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Irie WC, Mahone A, Johnson B, Marrazzo J, Mugavero MJ, Van Der Pol B, Elopre L. "Just the Stigma Associated with PrEP Makes You Feel Like It's HIV Itself": Exploring PrEP Stigma, Skepticism, and Medical Mistrust Among Black Cisgender Women in Urban and Rural Counties in the U.S. Deep South. Arch Sex Behav 2024; 53:1187-1195. [PMID: 38195827 DOI: 10.1007/s10508-023-02769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite its effectiveness in HIV prevention, PrEP use among Black women is suboptimal. Notably in the Deep South, Black women have the lowest PrEP uptake rates among all US regions. To increase PrEP engagement, research suggests the implementation of structural and social interventions particular to the needs of Black women. The state of Alabama is of priority to federal HIV prevention initiatives; therefore, this study conducted focus groups among 47 cis-gender Black women in rural and urban Alabama counties, with the highest statewide HIV incidence rates, to understand perceptions of PrEP and decision-making processes. Deductive coding analysis was conducted and themes were finalized based on consensus among the two coders. Four themes were identified. Findings show stigma undergirds Alabaman Black women's decisions to engage in PrEP care. Moreover, women reported stigma stifled community-level education about PrEP. Despite these experiences, education was regarded as a strategy to decrease stigma and PrEP skepticism, the latter of which emerged as a prominent theme. Medical mistrust and healthcare engagement were the other emergent themes influencing participation in PrEP care. To ensure PrEP efforts meet the needs of Black cisgender women in Alabama counties, interventions must address longstanding stigma, increase educational initiatives, and ensure interventions consider women's experiences with medical mistrust and health care engagement.
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Affiliation(s)
- Whitney C Irie
- Boston College School of Social Work, Chestnut Hill, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467-1037, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Anais Mahone
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Bernadette Johnson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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2
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Zeng C, Zhang J, Li Z, Sun X, Ning H, Yang X, Weissman S, Olatosi B, Li X. Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study. JMIR Public Health Surveill 2023; 9:e44257. [PMID: 38051568 DOI: 10.2196/44257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 09/17/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation. OBJECTIVE We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation. METHODS An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model. RESULTS As of October 19, 2022, among the 418 counties, the median of booster uptake was 40% (IQR 37.8%-43%). Compared with older adults (ie, at least 65 years; median 63.1%, IQR 59.5%-66.5%), youth (ie, 12 to 17 years; median 14.1%, IQR 11.3%-17.4%) and adults (ie, 18 to 64 years; median 33.4%, IQR 30.5%-36.5%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups. CONCLUSIONS The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities.
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Affiliation(s)
- Chengbo Zeng
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Zhenlong Li
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
- Geoinformation and Big Data Research Laboratory, Department of Geography, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Xiaowen Sun
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Huan Ning
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
- Geoinformation and Big Data Research Laboratory, Department of Geography, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Big Data Health Science Center, University of South Carolina, Columbia, SC, United States
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3
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Tipre M, Hardy C, Bowman T, Glover M, Gullet P, Baity D, Levy K, L Baskin M. Concept Mapping with Black Men: Barriers to Prostate Cancer Screening and Solutions. J Cancer Educ 2023; 38:1808-1815. [PMID: 37458874 DOI: 10.1007/s13187-023-02336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 11/18/2023]
Abstract
A structured participatory approach of group concept mapping (GCM) was used to understand barriers and concerns around prostate cancer screening (PCS) among African American (AA) men. One-hundred thirteen AA men aged 35-70 years enrolled from one urban and three rural counties in Alabama. Eighty-five men brainstormed and generated 41 unique ideas in response to a single prompt. Participants (n = 70) sorted ideas into groups and rated them in terms of importance and feasibility to change opinions. Multi-dimensional scaling and cluster analysis were used to analyze the data. Participants (n=50) discussed visual concept maps during three focus-groups and recommended solutions to address key barriers. The mean age of respondents was 52 (±10), 50% were rural, 37% were college-educated, 56% with income <$44,500, and 22% with PROCASE Knowledge Index ≤5. Cluster analyses revealed eight clusters. Participants ranked barriers grouped under "fear of consequences of test," "lack of knowledge," and "costs/no insurance" as most important to improve PCS among AA men. The same three clusters along with "dislike for digital rectal exam (DRE)" were ranked as most difficult to change. No major differences were noted by urban/rural status. Solutions to address barriers included education at a younger age, alternate testing options and open discussion about DRE, and clear and precise messaging by peers and relatable role models. Our study identified specific barriers to PCS among AA with diverse sociodemographic backgrounds. Culturally sensitive interventions delivered by trained healthcare professionals, peers, and relatable role models, can potentially increase PCS among AA men.
