Faculty Bibliography

A geospatial analysis of services that support transgender and gender diverse ("trans") people in New York City (NYC) was conducted to investigate associations with neighborhood-level sociodemographic characteristics. In June 2019, there were 5.3 services for every 100,000 of the general NYC population; controlling for other covariates, they were more commonly located in neighborhoods with larger populations of non-Hispanic Black (rate ratio [RR]=1.02, 95% confidence interval [CI]: 1.00-1.04), Hispanic/Latino (RR=1.03, 95% CI: 1.00-1.06), and gay/lesbian people (RR=1.53, 95% CI: 1.03-2.34). These findings suggest that the distribution of trans-focused services in NYC is proximal to communities that are most in need, but research should examine proximity to trans people specifically and distribution in nonurban areas.

OBJECTIVE:Sleep is an important determinant of various health outcomes, and insufficient sleep and sleep disorders are a public health crisis in the United States. The objective of this review is to provide an update on scientific contributions to our understanding of the social/built environmental determinants of sleep health. In particular, this review focuses on the diverse measurements of neighborhood characteristics and sleep outcomes, as well as analytic approaches for quantifying the effect of neighborhood on sleep health. METHODS:Two major electronic databases were searched and reviewed for relevant articles that examined the associations of social/built environments with sleep health. Inclusion criteria included peer-reviewed empirical studies on neighborhood-level characteristics and sleep health among adult populations. RESULTS:Systematic searches in MEDLINE/PubMed and SCOPUS identified 52 eligible articles (out of 11,084). Various social/built environmental characteristics of neighborhoods were identified as potential determinants of sleep health, and the majority of studies examined neighborhood social capital, safety, and environmental stressors. However, 88% of included articles employed cross-sectional study designs, limiting causal identification. We found substantial differences in neighborhood measures, variations in sleep health measurements with the majority employing self-reported methods, and inconsistent model specifications. While the majority of articles (48%) utilized perceived neighborhood conditions as the main exposure, more recent studies (23%) employed geographic information systems to measure neighborhood characteristics. CONCLUSIONS:To establish the causal relationships between social/physical neighborhood characteristics and sleep health, more studies should be conducted with longitudinal, quasi-experimental, and randomized trial designs coupled with objectively measured neighborhood and sleep health parameters.

PURPOSE/OBJECTIVE:The purpose of the present study was to evaluate the association of sleep duration and mental health among the general population. METHODS:A cross-sectional study was carried out with an adult Spanish population sample between 16 and 64 years old. The information was obtained from data provided by a randomly selected representative sample of 505 adults stratified by age, sex, and geographic area. Participants were interviewed face-to-face in their respective households with questions including sociodemographic characteristics, lifestyle, sleep duration, and the 12-item General Health Questionnaire to screen risk for poor mental health. The duration of sleep hours were grouped into the following categories: < 6 h, 6-7 h, and, > 7 h. Regression analysis was used to assess associations between sleep duration and risk of poor mental health. RESULTS:A percentage of respondents 13.1% reported sleeping less than 6 h. The analysis demonstrated a significant (p = 0.001) negative (B = - 0.512) relationship between hours of sleep and risk of poor mental health (GHQ-12), demonstrating that reduced sleep duration increases the risk of poor mental health. CONCLUSIONS:Sleep duration lower than 6 h is prevalent among the general population in Spain, especially among women and people who frequently use electronic devices. The results show that people who experience shorter sleep duration face a greater risk of poor mental health. These findings suggest that it is important to raise awareness of healthy sleeping habits, with emphasis on adequate sleep duration.

The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017-January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.

Black youth and their families living in urban settings may experience unique stressors that contribute to underlying issues due to the environmental context. Such factors may exacerbate and promote drug use and engagement in risky sexual behaviors, unknowingly. Little is known about how family factors, peer pressure, condom use, and other related factors are associated with substance use and engaging in sexual behaviors while on drugs among urban African American youth aged 12-22 (N = 638). We used regression models to examine associations between parental bonding, parent-adolescent sexual health communication, condom use, peer pressure on substance use, and having sex while on drugs. Multivariate results indicated that parental bonding was statistically significant and associated with drug use (OR: 1.36, 95%CI: 1.36). Our study highlights that parental bonding plays a critical role in youth using drugs while living in urban environments.

