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Ruiseñor-Escudero H, Lyons C, Ketende S, Pitche V, Anato S, Tchalla J, Dometo S, Baral S. Consistent Condom Use Among Men Who Have Sex With Men in Lomé and Kara, Togo. AIDS Res Hum Retroviruses 2019; 35:519-528. [PMID: 30714385 DOI: 10.1089/aid.2018.0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
High transmission probability of HIV during condomless anal sex puts men who have sex with men (MSM), transgender, and nonbinary individuals at increased risk of infection. This analysis aims to examine the socioeconomic, biological, and behavioral factors that are associated with consistent condom use (CCU) during insertive/receptive anal sex among MSM in the last month in the cities of Lomé and Kara, Togo. A total of 683 MSM ≥18 years of age were surveyed using respondent-driven sampling (RDS) for a cross-sectional survey in Lomé (n = 354; 51.8%) and Kara (n = 329; 48.2%). Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CIs), and logistic regression models. When compared with Lomé, MSM in Kara had lower odds of CCU [adjusted odds ratio (aOR) = 0.29, 95% CI = 0.19-0.44]. Other factors associated with lower CCU were having an income of 2,000 Communaute Financiere Africaine (CFA)-12,000 CFA (aOR = 0.53, 95% CI = 0.36-0.77) or above 12,000 CFA (aOR = 0.34, 95% CI = 0.20-0.57), transgender women (aOR = 0.47, 95% CI = 0.25-0.92), and intersex gender (aOR = 0.42, 95% CI = 0.24-0.73), and ever being forced to have sex (aOR = 0.42, 95% CI = 0.21-0.82). Factors associated with CCU were identified in this study including older age (aOR = 1.49, 95% CI = 1.04-2.14) and having easy access to condoms (aOR = 2.70, 95% CI = 1.23-5.94) and very easy access to condoms (aOR = 2.73, 95% CI = 1.20-6.16). Reported condom use in this study was low, and several factors associated with CCU were identified including older age and access to condoms. This study highlights multiple barriers to preventive services experienced by MSM in Togo and therefore leveraging strategies to address these barriers may improve prevention of HIV and syphilis.
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Affiliation(s)
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vincent Pitche
- Consell National de Lutte contre le SIDA (National AIDS Concil), Lomé, Togo
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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McDaid L, Hunt K, McMillan L, Russell S, Milne D, Ilett R, Lorimer K. Absence of holistic sexual health understandings among men and women in deprived areas of Scotland: qualitative study. BMC Public Health 2019; 19:299. [PMID: 30866882 PMCID: PMC6417029 DOI: 10.1186/s12889-019-6558-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/18/2019] [Indexed: 01/04/2023] Open
Abstract
Background There is a growing evidence base for the need for a holistic approach to sexual health improvement, but the challenges for realising this in the ‘real world’ may be harder in some communities than others. We examined sexual health understandings and behaviours among adult men and women in deprived areas of Scotland. Methods Thematic analysis, using the constant comparative method, of qualitative, semi-structured in-depth interviews with 19 men and 16 women aged 18–40 years from the most deprived areas of Glasgow, Edinburgh, Dundee, and three Highland towns. Results Even though most had been shown images designed to facilitate discussion about sexual consent and verbal/physical abuse, when first asked, participants overwhelmingly equated ‘sexual health’ with the avoidance of sexually transmitted infections (STIs) and pregnancy. Most of the women interviewed went on to locate their accounts of sexual health within a broader, social account of relationships that in an ideal world, in contrast with their everyday lives, were based on respect and freedom from violence. They expressed desires for more positive relationships, based on open communication and trust, choice and freedom from coercion. A few men did accept a broader definition of sexual health, but others actively resisted it and placed the onus to enact choices and freedom from coercion on women rather than men. Conclusions In the first UK study to examine understandings of holistic sexual health among adults living in deprived areas, we found a disjuncture between men and women. These findings suggest that, as a society, we are failing to equip people to enhance their own, and others’, sexual health and wellbeing in its broadest sense. New efforts to emphasise the breadth of sexual health are required, but addressing these complex issues, especially where there are negative underlying gender norms to challenge, will require multi-level interventions targeting individual, community and system levels. Electronic supplementary material The online version of this article (10.1186/s12889-019-6558-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK.