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Affiliation(s)
- Meghan Tipre
- Division of Hematology and Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Office of Community Outreach and Engagement and Health Equity, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Claudia Hardy
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcus Glover
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia Gullet
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Denise Baity
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathy Levy
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Hematology and Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Office of Community Outreach and Engagement and Health Equity, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Li Z, Qiao S, Ning H, Sun X, Zhang J, Olatosi B, Li X. Place Visitation Data Reveals the Geographic and Racial Disparities of COVID-19 Impact on HIV Service Utilization in the Deep South. AIDS Behav 2023:10.1007/s10461-023-04163-4. [PMID: 37792234 DOI: 10.1007/s10461-023-04163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States' Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization. OBJECTIVES Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic. METHODS We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders. RESULTS Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions. CONCLUSIONS Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period.
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Affiliation(s)
- Zhenlong Li
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA.
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
| | - Shan Qiao
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Huan Ning
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Geography, The Pennsylvania State University, University Park, PA, 16801, USA
| | - Xiaowen Sun
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Jiajia Zhang
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Bankole Olatosi
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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5
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Chandler-Laney P, Biggio JR, Tipre M, Carson TL, Bae S, Everett AB, Baskin ML. Relationship Between Race and Gestational Weight Gain in Pregnancy and Early Life in the South Birth-Cohort Study. Matern Child Health J 2023; 27:356-366. [PMID: 36662382 PMCID: PMC11092968 DOI: 10.1007/s10995-022-03584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. METHODS We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. RESULTS The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. CONCLUSION The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception.
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Affiliation(s)
- Paula Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffit Cancer Center & Research Institute, Tampa, FL, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Alysha B Everett
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA.
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Obidoa C, Thompson OP, Thitsa M, Smith E, Katner H. Sexual Behavior Patterns of Black Young Adults in Georgia: Results from a Latent Class Analysis. J Racial Ethn Health Disparities 2023; 10:271-81. [PMID: 35018580 DOI: 10.1007/s40615-021-01217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023]
Abstract
The state of Georgia ranks first in the rate of new diagnosis of HIV/AIDS, yet studies focused on understanding the drivers of this epidemic in the most at-risk groups outside the Atlanta Metropolitan Statistical Area (MSA) remain sparse. Among the many consequences of this is the inability to effectively design tailored intervention programs that appropriately address the reduction of HIV/AIDS and other STDS in the state. Reducing disparities in HIV/AIDS remains an important goal in the National HIV/AIDS Strategy. Given the disproportionate burden of the HIV/AIDS epidemic among Blacks in the state of Georgia, there is a significant need to focus research attention on the sexual behavior of young people that predisposes them to increased risk of HIV/AIDS infection. The current study used latent class analysis (LCA) to examine the sexual behavior patterns of Black young adults living in Georgia. LCA results revealed a two-class fit with distinct sexual behavior patterns. Gender and educational attainment emerged as significant predictors of class membership. Our findings contribute to the vast literature showing that sexual behavior patterns of Black young adults are not homogenous, and underscore the significance of socio-demographic and contextual factors in shaping sexual risk behavior.
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Newman SD, Moss K, Pichon M, Scott D, Rogers K, Orr A, Bui C, Payne-Foster P. The health of rural Black communities during COVID: Some affirmations, some surprises. Front Public Health 2023; 11:932451. [PMID: 37124765 PMCID: PMC10133505 DOI: 10.3389/fpubh.2023.932451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objective There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. Methods A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. Results The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. Conclusion The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.
