Adults In Baltimore Research Articles

Abstract MP08: Effects of Arm Position and Support on the Accuracy of Blood Pressure Readings: The Arm Rest and Support (ARMS) Trial

Background: Based on studies using mercury sphygmomanometers, arm support is recommended when measuring blood pressure (BP) to keep the cuff at heart level and prevent flexion of arm muscles. Still, BP is commonly measured without arm support, e.g. with the arm resting on the lap or hanging on the side, and the impact when using automated BP devices is unknown. Methods: We conducted a randomized crossover trial of among community dwelling adults in Baltimore, MD. Participants were randomly assigned to sets of triplicate BP measurements with the arm positioned in 3 ways: supported on a desk (desk1 [reference]); hand supported on lap (lap), and arm hanging at side unsupported (side). To account for intrinsic BP variability, all participants underwent a 4th set of BP measurements with the arm supported on a desk (desk2). Between each set of triplicate measurements participants walked for 2 minutes, then rested for 5 minutes prior to BP measurement with a WelchAllyn ProB 2000, using an appropriately sized cuff. We conducted difference-in-difference analysis overall and stratified by baseline systolic BP (SBP≥ vs. < 130mmHg) and age (≥ vs. <60yrs) Results: N=134, mean age 56 (SD 17) years, 78% Black race, and 52% female. 48 participants had SBP ≥130mmHg, 53% were ≥60 years. Overall, mean desk1 and desk2 BP was 126/74 each (Δ= -0.12; Table). Lap and side were greater than desk1 (Table) with the difference in differences significantly greater for both conditions [lap: SBP Δ 3.8 mmHg (95% CI:2.5, 5.2)/ DBP Δ 4.1 (95% CI:3.1, 5.0); side: SBP Δ 6.4 (95% CI:5.0, 7.9)/ DBP Δ 4.6 (95% CI:3.6, 5.5)]. The patterns were generally consistent across subgroups by SBP and age. Conclusion: Commonly used arm positions, i.e. the arm resting on the lap or hanging on the side, resulted in substantial overestimation of BP reading when using an automated device which may lead to patient misdiagnosis and overestimation of the population prevalence of hypertension. Every effort should be made to optimize arm support, even in resource-limited settings.

Abstract P319: Effects of Environment and Noise on Blood Pressure Readings: The (Decibel(s)) Trial

Background: While guidelines emphasize quiet settings for blood pressure (BP) measurement, large-scale hypertension screening is often conducted in noisy, public spaces (e.g., health fairs). However, the influence of noise and environment on BP readings is unknown. Methods: We conducted a randomized crossover trial of community dwelling adults in Baltimore, MD to determine the BP effect of noise and public environment. Participants were randomly assigned to the order of triplicate BPs in 3 spaces: private quiet office (private quiet 1 [reference]); noisy public space (public loud); noisy public space + earplugs (public quiet). To account for intrinsic BP variability, all participants underwent a 4th set of BP measurements in a private quiet office (private quiet 2 ). Between each set of triplicate BPs with a WelchAllyn ProB 2000 device and appropriately sized cuff, participants walked for ≥2 minutes, rested for 5 minutes, and had arm/back/feet supported. We conducted difference in difference analysis, overall and stratified by baseline SBP (≥ vs. < 130mmHg) and age (≥ vs. <60yrs). Results: N=108, mean age 56 (SD 17) yrs (55% ≥60 years), 91% Black race, and 44% female. 45% had SBP≥130mmHg. Mean private quiet 1 and private quiet 2 BP was 129/74 and 127/74 mmHg (SBPΔ -1.6 (SD 7.1)/DBPΔ -0.2 (SD 4.0)). The average noise level in public loud was 74 db and in private quiet was 37 db. Public loud and public quiet BPs were slightly different than private quiet 1 BPs, with difference in differences minimal (Table): [Public loud: SBPΔ 0.97 mmHg (95%CI: -0.61, 2.55)/DBPΔ 1.86 mmHg (95%CI: 0.94, 2.78); Public quiet: SBPΔ 1.72mmHg (95%CI: 0.05, 3.39)/DBPΔ 1.66 mmHg (95%CI: 0.79, 2.54)]. The patterns were generally consistent across subgroups by SBP and age. Conclusion: BP readings in noisy public spaces resulted in small overestimation of BP compared to readings in a quiet private office, but the difference was minimal. Large-scale hypertension screening programs in public loud places may be an acceptable option, especially in low resource settings.