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Lesley McMillan
- Department of Sociology and Social Policy, Glasgow Caledonian University, Glasgow, UK
| | - Siân Russell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Rosie Ilett
- Independent Research Consultant, Glasgow, UK
| | - Karen Lorimer
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Lorimer K, McMillan L, McDaid L, Milne D, Russell S, Hunt K. Exploring masculinities, sexual health and wellbeing across areas of high deprivation in Scotland: The depth of the challenge to improve understandings and practices. Health Place 2018; 50:27-41. [PMID: 29334618 PMCID: PMC5843873 DOI: 10.1016/j.healthplace.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 11/01/2017] [Accepted: 12/08/2017] [Indexed: 02/05/2023]
Abstract
Within and across areas of high deprivation, we explored constructions of masculinity in relation to sexual health and wellbeing, in what we believe to be the first UK study to take this approach. Our sample of 116 heterosexual men and women age 18-40 years took part in individual semi-structured interviews (n = 35) and focus group discussions (n = 18), across areas in Scotland. Drawing on a socio-ecological framework, findings revealed experience in places matter, with gender practices rooted in a domestically violent milieu, where localised, socio-cultural influences offered limited opportunities for more egalitarian performances of masculinity. We discuss the depths of the challenge in transforming masculinities in relation to sexual health and wellbeing in such communities.
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Affiliation(s)
- Karen Lorimer
- Glasgow Caledonian University, School of Health&Life Sciences, Glasgow G4 0BA, Scotland, United Kingdom.
| | - Lesley McMillan
- Glasgow Caledonian University, Glasgow School for Business&Society, Glasgow G4 0BA, Scotland, United Kingdom.
| | - Lisa McDaid
- MRC/CSO Social&Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, Scotland, United Kingdom.
| | - Dona Milne
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, United Kingdom.
| | - Siân Russell
- Glasgow Caledonian University, School of Health&Life Sciences, Glasgow G4 0BA, Scotland, United Kingdom.
| | - Kate Hunt
- MRC/CSO Social&Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, Scotland, United Kingdom.
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Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068). AIDS Behav 2017; 21:665-677. [PMID: 27260180 DOI: 10.1007/s10461-016-1435-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individual economic resources may have greater influence on school-enrolled young women's sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women's sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13-20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28-1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58-3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07-2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08-3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13-4.06), and discussing condom use (OR 1.99, 95 % CI 1.04-3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01-2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women's individual economic resources may complement future prevention initiatives.
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Stewart JM, Rogers CK, Bellinger D, Thompson K. A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women. West J Nurs Res 2016; 38:819-36. [PMID: 26879828 DOI: 10.1177/0193945916629621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings.
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Affiliation(s)
| | | | - Dawn Bellinger
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Keitra Thompson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Sheehan DM, Trepka MJ, Fennie K, Maddox L. Rate of new HIV diagnoses among Latinos living in Florida: disparities by country/region of birth. AIDS Care 2014; 27:507-11. [PMID: 25397859 PMCID: PMC4312518 DOI: 10.1080/09540121.2014.978731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV incidence in the USA is three times higher for Latinos than for non-Latino whites. Latinos differ in educational attainment, poverty, insurance coverage, and health-care access, factors that affect HIV knowledge, risk behaviors, and testing. The purpose of this study was to identify differences in demographics, risk factors, and rate of new HIV diagnoses by birth country/region among Latinos in Florida to guide the targeting of primary and secondary prevention programs. Using Florida HIV/AIDS surveillance data from 2007 to 2011 and the American Community Survey, we compared demographic and risk factors, and calculated annual and five-year age-adjusted rates of new HIV diagnoses for 5801 Latinos by birth country/region. Compared to