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Affiliation(s)
- Sharlene D. Newman
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- *Correspondence: Sharlene D. Newman,
| | - Kimberly Moss
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Melonie Pichon
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Deborah Scott
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Kileema Rogers
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Angela Orr
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
| | - Pamela Payne-Foster
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, United States
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Johnson KA, Binion S, Waller B, Sutton A, Wilkes S, Payne-Foster P, Carlson C. Left behind in the U.S.' Deep South: Addressing critical gaps in HIV and intimate partner violence prevention efforts targeting Black women. Front Reprod Health 2022; 4:1008788. [PMID: 36505393 PMCID: PMC9733498 DOI: 10.3389/frph.2022.1008788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Karen A. Johnson
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Stefanie Binion
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Bernadine Waller
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Amber Sutton
- Department of Sociology, Anthropology, and Social Work, Auburn University at Montgomery, Montgomery, AL, United States
| | - Sherron Wilkes
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Pamela Payne-Foster
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, United States
| | - Catherine Carlson
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
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Tipre M, Bolaji B, Blanchard C, Harrelson A, Szychowski J, Sinkey R, Julian Z, Tita A, Baskin ML. Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality. Ethn Dis 2022; 32:293-304. [PMID: 36388861 PMCID: PMC9590600 DOI: 10.18865/ed.32.4.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health. Purpose Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM. Methods Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence. Results Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM. Conclusion Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.
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Affiliation(s)
- Meghan Tipre
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL, Address correspondence to Meghan Tipre, DrPH MSPH; Department of Medicine, University of Alabama at Birmingham;
| | - Bolanle Bolaji
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
| | - Christina Blanchard
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alex Harrelson
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Jeff Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL
| | - Rachel Sinkey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Zoe Julian
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alan Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Monica L. Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
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10
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Zeng C, Zhang J, Li Z, Sun X, Yang X, Olatosi B, Weissman S, Li X. Population Mobility and Aging Accelerate the Transmission of Coronavirus Disease 2019 in the Deep South: A County-Level Longitudinal Analysis. Clin Infect Dis 2022; 74:e1-e3. [PMID: 35568472 PMCID: PMC9107377 DOI: 10.1093/cid/ciac050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Population mobility and aging at local areas contributed to the geospatial disparities in the coronavirus disease 2019 (COVID-19) transmission among 418 counties in the Deep South. In predicting the incidence of COVID-19, a significant interaction was found between mobility and the proportion of older adults. Effective disease control measures should be tailored to vulnerable communities.
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Affiliation(s)
- Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Zhenlong Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA.,Geoinformation and Big Data Research Laboratory, Department of Geography, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaowen Sun
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sharon Weissman
- University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA.,Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,University of South Carolina Big Data Health Science Center, Columbia, South Carolina, USA
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11
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Gant Z, Dailey A, Wang S, Lyons SJ, Watson M, Lee K, Johnson AS. TRENDS IN HIV CARE OUTCOMES AMONG ADULTS AND ADOLESCENTS IN THE U.S. SOUTH, 2015-2019. Ann Epidemiol 2022; 71:15-22. [PMID: 35525379 DOI: 10.1016/j.annepidem.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE HIV disparities continue to persist in the southern United States and among some populations. Early HIV diagnosis, prompt linkage to care, and viral suppression among persons with HIV in the South, in particular the Deep South, are critical to reduce disparities and achieve national prevention goals. METHODS Estimated annual percent changes were calculated to assess trends during 2015-2019 in percentage distributions for stage of disease at the time of diagnosis, linkage to HIV medical care, and viral suppression. RESULTS Among 95,488 persons with HIV diagnosed in the South (Deep South: 81,848; Other South:13,640), the overall percentage that received a diagnosis classified as stage 0 increased 9.0%, stages 1-2 increased 1.8%, linkage to HIV care increased 2.9%, and viral suppression increased 5.9%. Changes in care outcomes among American Indian/Alaska Native persons and persons with infection attributed to injection drug use were minimal. CONCLUSIONS To reach the goals of Ending the HIV Epidemic (EHE) and other federal initiatives, efforts need to focus on prevention and care among persons residing in the South. Addressing factors such as stigma and discrimination and elimination of barriers to HIV testing, care, and treatment are needed to effectively address these disparities in HIV-related care outcomes.