Race by Education Intersectional Differences in Exposure to Tobacco Advertisement in Baltimore City.

This study aimed to examine the intersectional effects of race and educational attainment on tobacco advertising exposure among adults in Baltimore, given the growing evidence on differential influence of education for Black and White populations. A survey was conducted in Baltimore, collecting data on educational attainment, demographics, and tobacco advertising exposure among adults (n = 3028, 22.7% 18 - 29, 17.9% 30 - 39, 23.4% 40 - 49, 20.9% 50-59, and 11.1% 60+ years old). The sample included both Black and White adult individuals. Logistic regression analyses were employed to assess the association between educational attainment and tobacco advertising exposure, without and with interaction with race, adjusting for relevant covariates such as age, gender, and employment. Sensitivity analysis also controlled for smoking status. The study results indicated that while high educational attainment is associated with less exposure to tobacco ads, highly educated Black adults report significantly higher tobacco advertising exposure compared to highly educated White adults. Same results were observed after controlling for smoking status. Educational attainment may not exhibit a large protective effect against environmental risks such as tobacco ad exposure for Black populations, possibly because of segregation and racism that hinder highly educated Black people ability to move to low-risk neighborhoods.

Effects of Neighborhood Disconnection on Psychological Distress and Suicide Risk Associated with Interpersonal Violence Within Racial Groups.

Negative mental health outcomes have been associated with adverse childhood experiences (ACEs) and intimate partner violence (IPV); however, few studies have identified risk and protective factors across levels of the social ecology that mitigate the onset of psychological distress and suicide risk associated with trauma. This study examines the relationship between ACEs, IPV, and mental health (i.e., psychological distress, suicidal ideation, and suicide attempts) within racial sub-populations of Black American, Latinx, and White adults.An online, cross-section survey was administered to a general population sample of adults in Baltimore and New York City. ACEs, IPV, and mental health outcomes were assessed within racial sub-populations of Black American (N = 390), Latinx (N = 178), and White (N = 339) adults, while accounting for within-group demographic differences. Moderating effects of social support and neighborhood disconnection on the relationship between ACEs, IPV, and mental health outcomes were also assessed.IPV was associated with psychological distress and suicidal ideation for Black and Latinx adults, but not for White adults. ACEs were associated with increased psychological distress for all three groups, and increased odds for suicidal ideation among Black and Latinx adults.. A significant negative interaction effect for neighborhood disconnection was found in the relationship between ACEs and psychological distress for Black adults.Findings highlight the significant mental health burdens of ACEs and IPV within racial and ethnic groups. Neighborhood disconnection may exacerbate psychological distress associated with ACEs among populations most impacted by interpersonal violence and mental health inequalities.

The Graying of the Cool Pose: Examining Active Care Strategies Among Older African-American Men With Type 2 Diabetes Mellitus.

The influence of masculinity norms on disparate health outcomes has been established in the literature. What is less understood are the specific ways in which African-American men "do health" by engaging in strategies promoting positive health outcomes. This article reframes what has been previously examined through a health deficit perspective by reporting the experiences and positive health maintenance strategies of older, African-American men with type 2 diabetes mellitus (diabetes). We employed an intersectional framework to thematically analyze qualitative interviews with African-American male participants (N = 15) in our National Institute on Aging-funded study of diabetes among older adults in Baltimore. Interviews consisted of a modified version of the McGill Illness Narrative Interview, which included discussions of diabetes experiences and self-management strategies. The majority of African-American men in our study link their successful diabetes management to purposeful self-care activities, despite structural and personal limitations. These activities include proactively seeking diabetes education, healthy eating, medication management, and engaging in supportive relationships. Active pursuit of a healthy lifestyle often requires redefining Black manhood, defying negative gender stereotypes of what it means to be a Black male. Results are described in the context of the "Cool Pose," a framework for understanding how African-American men and boys cope with systemic racial oppression and the unachievable dominant standards of masculinity in the United States. The results suggest that this framework may be less applicable for older African-American men who promote well-being in the wake of chronic disease as they age.