Interactions with the police may result in police brutality, particularly for people of color. Black men who have sex with men (BMSM) face disproportionate risk of police contact and may experience elevated violence risk. We measured longitudinal associations between discriminatory police harassment (DPH) and subsequent risk of a range of interpersonal violence experiences, including intimate partner violence (IPV). In this study, we estimated associations between DPH motivated by racism, homophobia, or both, and subsequent violent experiences (being physically harassed, hit, threatened with weapons, and intimate partner violence) among BMSM. Bivariate and multivariable regression analyses were used to control for demographic and behavioral factors. Among 1160 BMSM included at 12-month follow-up, experiencing DPH motivated by racism and homophobia was associated with over four times the odds of being threatened with violence (AOR 4.85, 95% CI 3.20, 7.33), four times the odds of or experiencing violence defined as being punched, kicked, or beaten, or having an object thrown at them (AOR 4.51, 95% CI 2.82, 7.19), and nearly three times the odds of physical partner abuse (AOR 3.49, 95% CI 1.69, 7.19). Findings suggest that for BMSM, DPH is associated with the threat and experience of violence, with a dose-response relationship between DPH motivated by one or more causes. Given that BMSM are a population particularly vulnerable to both police harassment related to race and sexual orientation and violence coupled with stigma, additional research evaluating mechanisms linking these associations is needed in order to develop additional supportive interventions.

Neighborhood deprivation plays an important role in childhood health and development, but defining the appropriate neighborhood definition presents theoretical as well as practical challenges. Few studies have compared neighborhood definitions outside of highly urbanized settings. The purpose of the current study was to evaluate how various administrative and ego-centric neighborhood definitions may impact measured exposure to deprivation across the urban-rural continuum. We do so using the Family Life Project, a prospective longitudinal population-based sample of families living in North Carolina and Pennsylvania (USA), which also sets the stage for future investigations of neighborhood impacts on childhood health and development. To measure neighborhood deprivation, a standardized index of socioeconomic deprivation was calculated using data from the 2007-2011 American Community Survey. Families' residential addresses when children were 2 months of age (n=1036) were geocoded and overlaid onto a deprivation index layer created at the census block group level to construct multiple administrative and ego-centric neighborhood definitions. Friedman tests were used to compare distributions of neighborhood deprivation across these neighborhood definitions within urbanized areas, urban clusters, and rural areas. Results indicated differences in urbanized areas (Chisquare= 897.75, P<0.001) and urban clusters (Chi-square=687.83, P<0.001), but not in rural areas (Chi-square=13.52, P=0.332). Findings imply that in urban areas, choice of neighborhood definition impacts measured exposure to neighborhood deprivation. Although exposure to neighborhood deprivation appears to be less sensitive to neighborhood definition in rural areas, researchers should apply theoretical reasoning to choose appropriate definitions of children's neighborhood.

The mental health impact of exposure to police harassment is understudied, particularly among Black men who have sex with men (BMSM), a group at elevated risk of exposure to such discrimination. This study aimed to identify the associations among BMSM between recent police harassment and psychosocial vulnerability, psychological distress, and depression measured six months later. Data come from the HIV Prevention Trials Network (HPTN) 061 Study, a cohort study of BMSM recruited in 6 U.S. cities (Atlanta, GA, Boston, MA, Los Angeles, CA, New York, NY, San Francisco, CA, and Washington DC). Participants completed baseline, 6-month follow-up, and 12-month follow-up interviews. A convenience sample of 1553 BMSM was recruited between July 2009 and October 2010 of whom 1155 returned for a follow-up interview 12 months later. Accounting for previous police interaction, poverty, psychopathology, drug use, and alcohol use, we estimated associations between recent police harassment reported at the 6 month follow-up interview and 12 month outcomes including psychosocial vulnerability (elevated racial/sexual identity incongruence), psychological distress (being distressed by experiences of racism and/or homophobia), and depression. About 60% of men reported experiencing police harassment between the baseline and 6-month interview due to their race and/or sexuality. Adjusted analyses suggested police harassment was independently associated with a 10.81 (95% CI: 7.97, 13.66) point increase and 8.68 (95% CI: 6.06, 11.30) point increase in distress due to experienced racism and distress due to experienced homophobia scores, respectively. Police harassment perceived to be dually motivated predicted disproportionate levels of distress. Police harassment is prevalent and associated with negative influences on psychosocial vulnerability and psychological distress among BMSM. Reducing exposure to police harassment may improve the psychosocial health of BMSM.

We assessed the geographic variation in socio-demographics, mobility, and built environmental factors in relation to COVID-19 testing, case, and death rates in New York City (NYC). COVID-19 rates (as of June 10, 2020), relevant socio-demographic information, and built environment characteristics were aggregated by ZIP Code Tabulation Area (ZCTA). Spatially adjusted multivariable regression models were fitted to account for spatial autocorrelation. The results show that different sets of neighborhood characteristics were independently associated with COVID-19 testing, case, and death rates. For example, the proportions of Blacks and Hispanics in a ZCTA were positively associated with COVID-19 case rate. Contrary to the conventional hypothesis, neighborhoods with low-density housing experienced higher COVID-19 case rates. In addition, demographic changes (e.g. out-migration) during the pandemic may bias the estimates of COVID-19 rates. Future research should further investigate these neighborhood-level factors and their interactions over time to better understand the mechanisms by which they affect COVID-19.