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Affiliation(s)
- Zanetta Gant
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - André Dailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Shacara Johnson Lyons
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meg Watson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kyung Lee
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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McDaniel CC, Chou C. Clinical risk factors and social needs of 30-day readmission among patients with diabetes: A retrospective study of the Deep South. Front Clin Diabetes Healthc 2022; 3:1050579. [PMID: 36992731 PMCID: PMC10012098 DOI: 10.3389/fcdhc.2022.1050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 03/31/2023]
Abstract
Introduction Evidence is needed for 30-day readmission risk factors (clinical factors and social needs) among patients with diabetes in the Deep South. To address this need, our objectives were to identify risk factors associated with 30-day readmissions among this population and determine the added predictive value of considering social needs. Methods This retrospective cohort study utilized electronic health records from an urban health system in the Southeastern U.S. The unit of analysis was index hospitalization with a 30-day washout period. The index hospitalizations were preceded by a 6-month pre-index period to capture risk factors (including social needs), and hospitalizations were followed 30 days post-discharge to evaluate all-cause readmissions (1=readmission; 0=no readmission). We performed unadjusted (chi-square and student's t-test, where applicable) and adjusted analyses (multiple logistic regression) to predict 30-day readmissions. Results A total of 26,332 adults were retained in the study population. Eligible patients contributed a total of 42,126 index hospitalizations, and the readmission rate was 15.21%. Risk factors associated with 30-day readmissions included demographics (e.g., age, race/ethnicity, insurance), characteristics of hospitalizations (e.g., admission type, discharge status, length of stay), labs and vitals (e.g., highest and lowest blood glucose measurements, systolic and diastolic blood pressure), co-existing chronic conditions, and preadmission antihyperglycemic medication use. In univariate analyses of social needs, activities of daily living (p<0.001), alcohol use (p<0.001), substance use (p=0.002), smoking/tobacco use (p<0.001), employment status (p<0.001), housing stability (p<0.001), and social support (p=0.043) were significantly associated with readmission status. In the sensitivity analysis, former alcohol use was significantly associated with higher odds of readmission compared to no alcohol use [aOR (95% CI): 1.121 (1.008-1.247)]. Conclusions Clinical assessment of readmission risk in the Deep South should consider patients' demographics, characteristics of hospitalizations, labs, vitals, co-existing chronic conditions, preadmission antihyperglycemic medication use, and social need (i.e., former alcohol use). Factors associated with readmission risk can help pharmacists and other healthcare providers identify high-risk patient groups for all-cause 30-day readmissions during transitions of care. Further research is needed about the influence of social needs on readmissions among populations with diabetes to understand the potential clinical utility of incorporating social needs into clinical services.
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Affiliation(s)
- Cassidi C. McDaniel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- *Correspondence: Chiahung Chou,
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13
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Williams MS, Poteat T, Bender M, Ugwu P, Burns PA. Revitalizing HIV Prevention Programs: Recommendations From Those Most Impacted by the HIV in the Deep South. Am J Health Promot 2021; 36:155-164. [PMID: 34409888 DOI: 10.1177/08901171211041097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The incidence of new HIV infections is disproportionately high among Black men who have sex with men (BMSM) in Mississippi. Community-based organizations received funding through the ACCELERATE! initiative to implement interventions aimed at increasing BMSM's access to HIV prevention, treatment and care interventions. APPROACH We conducted a mixed methods evaluation of the ACCELERATE! initiative to assess its impact. We also explored factors that act as barriers to and facilitators of BMSM's engagement in HIV prevention interventions. SETTING Interviews were conducted between July 2018 and February 2020. PARTICIPANTS Thirty-six BMSM and 13 non-grantee key informants who worked in the field of HIV in Mississippi participated. METHOD The qualitative data from the interview transcripts was analyzed using an iterative, inductive coding process. RESULTS We identified 10 key recommendations that were most common across all participants and that were aligned with UNAIDS Global AIDS Strategy strategic priorities. Several recommendations address the reduction of HIV- and LGBT-stigma. Two of the most common recommendations were to increase representation of the target population in health promotion program leadership and to include HIV with other Black health issues in community-based health education programs rather than singling it out. Another recommendation called for programs aimed at addressing underlying factors associated with HIV-risk behaviors, such as mental illness. CONCLUSION Our results indicate that HIV education interventions in the Deep South need to be revitalized to enhance their reach and effectiveness.