104 COVID-19 Exposure and Care-Seeking Behaviors Among Vulnerable Urban Adolescents and Young Adults–Baltimore, Maryland USA

OBJECTIVES/GOALS: This study seeks to determine the relationship between fear of COVID-19 infection and care-seeking behaviors including provider visit and telemedicine utilization among vulnerable adolescent and young adults in Baltimore, Maryland METHODS/STUDY POPULATION: Participants enrolled in the COVID-19 Youth study were 13-25 years old and recruited from four existing sexual health studies based in Baltimore, MD which focused on 1) PID, 2) HIV, 3) emerging sexually transmitted infections, and 4) a dyadic STI prevention, respectively. Participants agreed to be re-contacted for future studies and completed a telephone survey developed to inquire about the impacts of COVID-19 on care seeking behaviors. Bivariate analyses tested for correlations between fear of COVID-19 infection, demographic variables, and care-seeking behaviors. Multivariable logistic regression modeled associations between fear of COVID-19 infection and care-seeking behaviors. RESULTS/ANTICIPATED RESULTS: Adjusted multivariable logistic regression revealed a statistically significant association between fear of COVID-19 infection and having a provider visit; AYA who feared COVID-19 were at greater than two times increased odds of a provider visit compared to AYA who did not fear COVID-19 infection (OR: 2.37, 95%CI: 1.02, 6.15). Among those with a provider visit, fear of COVID-19 infection was associated with two-fold increased odds of having a telemedicine visit vs. an in-person visit (OR: 2.23, 95%CI: 1.09, 4.51), however this was not statistically significant in the adjusted model. There were however significant associations detected in the adjusted model for HIV status, insurance type and telemedicine utilization respectively. DISCUSSION/SIGNIFICANCE: This study demonstrates the ongoing need for health services during the recent pandemic and overall willingness of AYA to utilize telemedicine. Given the sexual health disparities faced by AYA, who bear more than half of the 50 million STI cases in the US, optimizing services for AYA is essential and consistent with new laws expanding telehealth use.

Innovative educational approaches to house calls in the time of COVID-19.

Innovative educational approaches to house calls in the time of COVID-19.

Police Violence and Associations With Public Perceptions of the Police

Objective: Police violence (PV) continues to be a national and global concern. Empirical inquiries focus on its prevalence, those who are most at risk, and associated mental health effects and frequently include all-male samples. Studies also tend to narrowly measure PV as incidents of physical force or fatal encounters. Our study examined these gaps in knowledge by exploring police neglect and psychological, physical, and sexual violence perpetrated by police to examine how these forms of PV relate to perceptions of police legitimacy/trust, police effectiveness, and police performance. Method: Using data from the 2017 Survey of Police–Public Encounters—a cross-sectional, demographically representative survey of adults in Baltimore, MD, and New York, NY —we assessed detailed forms of PV using the Police Practices Inventory. Results: Regression results indicated that most forms of PV were significantly and inversely associated with police perceptions. Individuals exposed to PV who were younger, female, had lower levels of education and income, identified as a racial/ethnic minority, and were born in the United States held more negative police perceptions. Conclusions: Findings provide insight into the ways specific forms of PV exposure influence how the police are perceived and how those perspectives vary across demographic factors.

