",
abstract="Background: During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs' underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree's nodes step-by-step in an interactive manner. Objective: This study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts. Methods: We developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention's guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants' accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants' ratings of the DSTs' usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants' perception of the tools. We used ANOVAs and t tests to assess statistical significance. Results: Our survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7\%, SD 14.1\%; static DST group: mean 80.5\%, SD 15.8\%) compared to the control group (mean 65.8\%, SD 20.8\%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants' perception of the DSTs. Conclusions: When the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other. Trial Registration: Deutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered) ",
doi="10.2196/33733",
url="https://publichealth.jmir.org/2022/4/e33733",
url="http://www.ncbi.nlm.nih.gov/pubmed/34882571"
}


@Article{info:doi/10.2196/33633,
author="Ye, Wenjing
and Lu, Weiwei
and Li, Xiaopan
and Chen, Yichen
and Wang, Lin
and Zeng, Guangwang
and Xu, Cheng
and Ji, Chen
and Cai, Yuyang
and Yang, Ling
and Luo, Zheng",
title="Long-term Changes in the Premature Death Rate in Lung Cancer in a Developed Region of China: Population-based Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="20",
volume="8",
number="4",
pages="e33633",
keywords="lung cancer",
keywords="mortality",
keywords="years of life lost",
keywords="trend analysis",
keywords="decomposition method",
abstract="Background: Lung cancer is a leading cause of death worldwide, and its incidence shows an upward trend. A study of the long-term changes in the premature death rate in lung cancer in a developed region of China has great exploratory significance to further clarify the effectiveness of intervention measures. Objective: This study examined long-term changes in premature lung cancer death rates in order to understand the changes in mortality and to design future prevention plans in Pudong New Area (PNA), Shanghai, China. Methods: Cancer death data were collected from the Mortality Registration System of PNA. We analyzed the crude mortality rate (CMR), age-standardized mortality rate by Segi's world standard population (ASMRW), and years of life lost (YLL) of patients with lung cancer from 1973 to 2019. Temporal trends in the CMR, ASMRW, and YLL rate were calculated by joinpoint regression expressed as an average annual percentage change (AAPC) with the corresponding 95\% CI. Results: All registered permanent residents in PNA (80,543,137 person-years) from 1973 to 2019 were enrolled in this study. There were 42,229 deaths from lung cancer. The CMR and ASMRW were 52.43/105 and 27.79/105 person-years, respectively. The YLL due to premature death from lung cancer was 481779.14 years, and the YLL rate was 598.16/105 person-years. The CMR and YLL rate showed significantly increasing trends in men, women, and the total population (P<.001). The CMR of the total population increased by 2.86\% (95\% CI 2.66-3.07, P<.001) per year during the study period. The YLL rate increased with an AAPC of 2.21\% (95\% CI 1.92-2.51, P<.001) per year. The contribution rates of increased CMR values caused by demographic factors were more evident than those caused by nondemographic factors. Conclusions: Lung cancer deaths showed an increasing trend in PNA from 1973 to 2019. Demographic factors, such as the aging population, contributed more to an increased CMR. Our research can help us understand the changes in lung cancer mortality and can be used for similar cities in designing future prevention plans. ",
doi="10.2196/33633",
url="https://publichealth.jmir.org/2022/4/e33633",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442209"
}