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Affiliation(s)
- Michelle S Williams
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill, NC, USA
| | - Melverta Bender
- Office of STD/HIV, Mississippi State Department of Health, Jackson, MS, USA
| | - Precious Ugwu
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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14
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Williams CP, Rocque GB, Azuero A, Kenzik KM, Williams GR, Sharma P, Rocconi RP, Demark-Wahnefried W, Martin MY, Pisu M. Impact of lay navigation on utilization and Medicare spending for cancer survivors in the " Deep South". J Cancer Surviv 2021. [PMID: 34152532 DOI: 10.1007/s11764-021-01064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Though lay navigation programs have proven beneficial for individuals during cancer treatment, little is known about the effects of lay navigation on health care utilization and Medicare spending among older adults during cancer survivorship. METHODS This retrospective cohort study used administrative claims data to evaluate a lay navigation program implemented from 2012 to 2015 at 12 academic and community cancer centers in the Southeast. Medicare beneficiaries age ≥65 years navigated during survivorship were compared to propensity score-matched, non-navigated cancer survivors. Quarterly trends in Medicare spending were estimated using repeated measures mixed models. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using repeated measures generalized linear models for quarterly emergency room (ER) visits and hospitalizations. RESULTS Medicare spending for navigated (n = 3255) versus non-navigated older cancer survivors (n = 3255) was initially higher but declined faster by $513 per patient per quarter (95% CI -$616, -$410). Per patient per quarter risk of ER visits decreased by 11% (RR 0.89, 95% CI 0.86, 0.92) and hospitalizations decreased by 16% (RR 0.84, 95% CI 0.81, 0.88) over time comparing navigated versus non-navigated patients. Similar results were seen for patients enrolled in navigation post-treatment (N = 1893). CONCLUSIONS In older cancer survivors receiving care in the Deep South, patients receiving lay navigation compared to those non-navigated had significant reductions in Medicare spending, hospitalizations, and ER visits. IMPLICATIONS FOR CANCER SURVIVORS Though much emphasis has been placed on lay navigation during initial cancer treatment, navigation is needed throughout survivorship due to the high costs and health care utilization that persist post-treatment.
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15
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Little RB, Desmond R, Carson TL. Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA. J Nutr Sci 2020; 9:e58. [PMID: 33354329 DOI: 10.1017/jns.2020.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 11/07/2022] Open
Abstract
Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ 2 analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1-63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.