US-born Latinos, those born in Cuba and South America were significantly more likely to report the HIV transmission mode of MSM; those born in the Dominican Republic (DR) heterosexual transmission; and those born in Puerto Rico injection drug use. Mexican- and Central American-born Latinos were more likely to be diagnosed with AIDS within a month of HIV diagnosis. The rate of new HIV diagnoses among Latinos declined 33% from 2007 to 2011. HIV diagnoses over time decreased significantly for Latinos born in Mexico and increased nonsignificantly for those born in the DR. Although this study was limited to Latinos living in Florida, results suggest that tailoring HIV primary prevention and testing initiatives to specific Latino groups may be warranted.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology and C-SALUD Center for Substance Use and AIDS Research on Latinos in the United States, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, PCA 362C, Miami, Florida 33199. ; P: (305) 348-5002
| | - Mary Jo Trepka
- Department of Epidemiology and C-SALUD Center for Substance Use and AIDS Research on Latinos in the United States, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC2 595, Miami, Florida 33199. ; P: (305) 348-7186
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC2 587, Miami, Florida 33199. . P: (305) 348-4545
| | - Lorene Maddox
- HIV/AIDS and Hepatitis Section, Florida Department of Health, 4052 Bald Cypress Way, BIN A09, Tallahassee, Florida 32399. ; P: (850) 245-4444 Ext. 2613
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Vaughan AS, Rosenberg E, Shouse RL, Sullivan PS. Connecting race and place: a county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization. Am J Public Health 2014; 104:e77-84. [PMID: 24832420 DOI: 10.2105/ajph.2014.301997] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the role of poverty in racial/ethnic disparities in HIV prevalence across levels of urbanization. METHODS Using national HIV surveillance data from the year 2009, we constructed negative binomial models, stratified by urbanization, with an outcome of race-specific, county-level HIV prevalence rates and covariates of race/ethnicity, poverty, and other publicly available data. We estimated model-based Black-White and Hispanic-White prevalence rate ratios (PRRs) across levels of urbanization and poverty. RESULTS We observed racial/ethnic disparities for all strata of urbanization across 1111 included counties. Poverty was associated with HIV prevalence only in major metropolitan counties. At the same level of urbanization, Black-White and Hispanic-White PRRs were not statistically different from 1.0 at high poverty rates (Black-White PRR = 1.0, 95% confidence interval [CI] = 0.4, 2.9; Hispanic-White PRR = 0.4, 95% CI = 0.1, 1.6). In nonurban counties, racial/ethnic disparities remained after we controlled for poverty. CONCLUSIONS The association between HIV prevalence and poverty varies by level of urbanization. HIV prevention interventions should be tailored to this understanding. Reducing racial/ethnic disparities will require multifactorial interventions linking social factors with sexual networks and individual risks.
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Affiliation(s)
- Adam S Vaughan
- Adam S. Vaughan, Eli Rosenberg, and Patrick S. Sullivan are with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. R. Luke Shouse is with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco. AIDS Behav 2014; 18:346-56. [PMID: 23760633 DOI: 10.1007/s10461-013-0508-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined socioeconomic status and social and sexual network factors and their relationship to HIV acquisition risk among HIV-negative Black MSM (BMSM), White MSM (WMSM) and transfemales (male to female transgenders). Geographic analysis examined residential patterns and neighborhood patterns of HIV prevalence in San Francisco. Factors associated with engaging in more episodes of potentially HIV serodiscordant unprotected receptive anal intercourse were analyzed. Transfemales and BMSM were more likely to live in areas of higher HIV prevalence and lower income compared to WMSM. BMSM and transfemales had lower socioeconomic scores (SES) scores compared to WMSM. BMSM were more likely to report serodiscordant partnerships and higher numbers of potentially serodiscordant unprotected sex acts. Decreasing individual SES did not predict serodiscordant partnerships in any group. Increasing neighborhood HIV prevalence predicted an increase in the number of potentially serodiscordant unprotected sex acts among transfemales and BMSM but only significantly so for transfemales. Prevention interventions must consider neighborhood HIV prevalence, and HIV prevalence in social/sexual networks, in addition to considering individual level behavior change or poverty reduction.