98. Getting Low-Income Adolescents and Young Adults in Baltimore Out of Transportation Deserts: Use of Ride-Sharing Services Before And During COVID-19 Pandemic

One third of Baltimore adolescents and young adults (AYA) live in poverty and in families without a car. Half of Baltimore’s AYA receive annual well visits despite significant health disparities. Access to care is further complicated by a cumbersome public transportation system leaving AYA without reliable transportation. Commercial ride-share services may be inaccessible due to neighborhood safety or cost. Public safety measures during the COVID-19 pandemic have further complicated AYA access to care and public transportation.

Abstract A013: “You can’t escape tobacco; you have to change your environment”: Perceived barriers to and recommendations for cessation among polytobacco using urban young adults in Baltimore, Maryland

Abstract Background/Purpose: Polyuse of tobacco products is increasing among urban young adults. Understanding different use profiles and the obstacles that this population faces in an attempt to quit smoking is important to inform effective cessation programs. We explored perceived barriers to tobacco cessation and recommendations for/interest in cessation programs among urban young adult polytobacco users. Methods/Approach: 17 focus groups were conducted among 97 tobacco users between the ages of 18 and 26 from Baltimore, Maryland. Qualitative data were analyzed using framework analysis. Results/Findings: All participants reported a history of tobacco product polyuse, and 85% reported polyuse in the past 30 days. Several barriers to tobacco cessation emerged, including: influence of social network, easy access, source of stress relief (anxiety management), belief in self-control (ability to stop on own if desired), and boredom. Most participants reported little interest in or success with standard pamphlet-based and in-person cessation programs, but did view mobile-based cessation programs favorably. Discussions suggested that the ideal program would be quick, interactive, and would provide tailored prompts along the way, delivering cues to action. Conclusions/Significance: Given the higher prevalence of polyuse in comparison to single use for this population, tobacco cessation interventions targeting urban young adults may need to account for polyuse of tobacco. Results from this study indicate that this population faces multiple barriers to cessation, but that there is interest in utilizing mobile-based interventions and social media for cessation attempts, ultimately allowing them to manage cessation in their own time, and is more fitting of their lifestyle. Citation Format: Daisy Le, Gypsyamber D'Souza, Rebkha Atnafou, Meghan B. Moran. “You can’t escape tobacco; you have to change your environment”: Perceived barriers to and recommendations for cessation among polytobacco using urban young adults in Baltimore, Maryland [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A013.

The Health Impact of Alcohol on American Cities: Modeling the Local Burden of Current Alcohol Use in One Jurisdiction.

Measurement of alcohol use and associated harms at the city level is often incomplete or non-existent even though such data are often critical to informing local prevention strategies. This paper models how to generate local estimates of the morbidity, mortality, and cost of current alcohol use instead of abstaining. Administrative data sources, including medical examiner records, hospital records, and police records, among others, were used to obtain local estimates of alcohol-attributable outcomes. In 2018, we used alcohol-attributable fractions and scaled national estimates to quantify the burden of current alcohol use in Baltimore, MD, in 2013. Fifty-two percent of Baltimore adults reported past 30-day drinking. There were 276 alcohol-attributable deaths in 2013, and 106 (38.4%) of these were persons other than the drinker. In 2013, current alcohol use cost $582.3 million in Baltimore City. This burden was distributed across drinkers (40.1%), persons other than the drinker (21.3%), and the government (38.6%). It is possible to quantify this burden at the local level, and these data could be used to inform evidence-based alcohol policy strategies at the local level.

Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults in Baltimore, Maryland.