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16
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Duncan DT, Sutton MY, Park SH, Callander D, Kim B, Jeffries WL, Henny KD, Harry-Hernández S, Barber S, Hickson DA. Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study. Arch Sex Behav 2020; 49:185-193. [PMID: 31950381 PMCID: PMC7410008 DOI: 10.1007/s10508-019-01619-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
There is a disproportionately high HIV incidence among Black men who have sex with men (MSM) despite equal or lower levels of HIV risk behaviors compared to White MSM. Due to high levels of racial segregation in the U.S., Black MSM have an elevated likelihood of living in neighborhoods that contain psychosocial stressors, which, in turn, may increase behaviors promoting HIV infection. We examined associations between perceived neighborhood problems and sexual behaviors among Black MSM in the Deep South, a population at highest risk of HIV. Data came from the MARI Study, which included Black MSM ages 18-66 years recruited from the Jackson, MS, and Atlanta, GA, metropolitan areas (n = 377). Participants completed questions about neighborhood problems (e.g., excessive noise, heavy traffic/speeding cars and trash/litter) and sexual behaviors (e.g., condomless sex and drug use before or during sex). We used Poisson's regression model with robust standard errors to estimate the adjusted prevalence ratio (aPR; 95% confidence intervals [CI]) of neighborhood problems (coded as tertiles [tertile 1 = low neighborhood problems, tertile 2 = medium neighborhood problems, tertile 3 = high neighborhood problems] as well as continuously) with sexual behaviors, after adjustment for sociodemographic characteristics and other variables. About one-fourth of the sample reported at least one neighborhood problem, with the most common (31.6%) being no/poorly maintained sidewalks, which indicates an infrastructural problem. In multivariable models, compared to those in the lowest tertile, those reporting more neighborhood problems (tertile 2: aPR = 1.49, 95% CI = 1.04, 2.14 and tertile 3: aPR = 1.53, 95% CI = 1.05, 2.24) reported more drug use before or during sex (p for trend = .027). Neighborhood problems may promote behaviors (e.g., drug use before or during sex) conducive to HIV infection. Structural interventions could improve community infrastructure to reduce neighborhood problems (e.g., no/poorly maintained sidewalks and litter). These interventions may help to reduce HIV incidence among Black MSM in the Deep South.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA.
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kirk D Henny
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salem Harry-Hernández
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - DeMarc A Hickson
- Center for Research, Evaluation and Environmental and Policy Change, My Brother's Keeper, Inc, Jackson, MS, USA
- Us Helping Us, People Into Living, Inc, Washington, DC, USA
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17
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Lanzi RG, Footman AP, Jackson E, Araya BY, Ott C, Sterling RD, Davis TR, Kaiser KA. Love with No Exceptions: A Statewide Faith-Based, University-Community Partnership for Faith-Based HIV Training and Assessment of Needs in the Deep South. AIDS Behav 2019; 23:2936-2945. [PMID: 31321638 DOI: 10.1007/s10461-019-02604-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This project established a faith-based, university-community partnership with the African Methodist Episcopal (AME) church in Alabama to develop a statewide training model to address HIV knowledge and stigma, promote discussion and generate action plans to address HIV in the Deep South. A community-engaged research team consisting of church leadership and university researchers developed and implemented the model, "Love with No Exceptions." Mixed methods were used to evaluate the model delivered in 3-h sessions in five state regions (N = 146 clergy and laity). The majority of participants reported feeling better prepared to serve those living with or affected by HIV and would implement education and awareness activities in their churches. Participants' HIV knowledge increased from pre- to post-training. Stigma-related attitudes showed minor changes from baseline. These results reflect that partnerships between academic institutions and churches can deliver promising steps towards impactful HIV education in the Deep South.
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Affiliation(s)
- Robin G Lanzi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, 227 Ryals School of Public Health Building, Birmingham, AL, 35924, USA.
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA.
