Faculty Bibliography

Background This study examined if the intersection of stress and experiences of incarceration was associated with sexual risk-taking among Black gay, bisexual and other men who have sex with men ('Black MSM') in the Deep South of the United States. Methods Data for this analysis were collected during 2013- 2015 as part of a study of sexual health among Black cisgender MSM in the states of Mississippi and Georgia. At baseline, participants responded to a 12-item scale of stressful experiences in the previous year with responses organized into tertiles (low, medium, high stress). Multivariate analyses assessed independent and interactional associations between stress/incarceration and several key sexual health risk practices. Results Among our overall sample of 355 Black MSM, compared to those reporting a relatively low level of stress, a high level of stress was associated with drug use in the context of sex (adjusted odds ratio [OR]=2.0, 95% confidence interval [CI]:1.1-3.6, p=0.03). While this association was observed for men without incarceration histories (aOR=2.6, 95%CI:1.2-5.8, p=0.015), among those who had been incarcerated the relationship was stronger (aOR=3.9, 95%CI:1.8- 8.6, p<0.001) and for these men experiencing even a medium level of stress was associated with sexual drug use (aOR=3.4, 95%CI:1.6-9.1, p<0.001). High stress among previously incarcerated MSM was also associated with condomless casual sex (aOR=2.8, 95%CI:1.3-6.1, p<0.001) and having >=6 partners in six months (aOR=2.8, 95%CI:2.8-1.1-7.1, p=0.03); similar associations were not observed among men who had not been incarcerated. Conclusion While stress was associated with some sexual risk taking among Black MSM, its intersection with incarceration was consistently (and more strongly) associated with a greater number and diversity of sexual risk practices. Men who have been incarcerated may struggle to deal with life stressors. Post-release programs for this population should provide adaptive tools for dealing with stress, including specific attention to safer sex and sexual risk

Background Understanding the relationships between demographic, healthcare-related and psychosocial factors with STI vulnerability will provide information that can guide development of STI prevention efforts tailored to the lived realities of YMSM. Methods Between 2009-2011, n=600 YMSM were enrolled at age 18 in a prospective cohort study examining psychosocial and physical health during semi-annual visits conducted over a 36-month period. Reports of recent STIs were collected by self-report and a composite outcome variable was created: self-report of any STI (CT, GC, and/or syphilis) in the prior 90 days (hereafter called STI diagnoses). Bivariate analysis was conducted to examine relationships between STI diagnoses and 3 domains of covariates: demographic factors, psychosocial factors, and healthcare system related factors. Generalized estimating equations (GEE) with link logit was used to model factors from each domain associated with STI diagnoses. Results Over the course of the study period, these 597 participants contributed a total of 2,765 visits and self-reported n=205 STI diagnoses (composite variable detailed above). Increased age was associated with increased likelihood of STI diagnoses (aOR=1.22 per year, 95% CI 1.04-1.43) after adjustment for SES, race, #insertive/receptive anal intercourse acts, type of healthcare obtained (private clinic, public clinic, VA), and insurance status. Black/African YMSM were more likely to self-report an STI (aOR=2.90, 95% CI 1.50-5.61), compared to White (non-hispanic) peers (adjusted for age, SES, #sex acts, clinic type, and insurance). Participants receiving healthcare at public clinics (aOR= 1.89, 95% CI 1.30- 2.77) and VA facilities (aOR= 4.13 95% CI 2.24-7.60) were more likely to report STI diagnoses than those attending private clinics (adjusted for age, race, SES, #sex acts, insurance). Depression score, gay-related stigma, internalized homophobia were not associated with STI diagnoses. Conclusion Older black/african YMSM were more likely to self-report an STI, perhaps because they participant in a different core mixing group of sexual contacts than other participants

Objective: To examine the impact of potential infertility that often affects adolescent and young adult cancer survivors (AYA) attributable to late effects of gonadotoxic treatment. Method: This paper examines the psychosocial, legal, and ethical concerns that hinder conversations around potential infertility and considerations of fertility preservation with an AYA cancer patient. Results: Although recent guidelines advocate for providers to address the potential loss of fertility and fertility preservation with every AYA cancer patient prior to treatment, evidence suggests that many clinicians either do not discuss or discuss in a manner that does not facilitate patient decision making. Conclusions: Suggestions are offered to guide communication best practices to ensure AYA and their families receive relevant and timely information about cancer related infertility and family building options.

The metabolome of World Trade Center (WTC) particulate matter (PM) exposure has yet to be fully defined and may yield information that will further define bioactive pathways relevant to lung injury. A subset of Fire Department of New York firefighters demonstrated resistance to subsequent loss of lung function. We intend to characterize the metabolome of never smoking WTC-exposed firefighters, stratified by resistance to WTC-Lung Injury (WTC-LI) to determine metabolite pathways significant in subjects resistant to the loss of lung function. The global serum metabolome was determined in those resistant to WTC-LI and controls (n = 15 in each). Metabolites most important to class separation (top 5% by Random Forest (RF) of 594 qualified metabolites) included elevated amino acid and long-chain fatty acid metabolites, and reduced hexose monophosphate shunt metabolites in the resistant cohort. RF using the refined metabolic profile was able to classify cases and controls with an estimated success rate of 93.3%, and performed similarly upon cross-validation. Agglomerative hierarchical clustering identified potential influential pathways of resistance to the development of WTC-LI. These pathways represent potential therapeutic targets and warrant further research.

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.

BACKGROUND:Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay seeking hypertension care is associated with increased mortality. OBJECTIVE:We investigated whether community health workers, equipped with behavioral communication strategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension care program in western Kenya and significantly reduce BP. METHODS:We conducted a cluster randomized trial with three arms: 1) usual care (standard training); 2) "paper-based" (tailored behavioral communication, using paper-based tools); and 3) "smartphone" (tailored behavioral communication, using smartphone technology). The co-primary outcomes were: 1) linkage to care, and 2) change in systolic BP (SBP). A covariate-adjusted mixed-effects model was used, adjusting for differential time to follow-up. Bootstrap and multiple imputation were used to handle missing data. RESULTS:1460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mmHg. Follow-up measures of linkage were available for 1128 (77%) and BP for 1106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms. Average overall follow-up SBP was 149.9 mmHg. Participants in the smartphone arm experienced a modestly greater reduction in SBP vs. usual care (-13.1 mmHg vs. -9.7), but this difference was not statistically significant. Mediation analysis revealed that linkage to care contributed to SBP change. CONCLUSIONS:A strategy combining tailored behavioral communication and mHealth for CHWs led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed.