Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California

Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.

Prevalence of nicotine and tobacco product use by sexual identity, gender identity, and sex assigned at birth among emerging adult tobacco users in California, United States

INTRODUCTION

Sexual and gender minority (SGM) nicotine and tobacco use disparities are well-documented among youth and young adults (YYA), and despite decades of prevention efforts, these disparities stubbornly persist. To better understand tobacco use disparities and craft tailored interventions, tobacco use patterns must be assessed in a contemporary sample of YYA across lines of sexual and gender identity, sex assigned at birth, and tobacco product types.

METHODS

Data were from an online survey of a diverse sample of emerging adult tobacco users (ages 18-29; N=1,491) in California, United States (U.S., 2020-2021). Participants were recruited from various online and in-person locations. Bivariate and adjusted models assessed differences in four nicotine and tobacco use outcomes (past 30-day use of cigarettes, e-cigarettes, other tobacco products, multiple tobacco product types) across six groups: cisgender heterosexual males, cisgender heterosexual females, cisgender sexual minority (SM) males, cisgender SM females, transfeminine participants, and transmasculine participants.

RESULTS

Compared to cisgender heterosexual males, both transfeminine (OR=2.25, 95% CI=1.29-4.05) and transmasculine (OR=1.85, 95% CI=1.32-2.80) participants had higher odds of using cigarettes. Few differences were noted between groups in use of e-cigarettes. Cisgender heterosexual males had higher odds of other tobacco product use, compared to most other groups (e.g., cisgender SM males: OR=0.57, 95% CI=0.37-0.87). Transmasculine participants had higher odds of multiple product use, compared to cisgender heterosexual females. Among multiple product users, transfeminine participants had the highest prevalence of using all three individual product types (35.6%).

CONCLUSIONS

Results highlight the need for different tobacco control approaches across sexual and gender identities, sex assigned at birth, and nicotine and tobacco products.

IMPLICATIONS

Sexual and gender minority (SGM) nicotine and tobacco use disparities remain entrenched, despite concerted efforts to reduce them. The SGM population is heterogeneous and different SGM subgroups may have different needs. This study assessed, among young adult nicotine and tobacco users in California, U.S., patterns of tobacco use across sexual and gender identities, sex assigned at birth, as well as specific tobacco products used - a necessity to craft tailored tobacco control measures. We found patterns of nicotine and tobacco product use across several of these characteristics, highlighting how different prevention and cessation interventions may be needed to meaningfully address SGM nicotine and tobacco use disparities.

High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations

OBJECTIVES

Pharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are often undiagnosed due to their asymptomatic nature. This study aims to determine (1) the prevalence of CT/NG infections by anatomical site among cisgender men; (2) the proportion of missed CT/NG rectal/pharyngeal infections if urogenital testing alone was performed or screening depended on self-reported behaviour alone; and (3) the predictive probability of self-reported behaviours for rectal CT/NG.

METHODS

This cross-sectional study used electronic health records collected at a sexual health clinic in Los Angeles from 18 November 2018 until 28 February 2020. The included patients were ≥18 years of age cisgender men who received CT/NG testing at least once during the study period. We calculated the proportion of missed pharyngeal/rectal CT/NG infections if only urogenital testing had been done and if testing was based only on self-reported anal sex. Separately, we ran logistic regressions for predictive probability of self-reported anal sex on CT/NG rectal infections.

RESULTS

Overall, there were 13 476 unique patients with 26 579 visits. The prevalence of any extragenital CT/NG infection was 37.28%. Over 80% rectal/pharyngeal CT cases and over 65% rectal/pharyngeal NG cases would be missed if urogenital testing alone was performed. Likewise, over 35% rectal CT/NG cases would be missed had testing relied on self-reported sexual behaviours alone.

CONCLUSIONS

The proportion of missed rectal and pharyngeal CT/NG infections is high. Our data from a sexual health clinic lend support to three-site opt-out testing for cisgender men attending a sexual health/Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) specialty clinic regardless of their sexual orientation or reported sexual behaviours.

Evolving Primary Care Utilization of Transgender and Gender-Nonconforming People at a Community Sexual Health Clinic

Purpose

Prior research has found that transgender people are less likely to have access to health care and health insurance than their cisgender peers and are more likely to delay seeking care due to systemic discrimination and stigma. To this end, this study seeks to measure transgender and gender-nonconforming (TGNC) clients' primary care utilization and compare them to their cisgender peers.

Methods

Demographic data and self-reported primary care utilization from 14,372 clients attending a community health center in Los Angeles, CA, from 2018 to 2020 were examined. Descriptive statistics and multivariable regression analyses were used to examine correlates of gender identity on primary care utilization metrics-Hepatitis A, Hepatitis B, and Human Papillomavirus (HPV) vaccinations and recent primary care visits.