@Article{info:doi/10.2196/32156,
author="Chiou, Piao-Yi
and Hung, Chien-Ching
and Chen, Chien-Yu",
title="Sexual Partner Referral for HIV Testing Through Social Networking Platforms: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="5",
volume="8",
number="4",
pages="e32156",
keywords="HIV testing",
keywords="men who have sex with men",
keywords="mobile health",
keywords="motivational interviewing",
keywords="referral and consultation",
keywords="risk behavior",
keywords="sexual partners",
keywords="social networking",
abstract="Background: Men who have sex with men (MSM) who undergo voluntary HIV counseling and testing (VCT) often report condomless anal sexual intercourse, having many sexual partners, and being exposed to risky sexual networks. Limited research has discussed the application of motivational interviewing and convenience referral platforms to facilitate the referral of sexual partners for HIV testing among MSM. Objective: This study aimed to evaluate the effects of VCT referral by sexual partners through social networking platforms and the test results after elicited interviews with MSM; compare the characteristics and risk behaviors among MSM tested without referral, index subjects, and referred sexual partners; and explore unknown sexual affiliations through visualizing and quantifying the social network graph. Methods: This was a cross-sectional study. Purposeful sampling was used to recruit index subjects from a community HIV screening station frequented by MSM in Taipei City on Friday and Saturday nights. Respondent-driven sampling was used to recruit sexual partners. Partner-elicited interviews were conducted by trained staff before VCT to motivate MSM to become index subjects and refer sexual partners via the Line app, or to disclose the accounts and profiles of sexual partners on relevant social networking platforms. Referred sexual partners received rapid HIV testing, and the recruitment process was repeated until leads were exhausted. Results: After the interviews, 28.2\% (75/266) of MSM were successfully persuaded to become index subjects in the first wave, referring 127 sexual partners via the Line app for rapid HIV testing and disclosing 40 sexual partners. The index subjects and tested sexual partners had more sexual partners (F2=3.83, P=.02), more frequent anal intercourse (F2=10.10, P<.001), and higher percentages of those who had not previously received HIV testing ($\chi$21=6.1, P=.047) compared with MSM tested without referrals. The new HIV-seropositivity rate among tested sexual partners was 2.4\%, which was higher than the rate in the other 2 groups. The social network analysis revealed the following 4 types of sexual affiliation: chain, Y, star, and complicated. Among the HIV-negative sexual partners, 26.9\% (43/160) had sexual affiliations with HIV-positive nodes, and 40\% (10/25) were untested sexual partners with a direct sexual affiliation with an HIV-positive node. Four transmission bridges were found in the network graph. Conclusions: Partner-elicited interviews can effectively promote referral for HIV testing and case identification via Line, and can clarify unknown sexual affiliations of MSM to facilitate the development of a tailored prevention program. Social network analysis is needed for an insightful understanding of the different network structures. ",
doi="10.2196/32156",
url="https://publichealth.jmir.org/2022/4/e32156",
url="http://www.ncbi.nlm.nih.gov/pubmed/35380540"
}


@Article{info:doi/10.2196/27792,
author="Okumu, Moses
and Logie, H. Carmen
and Ansong, David
and Mwima, Simon
and Hakiza, Robert
and Newman, A. Peter",
title="Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e27792",
keywords="condom negotiation",
keywords="sexting",
keywords="refugee and displaced adolescents",
keywords="digital sexual communication",
keywords="HIV prevention",
keywords="gender",
abstract="Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective: This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods: Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results: The one-factor CuNET with the validation sample was valid ($\chi$24=5.3; P=.26; root mean square error of approximation=0.05, 90\% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach $\alpha$=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95\% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95\% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95\% CI 0.64-1.26). Conclusions: The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. ",
doi="10.2196/27792",
url="https://publichealth.jmir.org/2022/4/e27792",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384852"
}