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HIV prevalence and risk behaviours from three consecutive surveys among men who have multiple female sexual partners in Cape Town. AIDS Behav 2013; 17:2367-75. [PMID: 22797932 DOI: 10.1007/s10461-012-0264-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV bio-behavioural surveillance surveys conducted at regular intervals are critical for monitoring of, and informing a targeted response to the HIV pandemic. We used Respondent-driven Sampling in 2006, 2008 and 2010 to recruit men who have multiple female sexual partners. We performed several logistic regression analyses to compare HIV sexual risk behaviours, and HIV infection over time. Decreases in inconsistent condom use with main partners were not sustained in 2010. Inconsistent condom use with non-main partners, partner numbers and having one-time partners continued to decrease over time. Levels of alcohol consumption in 2010 reverted to a level higher than in 2006. Non-significant increases in HIV prevalence and reporting a symptom of a sexually transmitted infection (STI) were found. The decrease in numbers of and one-time sexual partners, and in inconsistent condom use with non-main partners augers well for decreasing HIV incidence among men in the study community, but might be offset by decreases in consistent condom use with main partners, and increases in alcohol consumption and STIs.
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An Q, Prejean J, McDavid Harrison K, Fang X. Association between community socioeconomic position and HIV diagnosis rate among adults and adolescents in the United States, 2005 to 2009. Am J Public Health 2013; 103:120-6. [PMID: 23153140 PMCID: PMC3518324 DOI: 10.2105/ajph.2012.300853] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We examined the association between socioeconomic position (SEP) and HIV diagnosis rates in the United States and whether racial/ethnic disparities in diagnosis rates persist after control for SEP. METHODS We used cases of HIV infection among persons aged 13 years and older, diagnosed 2005 through 2009 in 37 states and reported to national HIV surveillance through June 2010, and US Census data, to examine associations between county-level SEP measures and 5-year average annual HIV diagnosis rates overall and among race/ethnicity-sex groups. RESULTS The HIV diagnosis rate was significantly higher for individuals in the low-SEP tertile than for those in the high-SEP tertile (rate ratios for low- vs high-SEP tertiles range = 1.68-3.38) except for White males and Hispanic females. The SEP disparities were larger for minorities than for Whites. Racial disparities persisted after we controlled for SEP, urbanicity, and percentage of population aged 20 to 50 years, and were high in the low-SEP tertile for males and in low- and high-SEP tertiles for females. CONCLUSIONS Findings support continued prioritization of HIV testing, prevention, and treatment to persons in economically deprived areas, and Blacks of all SEP levels.
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Affiliation(s)
- Qian An
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Davey –Rothwell MA, Linas BS, Latkin CA. Sources of personal income and HIV risk among sexually active women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:422-430. [PMID: 23016503 PMCID: PMC3562362 DOI: 10.1521/aeap.2012.24.5.422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We examined the relationship between sources of income and sex behaviors among a sample of low-income, sexually active women in Baltimore, MD (n = 517). Data were collected through interviews administered by a trained interviewer and audio computer-assisted self-interviewing (ACASI). The study assessed four categories of income: government payments, money from other people, selling items, and irregular jobs (i.e., odds jobs). Having multiple sex partners was associated with receiving income from other people [AOR: 2.60, 95% CI: 1.66-4.09], selling items [AOR: 2.67, 95% CI: 1.64-4.36], and irregular jobs [AOR: 1.57, 95% CI: 1.08, 2.29]. Women who exchanged sex were more likely to acquire income through these sources but less likely to receive government assistance [AOR: 0.62, 95% CI: 0.39-0.97]. Sexual behaviors are associated with multiple sources of personal income. HIV prevention interventions should address the role that economic factors play in risk behaviors.
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Affiliation(s)
- Melissa A. Davey –Rothwell
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health, Behavior and Society, 2213 McElderry Street- 2 Floor, Baltimore, MD 21205, Phone: (410) 502-5368, Fax: (410) 502-5385,
| | - Beth S. Linas
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St., Baltimore, MD 21205, Phone: (410) 502-5368, Fax: (410) 502-5385,
| | - Carl A. Latkin
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Behavior and Society, 624 North Broadway, Baltimore, MD 21205, Phone: (410) 955-3972, Fax: (410) 502-5385,
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