Results

Of TGNC clients, 38.0% reported being vaccinated for Hepatitis A compared to 49.2% of cisgender clients (p<0.01) and 42.6% reported being vaccinated for Hepatitis B compared to 51.6% of cisgender clients (p<0.01). TGNC clients had higher odds of engaging with the HPV vaccination series than their cisgender peers (adjusted odds ratio [aOR]=1.28, 95% confidence interval [CI] 1.03-1.59). TGNC clients had higher odds of seeing their primary care provider within the preceding 2 years (aOR=1.72, 95% CI 1.01-2.93) compared to non-TGNC clients.

Conclusions

This study's results found that TGNC clients were more likely to access certain primary care services more often than their cisgender counterparts. Our results support the efficacy of such interventions, such as a health care setting designed to support the health of gender minority people, and see similar, if not greater, primary care engagement in transgender persons compared to their cisgender peers.

Metabolomic Predictors of Non-alcoholic Steatohepatitis and Advanced Fibrosis in Children

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in western countries both in children and adults. Metabolic dysregulation associated with gut microbial dysbiosis may influence disease progression from hepatic steatosis to inflammation and subsequent fibrosis. Using a multi-omics approach, we profiled the oral and fecal microbiome and plasma metabolites from 241 predominantly Latino children with non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver (NAFL), and controls. Children with more severe liver pathology were dysbiotic and had increased gene content associated with lipopolysaccharide biosynthesis and lipid, amino acid and carbohydrate metabolism. These changes were driven by increases in Bacteroides and concomitant decreases of Akkermansia, Anaerococcus, Corynebacterium, and Finegoldia. Non-targeted mass spectrometry revealed perturbations in one-carbon metabolism, mitochondrial dysfunction, and increased oxidative stress in children with steatohepatitis and fibrosis. Random forests modeling of plasma metabolites was highly predictive of non-alcoholic steatohepatitis (NASH) (97% accuracy) and hepatic fibrosis, steatosis and lobular inflammation (93.8% accuracy), and can differentiate steatohepatitis from simple steatosis (90.0% accuracy). Multi-omics predictive models for disease and histology findings revealed perturbations in one-carbon metabolism, mitochondrial dysfunction, and increased oxidative stress in children with steatohepatitis and fibrosis. These results highlight the promise of non-invasive biomarkers for the growing epidemic of fatty liver disease.

Evidence supporting the standardisation of extragenital gonorrhoea and chlamydia screenings for women

OBJECTIVE

Current guidelines for women do not include extragenital screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) and do not mention anal sex behaviour. The objective of this cross-sectional study was to determine the number of potentially missed CT and NG cases by relying on urogenital screening and self-reported anal sex behaviour among women.

METHODS

Demographic and clinical data of 4658 women attending a community health centre in Los Angeles, California, USA from 2015 to 2018 were examined. CT and NG were detected using nucleic acid amplification test (APTIMA Combo 2, Hologic Gen-Probe, San Diego, California). Demographic and behavioural factors were also examined to assess potentially missed NG/CT cases. Multivariable regression analyses were used to determine whether reported anal sex behaviour predicts NG/CT rectal infection.

RESULTS

A total of 193 NG cases and 552 CT cases were identified; however, 53.9% of NG cases and 25.5% of CT cases were identified exclusively through extragenital screening. Of all positive cases of rectal CT, 87.0% did not report anal sex without a condom and 91.3% did not report any anal sex with their last sexual partner. Of all positive cases of rectal NG, 78.9% did not report anal sex without a condom and 76.3% did not report any anal sex with their last sexual partner. Anal sex with last partner was not predictive of NG/CT rectal infection.

CONCLUSIONS

Relying solely on urogenital screening and reported behaviour misses NG/CT cases. Extragenital NG/CT screening should be conducted in all women regardless of reported anal sex behaviour.

Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance

BACKGROUND

Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a "fentanyl breakthrough" in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available.

METHODS

We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl.

RESULTS

Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown.

DISCUSSION

Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.

Structural, Dosing, and Risk Change Factors Affecting Discontinuation of Pre-exposure Prophylaxis (PrEP) in a Large Urban Clinic

Understanding why clients stop taking pre-exposure prophylaxis (PrEP) is critical to improve PrEP delivery and ultimately reduce HIV incidence. We analyzed data from a programmatic evaluation conducted at the Los Angeles LGBT Center from February to May 2018. Of 180 respondents to the emailed survey, 91 had stopped taking PrEP and 11 never started. Among former PrEP users, most common reasons for stopping were entering a monogamous relationship (43%) and side effects (40%). Ten of 11 who never started PrEP reported access barriers (e.g., cost, insurance problems). A quarter of inactive clients re-engaged with PrEP services following the survey and 15% restarted PrEP by October 2018. Improving PrEP retention may require multifaceted interventions-e.g., tailored discussions about stopping and restarting PrEP safely as HIV risk changes, ensuring consistent access to affordable PrEP, and alternative dosing strategies. An emailed survey may be a simple, effective strategy to reengage some PrEP clients.