@Article{info:doi/10.2196/32405,
author="Klein, Z. Ari
and Meanley, Steven
and O'Connor, Karen
and Bauermeister, A. Jos{\'e}
and Gonzalez-Hernandez, Graciela",
title="Toward Using Twitter for PrEP-Related Interventions: An Automated Natural Language Processing Pipeline for Identifying Gay or Bisexual Men in the United States",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="25",
volume="8",
number="4",
pages="e32405",
keywords="natural language processing",
keywords="social media",
keywords="data mining",
keywords="PrEP",
keywords="pre-exposure prophylaxis",
keywords="HIV",
keywords="AIDS",
abstract="Background: Pre-exposure prophylaxis (PrEP) is highly effective at preventing the acquisition of HIV. There is a substantial gap, however, between the number of people in the United States who have indications for PrEP and the number of them who are prescribed PrEP. Although Twitter content has been analyzed as a source of PrEP-related data (eg, barriers), methods have not been developed to enable the use of Twitter as a platform for implementing PrEP-related interventions. Objective: Men who have sex with men (MSM) are the population most affected by HIV in the United States. Therefore, the objectives of this study were to (1) develop an automated natural language processing (NLP) pipeline for identifying men in the United States who have reported on Twitter that they are gay, bisexual, or MSM and (2) assess the extent to which they demographically represent MSM in the United States with new HIV diagnoses. Methods: Between September 2020 and January 2021, we used the Twitter Streaming Application Programming Interface (API) to collect more than 3 million tweets containing keywords that men may include in posts reporting that they are gay, bisexual, or MSM. We deployed handwritten, high-precision regular expressions---designed to filter out noise and identify actual self-reports---on the tweets and their user profile metadata. We identified 10,043 unique users geolocated in the United States and drew upon a validated NLP tool to automatically identify their ages. Results: By manually distinguishing true- and false-positive self-reports in the tweets or profiles of 1000 (10\%) of the 10,043 users identified by our automated pipeline, we established that our pipeline has a precision of 0.85. Among the 8756 users for which a US state--level geolocation was detected, 5096 (58.2\%) were in the 10 states with the highest numbers of new HIV diagnoses. Among the 6240 users for which a county-level geolocation was detected, 4252 (68.1\%) were in counties or states considered priority jurisdictions by the Ending the HIV Epidemic initiative. Furthermore, the age distribution of the users reflected that of MSM in the United States with new HIV diagnoses. Conclusions: Our automated NLP pipeline can be used to identify MSM in the United States who may be at risk of acquiring HIV, laying the groundwork for using Twitter on a large scale to directly target PrEP-related interventions at this population. ",
doi="10.2196/32405",
url="https://publichealth.jmir.org/2022/4/e32405",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468092"
}


@Article{info:doi/10.2196/34070,
author="Shin, Hyunjeong
and Jeon, Songi
and Cho, Inhae
and Park, HyunJi",
title="Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e34070",
keywords="health service use",
keywords="men",
keywords="papillomavirus",
keywords="papillomavirus vaccines",
keywords="systematic review",
keywords="vaccination",
keywords="vaccine",
keywords="HPV",
keywords="review",
keywords="gender",
abstract="Background: Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. Objective: The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. Methods: A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. Results: In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. Conclusions: To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination. ",
doi="10.2196/34070",
url="https://publichealth.jmir.org/2022/4/e34070",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471242"
}


