Faculty Bibliography

Background: Little research has evaluated the social and sexual network-related health outcomes of young black transgender women (TGW) or compared these outcomes with those of black men who have sex with men (MSM). Social network analysis offers one potent means of understanding the dynamics driving the broad spectrum of adverse outcomes experienced by these subgroups. Methods: We examined the social and sexual health network traits of 618 black individuals assigned male at birth who have sex with men, 47 (7.6%) of whom identified as TGW. Using respondent-driven sampling, data collection occurred over three waves between 2013 and 2016, in Chicago, Illinois. Univariate, logistic regression, and confidant and sexual network analyses were conducted to characterize dynamic network features. Results: TGW's mean age was 22.1 (standard deviation ±2.6). TGW's sexual networks were significantly less stable (stability ratio of 0.175 vs. 0.278 among MSM, p=0.03) and had greater network turnover (turnover ratio of 0.825 vs. 0.735, p=0.04). TGW also had significantly more sex partners (7.6 vs. 4.0, p=0.0002) and exchange sex (odds ratio=2.97; 95% confidence interval: 1.66-5.32, p<0.001), lower rates of employment (39.6% vs. 71.1%, p<0.001), and more reported an income <$20,000 (93.5% vs. 80.8%, p=0.029). Within confidant networks, TGW had a borderline significantly higher network turnover ratio (0.703 vs. 0.625, p=0.06). Furthermore, both TGW and MSM had high, but similar, HIV rates (42.3% vs. 30.6%, respectively; p=0.17). There were no significant structural network differences vis-à-vis mean degree (p=0.46), betweenness centrality (p=0.40), closeness centrality (p=0.18), or average shortest path length (borderline statistically significant at p=0.06). Conclusion: Using data from a representative sample of younger black individuals, we observed black TGW have less sexual network stability in contrast to black MSM but comparable structural network features. We further observed that both groups, and black TGW especially, possess considerable system-level, socioeconomic, and sexual health burdens.

A 16-year-old adolescent who identifies as transgender wishes to consider fertility preservation prior to the use of gender-affirming hormones. The adolescent's parents are divorced, and one parent supports fertility preservation while the other does not. This case explores the minor's future reproductive autonomy and parental decision making in a field where there is limited evidence of known harms and benefits to the use of fertility preservation in the transgender population and about future potential regret from lack of consideration of fertility preservation during the prime window of opportunity. This case is created from a composite of cases seen at multiple institutions.

INTRODUCTION/BACKGROUND:The use of alternative tobacco products (ATPs) is becoming increasingly popular among the youth. This study aimed to assess cigarette-only smoking, exclusive ATP use, and concurrent use (cigarettes and ATPs) among adolescents in Hong Kong. METHODS:We analyzed data of the Hong Kong School-based Survey on Smoking among Students 2012/13 from a representative sample of 45 857 secondary school students. Weighted prevalence of cigarette-only smoking, exclusive ATP use, and concurrent tobacco use were calculated. Multinomial logistic regression examined correlates of exclusive ATP use and concurrent use relative to cigarette-only smoking. Among current (past-30-days) cigarette smokers, multivariable logistic regression assessed whether ATP use was associated with nicotine dependence, quit intention and quit attempt. RESULTS:Overall, 5.8% of adolescents reported current tobacco use (2.1% cigarette-only smoking, 2.5% exclusive ATP use and 1.2% concurrent use). Compared with cigarette-only smoking, exclusive ATP use and concurrent tobacco use were associated with younger age, higher perceived family financial status, absence of cigarette smoking peers, poor knowledge about smoking and more frequent alcohol use. Among current cigarette smokers, ATP use was negatively associated with cigarette quit intention and quit attempt. CONCLUSIONS:ATP use was as prevalent as cigarette smoking among adolescents, and ATP users were different from cigarette smokers in many demographic and psychosocial factors. Tobacco control programs among youth should target different types of tobacco users and address all forms of tobacco products.

BACKGROUND:Globally adolescents continue to have an upward trend in HIV incidence and AIDS-related mortality. The interplay between the rapid physical growth, sexual maturation, and enormous albeit slow-evolving cognitive and psychological changes in adolescence may partly explain this trend. Our main purpose was to highlight key psychosocial characteristics of HIV-infected adolescents and explore if these characteristics are associated with depression symptoms. METHODS:From August to December 2016 after obtaining informed consent, adolescents living with HIV at Kenyatta National Hospital were interviewed using the Home environment, Education and Employment, Activity, Sexuality, Suicide and depression traits (HEADSS) tool combined with the Patient Health Questionnaire (PHQ-9) to elucidate which key symptoms of depression and link with psychosocial characteristics mapped on HEADSS. In order to determine which psychosocial characteristics were linked with risk of depression, the traits of adolescents who were symptomatic were compared to those who were not using univariate and multivariate regression analysis. RESULTS: = 0.06]. CONCLUSION/CONCLUSIONS:One in two of the adolescents interviewed had depression symptoms which were significantly associated with lack of school fees, missing meals, non-adherence to medication, and substance abuse.

The recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate balanced subsamples, we compared outcomes in our survey to those from a recent household survey (the 2013 Liberian Demographic Health Survey). We found that the matched subgroups had similar patterns of delivery location in aggregate, and utilizing data on the date of birth, we were able to show that facility-based deliveries were significantly decreased during, compared to after the outbreak (p < 0.05) consistent with findings from retrospective studies using healthcare-based data. Directly assessing behaviors from individuals via SMS also enabled the measurement of public and private sector facility utilization separately, which has been a challenge in other studies in countries including Liberia which rely mainly on government sources of data. In doing so, our data suggest that public facility-based deliveries returned to baseline values after the outbreak. Thus, we demonstrate that with the appropriate methodological approach to account for different population denominators, data sourced via mobile tools such as SMS polling could serve as an important low-cost complement to existing data collection strategies especially in situations where higher-frequency data than can be feasibly obtained through surveys is useful.