| | - Alison P Footman
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, 227 Ryals School of Public Health Building, Birmingham, AL, 35924, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Jackson
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Brook Y Araya
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, 227 Ryals School of Public Health Building, Birmingham, AL, 35924, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Corilyn Ott
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, USA
| | - Ronald D Sterling
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
- Alabama Ninth Episcopal District of the African Methodist Episcopal Church, Birmingham, USA
| | - Tammy R Davis
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
- Alabama Ninth Episcopal District of the African Methodist Episcopal Church, Birmingham, USA
| | - Kathryn A Kaiser
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, 227 Ryals School of Public Health Building, Birmingham, AL, 35924, USA
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18
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Stringer KL, Azuero A, Ott C, Psaros C, Jagielski CH, Safren SA, Haberer JE, Kempf MC. Feasibility and Acceptability of Real-Time Antiretroviral Adherence Monitoring among Depressed Women Living with HIV in the Deep South of the US. AIDS Behav 2019; 23:1306-1314. [PMID: 30377982 DOI: 10.1007/s10461-018-2322-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study presents feasibility and acceptability data on the use of a real-time wireless electronic adherence monitor (EAM), among African American women living with HIV with co-occurring depression, residing in remote areas of the Southeastern United States. EAM and self-report ART adherence was monitored over an average of 14.8 weeks among 25 participants who were recruited at four HIV clinics in Alabama. Intra-class correlation showed a low degree of concordance between EAM and self-report (ICC = 0.33, 95% bootstrap CI 0.13, 0.59). 83% of data collected via EAM was transmitted in real-time. Due to technological failures, 11.4% were not transmitted in real-time, but were later recovered, and 5.7% were lost entirely. Acceptability was examined through surveys and qualitative interviews. Results suggest that EAM monitoring is acceptable and feasible in a rural US setting; however, technological difficulties, such as loss of connectivity may impede the device's usefulness for just-in-time adherence interventions.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Corilyn Ott
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina Psaros
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
- Departments of Health Behavior and Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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19
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McNair OS, Gipson JA, Denson D, Thompson DV, Sutton MY, Hickson DA. The Associations of Resilience and HIV Risk Behaviors Among Black Gay, Bisexual, Other Men Who Have Sex with Men (MSM) in the Deep South: The MARI Study. AIDS Behav 2018; 22:1679-87. [PMID: 28856456 DOI: 10.1007/s10461-017-1881-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Resilience is an understudied intrapersonal factor that may reduce HIV risk among men who have sex with men (MSM). Multivariable Poisson regression models were used to estimate the prevalence ratio (PR) of sexual risk behaviors, HIV prevalence, and history of sexually transmitted infections (STIs) with resilience scores in a population-based study among 364 black MSM in the Deep South. Participants with higher resilience scores had a lower prevalence of condomless anal sex with casual sexual partners in past 12 months (PR = 0.80, p value = 0.001) and during their last sexual encounter (PR = 0.81; p value = 0.009). Resilience was inversely associated with a lower prevalence of condomless anal sex with main sexual partners, participating in a sex party/orgy and having a STI in the past 12 months. Resilience may have a protective effect on HIV among black MSM, especially in the Deep South, and should be further explored in studies with prospective designs.
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20
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Carson TL, Jackson BE, Nolan TS, Williams A, Baskin ML. Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program. Transl Behav Med 2017; 7:320-9. [PMID: 27909882 DOI: 10.1007/s13142-016-0452-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Depression and stress have been associated with less weight loss among some participants in behavioral weight loss (BWL) programs. The purpose of this study was to (1) measure the levels of depression and stress among a sample of black women living in rural Alabama and Mississippi who were participating in a BWL program and (2) examine the association between these psychosocial variables and weight loss outcomes of participants at 6 months. Overweight and obese black women in a BWL program (n = 409) completed validated surveys to measure depression and stress at baseline and 6 months. Weight and height were also measured at baseline and 6 months. Statistical tests were conducted to examine associations between depression, stress, and weight loss. Mean BMI at baseline was 38.68 kg/m2. Participants achieved a 1.17 kg/m2 reduction in BMI at 6 months. When comparing by baseline depression or stress categories, no significant differences in weight loss outcomes were observed. Analysis of continuous data revealed a significant correlation between baseline depression score and change in BMI. In adjusted models, change in depression score over time was significantly associated with change in weight. No differences in weight loss outcomes at 6 months were observed when comparing participants with and without elevated depressive symptoms or elevated stress at baseline. This suggests that potential participants may not need to be excluded from BWL programs based on pre-specified cut points for these psychological conditions. Greater improvements in depression were associated with better weight loss outcomes suggesting that more emphasis on reducing depression may lead to greater weight losses for black women in BWL programs.
