Faculty Bibliography

Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.

Introduction: Using the National Health and Aging Trends Study (NHATS), we examined use of sleeping medication, difficulty falling asleep, and trouble falling back asleep among individuals with and without cognitive impairment.
Method(s): Binomial logistic regression examined sleep medication use and insomnia symptoms (difficulty falling asleep or falling back asleep after awakening) by cognitive impairment (no dementia and possible or probable dementia). Sleep-related variables were collected on frequency scales ranging from 1 (every day) to 5 (never). Of the sample, 71.1% were White (n=3,369), 20.7% were Black (n=982), 5.0% were Hispanic (n=235), and 2.4% other (n=113); 60.4% were female (n=2,662) and 39.6% were male (n=1,875).
Result(s): Respondents were classified as having no dementia (63.7%), possible dementia (8.5%), or probable dementia (12.9%). Of the sample, 10.7% reported medication use every night, 2.5% 5-6 nights/week, 5.7% 2-4 nights/week, 6.6% once/week and 59.4% reported no use. Of the respondents, 8.3% reported difficulty sleeping every night, 8.0% reported 5-6 nights/week, 21.4% reported 2-4 nights/week, 22.9% reported rarely, and 23.5% reported never experiencing difficulty sleeping. Regarding difficulty falling back asleep, 4.9% reported difficulty every night, 7.4% reported 5-6 nights/week, 26.0% reported 2-4 nights/week, 20.4% reported rarely, and 24.3% reported never. Compared to individuals who reported never using sleep medications, those reporting nightly use were significantly more likely to be cognitively impaired (OR=1.44,95%CI: 1.14-1.82). Compared to individuals reporting never having difficulty falling asleep, those reporting difficulty falling asleep nightly were not more likely to have cognitive impairment (OR=0.74 95%CI: 0.67 to 1.19). Compared to individuals reporting never having difficulty falling back asleep after awakening, those frequently reporting difficulty falling back asleep were less likely to be cognitively impaired (OR=0.44,95%CI:0.22 to 0.64).
Conclusion(s): Cognitive impairment was positively associated with sleep medication use in adjusted models, but not with trouble falling asleep or difficulty falling back asleep after awakening. Our findings are consistent with the literature on deleterious consequences of sleep medications

The recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary, we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technology-based methodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.

We describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.

PURPOSE/OBJECTIVE:To better understand sexual health disparities among African-American sexual minority adolescents. METHODS:African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history. RESULTS:Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV. CONCLUSIONS:African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.

Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.

African American women are vulnerable for sexual health risk; thus, condom use is essential. Guided by research linking goals to communicative content, this study explored women's use of I-, you-, we-, and hedging language during condom negotiation. Female participants (N = 193) engaged in a condom negotiation role play with male confederates, where language use measures were coded. I-language was used the most frequently. Language use differed as a function of men's tactics, such that women primarily used I-language in response to verbal attacks, you-language in response to seduction, and I- and we-language in response to information seeking. Women who engaged in more recent condom use were more likely to use you-language, and when confederates attacked, they responded with more you-language and less hedging.