@Article{info:doi/10.2196/36022,
author="Rovetta, Alessandro
and Bhagavathula, Srikanth Akshaya",
title="The Impact of COVID-19 on Mortality in Italy: Retrospective Analysis of Epidemiological Trends",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="7",
volume="8",
number="4",
pages="e36022",
keywords="COVID-19",
keywords="deniers",
keywords="excess deaths",
keywords="epidemiology",
keywords="infodemic",
keywords="infodemiology",
keywords="Italy",
keywords="longitudinal analysis",
keywords="mortality",
keywords="time series",
keywords="pandemic",
keywords="public health",
abstract="Background: Despite the available evidence on its severity, COVID-19 has often been compared with seasonal flu by some conspirators and even scientists. Various public discussions arose about the noncausal correlation between COVID-19 and the observed deaths during the pandemic period in Italy. Objective: This paper aimed to search for endogenous reasons for the mortality increase recorded in Italy during 2020 to test this controversial hypothesis. Furthermore, we provide a framework for epidemiological analyses of time series. Methods: We analyzed deaths by age, sex, region, and cause of death in Italy from 2011 to 2019. Ordinary least squares (OLS) linear regression analyses and autoregressive integrated moving average (ARIMA) were used to predict the best value for 2020. A Grubbs 1-sided test was used to assess the significance of the difference between predicted and observed 2020 deaths/mortality. Finally, a 1-sample t test was used to compare the population of regional excess deaths to a null mean. The relationship between mortality and predictive variables was assessed using OLS multiple regression models. Since there is no uniform opinion on multicomparison adjustment and false negatives imply great epidemiological risk, the less-conservative Siegel approach and more-conservative Holm-Bonferroni approach were employed. By doing so, we provided the reader with the means to carry out an independent analysis. Results: Both ARIMA and OLS linear regression models predicted the number of deaths in Italy during 2020 to be between 640,000 and 660,000 (range of 95\% CIs: 620,000-695,000) against the observed value of above 750,000. We found strong evidence supporting that the death increase in all regions (average excess=12.2\%) was not due to chance (t21=7.2; adjusted P<.001). Male and female national mortality excesses were 18.4\% (P<.001; adjusted P=.006) and 14.1\% (P=.005; adjusted P=.12), respectively. However, we found limited significance when comparing male and female mortality residuals' using the Mann-Whitney U test (P=.27; adjusted P=.99). Finally, mortality was strongly and positively correlated with latitude (R=0.82; adjusted P<.001). In this regard, the significance of the mortality increases during 2020 varied greatly from region to region. Lombardy recorded the highest mortality increase (38\% for men, adjusted P<.001; 31\% for women, P<.001; adjusted P=.006). Conclusions: Our findings support the absence of historical endogenous reasons capable of justifying the mortality increase observed in Italy during 2020. Together with the current knowledge on SARS-CoV-2, these results provide decisive evidence on the devastating impact of COVID-19. We suggest that this research be leveraged by government, health, and information authorities to furnish proof against conspiracy hypotheses that minimize COVID-19--related risks. Finally, given the marked concordance between ARIMA and OLS regression, we suggest that these models be exploited for public health surveillance. Specifically, meaningful information can be deduced by comparing predicted and observed epidemiological trends. ",
doi="10.2196/36022",
url="https://publichealth.jmir.org/2022/4/e36022",
url="http://www.ncbi.nlm.nih.gov/pubmed/35238784"
}


@Article{info:doi/10.2196/32645,
author="McIntyre, F. Anne
and Fellows, E. Ian
and Gutreuter, Steve
and Hladik, Wolfgang",
title="Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e32645",
keywords="population size estimation",
keywords="multiple-source capture-recapture",
keywords="Bayesian models",
keywords="latent-class models",
keywords="Shiny",
keywords="HIV",
keywords="key populations",
keywords="epidemiology",
keywords="digital health",
keywords="online health application",
keywords="populations",
keywords="risk factors",
keywords="online communities",
abstract="Background: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis. Objective: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE. Methods: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine. Results: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided. Conclusions: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa. ",
doi="10.2196/32645",
url="https://publichealth.jmir.org/2022/4/e32645",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471234"
}


@Article{info:doi/10.2196/32133,
author="Abell-Hart, Kayley
and Rashidian, Sina
and Teng, Dejun
and Rosenthal, N. Richard
and Wang, Fusheng",
title="Where Opioid Overdose Patients Live Far From Treatment: Geospatial Analysis of Underserved Populations in New York State",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="12",
volume="8",
number="4",
pages="e32133",
keywords="opioid use disorder",
keywords="opioid overdose",
keywords="buprenorphine",
keywords="naloxone",
keywords="geospatial analysis",
keywords="epidemiology",
keywords="opioid pandemic",
keywords="public health",
abstract="Background: Opioid addiction and overdose have a large burden of disease and mortality in New York State (NYS). The medication naloxone can reverse an overdose, and buprenorphine can treat opioid use disorder. Efforts to increase the accessibility of both medications include a naloxone standing order and a waiver program for prescribing buprenorphine outside a licensed drug treatment program. However, only a slim majority of NYS pharmacies are listed as participating in the naloxone standing order, and less than 7\% of prescribers in NYS have a buprenorphine waiver. Therefore, there is a significant opportunity to increase access. Objective: Identifying the geographic regions of NYS that are farthest from resources can help target interventions to improve access to naloxone and buprenorphine. To maximize the efficiency of such efforts, we also sought to determine where these underserved regions overlap with the largest numbers of actual patients who have experienced opioid overdose. Methods: We used address data to assess the spatial distribution of naloxone pharmacies and buprenorphine prescribers. Using the home addresses of patients who had an opioid overdose, we identified geographic locations of resource deficits. We report findings at the high spatial granularity of census tracts, with some neighboring census tracts merged to preserve privacy. Results: We identified several hot spots, where many patients live far from the nearest resource of each type. The highest density of patients in areas far from naloxone pharmacies was found in eastern Broome county. For areas far from buprenorphine prescribers, we identified subregions of Oswego county and Wayne county as having a high number of potentially underserved patients. Conclusions: Although NYS is home to thousands of naloxone pharmacies and potential buprenorphine prescribers, access is not uniform. Spatial analysis revealed census tract areas that are far from resources, yet contain the residences of many patients who have experienced opioid overdose. Our findings have implications for public health decision support in NYS. Our methods for privacy can also be applied to other spatial supply-demand problems involving sensitive data. ",
doi="10.2196/32133",
url="https://publichealth.jmir.org/2022/4/e32133",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412467"
}