Age at first HIV test for MSM at a community health clinic in Los Angeles

Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.

Concordance between self-reported STI history and biomedical results among men who have sex with men in Los Angeles, California

OBJECTIVES

HIV studies and risk assessments among men who have sex with men (MSM) frequently use self-reported STI history as a proxy for true STI history. The objective of our study was to assess the validity of self-reported STI history through comparison with laboratory-confirmed biomedical results.

METHODS

Data were analysed for MSM attending the Los Angeles LGBT Center (the Center) from August 2011 to July 2015. We identified 10 529 unique MSM who received testing for chlamydia, gonorrhoea and/or syphilis and had a later visit in which they self-reported their STI history to a clinic counsellor during a risk assessment.

RESULTS

MSM who had an STI in the past year self-reported their STI history with 51%-56% accuracy, and MSM who had an STI more than a year ago self-reported their STI history with 65%-72% accuracy. Among MSM with any positive STIs at the Center, black/African-American and Hispanic MSM were more likely to inaccurately self-report their positive results for gonorrhoea (adjusted OR (aOR): 1.48, 95% CI 1.09 to 2.01; aOR: 1.39, 95% CI 1.14 to 1.70). Additionally, HIV-positive MSM were more likely to inaccurately self-report their positive results for gonorrhoea (aOR: 1.63, 95% CI 1.22 to 2.18) and/or syphilis (aOR: 2.19, 95% CI 1.08 to 4.47).

CONCLUSIONS

This is the first study that attempts to evaluate the validity of self-reported STI history among MSM. We found that self-reported STI history may not be an appropriate proxy for true STI history in certain settings and minority populations. Clinical guidelines and research studies that rely on self-reported STI history will need to modify their recommendations in light of the limited validity of these data.

Resuscitation skills for radiologists: a short paper

The radiologist is likely to be the first medical practitioner on the scene for contrast reactions, anaphylaxis and other common medical emergencies that occur in radiology departments and stand-alone practices. Until 2007, the Royal Australian and New Zealand College of Radiologists (RANZCR) did not provide resuscitation training as a CPD service for fellows, and the need for such a service has not been gauged. In 2007, the authors ran the first RANZCR large-group resuscitation refresher training workshop at the Melbourne 2007 annual scientific meeting. The workshop maximized audience participation and knowledge transfer in a constrained time, disseminated guidelines, and collected feedback on the need for further resuscitation training for radiologists. Of the 100 feedback forms, 82 were returned. All the 82 responses wanted the workshop repeated at future annual scientific meetings, and 71 wanted RANZCR to provide hands-on refresher training. Sixty-six responders indicated when they had their most recent resuscitation training: six in the past 12 months, 25 in the past 3 years and 35 longer than 3 years. Sixty-nine responded on availability of resuscitation training at their workplace: 33 indicated 'Yes' and 36 'No'. There is a definite need to provide resuscitation training for radiologists in Australia. At the end of this article, we reproduce the currently applicable guidelines as a service to our readers.

Spatial and temporal operation of the Scotia Sea ecosystem: a review of large-scale links in a krill centred food web

The Scotia Sea ecosystem is a major component of the circumpolar Southern Ocean system, where productivity and predator demand for prey are high. The eastward-flowing Antarctic Circumpolar Current (ACC) and waters from the Weddell-Scotia Confluence dominate the physics of the Scotia Sea, leading to a strong advective flow, intense eddy activity and mixing. There is also strong seasonality, manifest by the changing irradiance and sea ice cover, which leads to shorter summers in the south. Summer phytoplankton blooms, which at times can cover an area of more than 0.5 million km2, probably result from the mixing of micronutrients into surface waters through the flow of the ACC over the Scotia Arc. This production is consumed by a range of species including Antarctic krill, which are the major prey item of large seabird and marine mammal populations. The flow of the ACC is steered north by the Scotia Arc, pushing polar water to lower latitudes, carrying with it krill during spring and summer, which subsidize food webs around South Georgia and the northern Scotia Arc. There is also marked interannual variability in winter sea ice distribution and sea surface temperatures that is linked to southern hemisphere-scale climate processes such as the El Niño-Southern Oscillation. This variation affects regional primary and secondary production and influences biogeochemical cycles. It also affects krill population dynamics and dispersal, which in turn impacts higher trophic level predator foraging, breeding performance and population dynamics. The ecosystem has also been highly perturbed as a result of harvesting over the last two centuries and significant ecological changes have also occurred in response to rapid regional warming during the second half of the twentieth century. This combination of historical perturbation and rapid regional change highlights that the Scotia Sea ecosystem is likely to show significant change over the next two to three decades, which may result in major ecological shifts.