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21
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Lichtenstein B, Kay ES, Klinger I, Mutchler MG. Ricky and Lucy: gender stereotyping among young Black men who have sex with men in the US Deep South and the implications for HIV risk in a severely affected population. Cult Health Sex 2018; 20:351-365. [PMID: 28720021 PMCID: PMC5775064 DOI: 10.1080/13691058.2017.1347280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
HIV disproportionately affects young Black men who have sex with men in the USA, with especially high rates in the Deep South. In this Alabama study, we interviewed 24 pairs of young Black men who have sex with men aged 19-24 and their close friends (n = 48) about sexual scripts, dating men and condom use. Three main themes emerged from the study: the power dynamics of 'top' and 'bottom' sexual positions for condom use; gender stereotyping in the iconic style of the 'I Love Lucy' show of the 1950s; and the sexual dominance of 'trade' men. Gender stereotyping was attributed to the cultural mores of Black families in the South, to the preferences of 'trade' men who exerted sexual and financial control and to internalised stigma relating to being Black, gay and marginalised. The findings suggest that HIV prevention education for young Black men who have sex with men is misguided if gendered power dynamics are ignored, and that funded access to self-protective strategies such as pre-exposure prophylaxis and post-exposure prophylaxis could reduce HIV risk for this severely affected population.
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Affiliation(s)
- Bronwen Lichtenstein
- Department of Criminology/Criminal Justice, The University of Alabama, Tuscaloosa, AL, USA
- Corresponding Author: Bronwen Lichtenstein,
| | - Emma Sophia Kay
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Ian Klinger
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
| | - Matt G. Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
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Foster PP, Thomas M, Lewis D. Reverse Migration, the Black Church and Sexual Health: Implications for Building HIV/AIDS Prevention Capacity in the Deep South. AIMS Public Health 2016; 3:242-254. [PMID: 29546159 PMCID: PMC5690351 DOI: 10.3934/publichealth.2016.2.242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
The Black Church has long been purported as being strongly influential in the lives of Blacks in America. Recent U.S. census data trends highlight a “reverse migration” pattern where Blacks are moving back to the South from larger metropolitan areas in other U.S. geographical regions. This migration pattern parallels the increasing HIV/AIDS prevalence among Blacks in the Deep South. This paper reviews both the historical and current migration patterns among Blacks, as well as the current HIV/AIDS epidemic among Blacks in the Deep South. Thereafter, the authors discuss an existing framework for increasing HIV/AIDS prevention capacity through a conceptual connection of migration, religion and sexual health. The authors use case studies to support the proposed framework. It is hoped that the framework could be used to address HIV/AIDS health disparities and other chronic diseases affecting Blacks in America.
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Affiliation(s)
- Pamela Payne Foster
- Department of Community and Rural Health, The University of Alabama School of Medicine, Tuscaloosa, Alabama, USA.,Institute for Rural Health Research, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Martina Thomas
- Anthropology Department, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Dwight Lewis
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, Alabama, USA
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Smallwood SW, Spencer SM, Ingram LA, Thrasher JF, Thompson-Robinson MV. Different Dimensions: Internalized Homonegativity Among African American Men Who Have Sex With Men in the Deep South. J Homosex 2016; 64:45-60. [PMID: 27042869 DOI: 10.1080/00918369.2016.1172869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined the psychometric properties of the Internalized Homonegativity Inventory (IHNI) among African American men who have sex with men (AAMSM) in the southeastern United States. Data from 261 AAMSM were analyzed using exploratory factor analysis. Results showed evidence of a two-factor solution: personal and moral homonegativity and gay affirmation. Internal consistencies were greater than .80, and correlations with other variables (e.g., sociodemographics, religiosity, masculinity) provided evidence of validity. Findings suggesting a two-factor instead of a three-factor solution may indicate that the IHNI manifests differently for AAMSM in the Deep South than for predominantly White MSM. Further research should examine how incorporating new conceptions of internalized homonegativity into culturally specific health-promotion interventions for AAMSM might enhance effectiveness.
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Affiliation(s)
- Stacy W Smallwood
- a Department of Community Health Behavior and Education , Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro , Georgia , USA
| | - S Melinda Spencer
- b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Lucy Annang Ingram
- b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Jim F Thrasher
- b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Melva V Thompson-Robinson
- c Department of Health Promotion, School of Public Health , University of Nevada , Las Vegas , Nevada , USA
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