@Article{info:doi/10.2196/33394,
author="Huo, Shutong
and Wang, Kai
and Liu, Zongchao
and Yang, Yuao
and Hee, Yi Jia
and He, Qiwei
and Takesue, Rie
and Tang, Kun",
title="Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e33394",
keywords="water, sanitation and hygiene",
keywords="mass media",
keywords="malnutrition",
keywords="Democratic Republic of Congo",
keywords="DRC",
keywords="mediation analysis",
keywords="children",
keywords="pediatric",
keywords="stunting",
keywords="television",
keywords="internet",
keywords="sanitation",
keywords="hygiene",
abstract="Background: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results: Mothers' exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5\% and 10\%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television. ",
doi="10.2196/33394",
url="https://publichealth.jmir.org/2022/4/e33394",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384848"
}


@Article{info:doi/10.2196/32411,
author="Lee, An Hsiu
and Wu, Wei-Chen
and Kung, Hsin-Hua
and Udayasankaran, Ganesh Jai
and Wei, Yu-Chih
and Kijsanayotin, Boonchai
and Marcelo, B. Alvin
and Hsu, Chien-Yeh",
title="Design of a Vaccine Passport Validation System Using Blockchain-based Architecture: Development Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e32411",
keywords="COVID-19",
keywords="vaccine passport",
keywords="global border control",
keywords="health policy",
keywords="international infectious disease strategy",
keywords="vaccine",
keywords="policy",
keywords="strategy",
keywords="blockchain",
keywords="privacy",
keywords="security",
keywords="testing",
keywords="verification",
keywords="certification",
keywords="Fast Healthcare Interoperability Resource",
abstract="Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced. Conclusions: Blockchain architecture can be used to build a viable international VP authentication process with the advantages of low cost, high interoperability, effectiveness, security, and verifiability. ",
doi="10.2196/32411",
url="https://publichealth.jmir.org/2022/4/e32411",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377316"
}


@Article{info:doi/10.2196/29906,
author="Qu, Shuiling
and Wang, Ailing
and Wang, Xiaoyan
and Yang, Yehuan
and Pan, Xiaoping
and Zhang, Tong",
title="Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="5",
volume="8",
number="4",
pages="e29906",
keywords="health-related quality of life",
keywords="EQ-5D-3L",
keywords="HIV",
keywords="impoverished area",
keywords="public health",
keywords="pregnant women",
keywords="depression",
keywords="anxiety",
abstract="Background: Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10\% of China's total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places. Objective: This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area. Methods: From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient). Results: A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35\%) and 75 (64.10\%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR --0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR --0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status. Conclusions: Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups. ",
doi="10.2196/29906",
url="https://publichealth.jmir.org/2022/4/e29906",
url="http://www.ncbi.nlm.nih.gov/pubmed/35380543"
}