Adults with perinatally acquired human immunodeficiency virus (PHIV) infection may be at increased risk for nonacquired immunodeficiency syndrome (AIDS) diseases, including systemic hypertension (HTN). The purpose of this study was to examine the prevalence of HTN among young adults with PHIV compared with recently infected and uninfected young adults. We conducted a cross-sectional study of young adults with PHIV, frequency matched on race and sex to a stratified random sample of young adults with nonperinatally acquired HIV (NPHIV) and HIV-uninfected young adults. All of the subjects were aged 18 to 29 years. HTN was defined as two systolic blood pressure measurements ≥140 mm Hg or diastolic ≥90 mm Hg at least 3 months apart and/or prescription for an antihypertensive medication. Logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals (CIs) for the association between HIV infection and HTN. A total of 324 patients were included-108 per exposure group. The prevalence of HTN was 23% among individuals with PHIV, 10% among individuals with NPHIV, and 8% among HIV-uninfected patients. PHIV patients had 3.4 (95% CI 1.48-7.66) times the base odds of having HTN compared with HIV-uninfected patients, and 2.7 (95% CI 1.23-5.71) times the odds compared with NPHIV patients. By multivariable analysis, PHIV patients had 4.7 and 2.9 times the odds of having HTN compared with HIV-uninfected patients and NPHIV patients, respectively, after controlling for sex, race, and family history of hypertension. Our findings suggest that HTN prevalence among PHIV young adults is significantly higher than sex- and race-matched NPHIV and HIV-uninfected patients of similar age.

Polyneuritis and Rare Sequelae of Leptospirosis Contracted While on an Urban Clean-Up Mission in Detroit : A Case Report of Weil’s Disease and Literature Review

Leptospirosis is a common zoonosis, an infectious disease that infects both humans and animals, which is caused by spirochete bacteria from genus Leptospira . Approximately 30% of children in urban Detroit and 16% of adults in Baltimore demonstrated serologic evidence of previous leptospirosis infections. The Detroit study showed correlation between degree of rat infestation and seropositivity rates. This finding suggests rats are major vectors for human leptospirosis in mainland United States. The leptospires from infected animals survive best in fresh water, damp alkaline soil, vegetation, and mud with temperatures higher than 22 °C. Although leptospirosis is a well documented clinical condition, the sequelae of polyneuritis has not yet been reported to our knowledge. The following case is an example of such an occurrence. A 49-year-old Caucasian female presented to the emergency department with flu-like symptoms after volunteering in an urban Detroit neighborhood clean-up project. She admitted to picking up wood from stagnant water without wearing personal protective equipment. The primary differential diagnosis being Weil’s disease from leptospirosis and was proven positive with serologic testing via the Center for Disease Control. A computed tomography (CT) abdomen and pelvis demonstrated lymphadenopathy throughout the abdomen and near the spinal column. She was treated with ceftriaxone and doxycycline for 12 days but developed chronic neuralgia and polyneuritis. Leptospires are known to cause vasculitis. This patient developed polyneuritis either from direct invasion of the nerves from leptospires or compromised blood supply to the nerves. In addition to antibiotics, patients with severe cases of leptospirosis also require supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis may reduce mortality. Rapid identification of symptoms and a high clinical suspicion are paramount because early intervention can save their life. J Med Cases. 2019;10(6):183-187 doi: https://doi.org/10.14740/jmc3320

Vitamin D Status and Intakes and Their Association With Cognitive Trajectory in a Longitudinal Study of Urban Adults.

Serum 25-hydroxyvitamin D [25(OH)D], and dietary and supplemental vitamin D may influence cognitive outcomes. Sex-, age-, and race-specific associations of vitamin D status and intake with longitudinal change in various cognitive domains were examined in a large sample of ethnically and socioeconomically diverse US urban adults. Two prospective waves of data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study were used. Adults in Baltimore, Maryland, aged 30 to 64 years at baseline (n = 1231 to 1803), were followed for a mean (± standard deviation) of 4.64 ± 0.93 years. Visit 1 occurred between 2004 and 2009; visit 2, between 2009 and 2013; there were 1.5 to 2.0 visits per participant. Cognitive performance was assessed using 11 test scores covering domains of global cognition, attention, learning/memory, executive function, visuospatial/visuoconstruction ability, psychomotor speed, and language/verbal. Serum 25(OH)D, vitamin D intake, and use of supplements containing vitamin D were the key exposures. A consistent relationship was found between vitamin D status (overall) and supplemental intake (older women and black adults), with a slower rate of decline in the domain of verbal fluency. Higher dietary intake of vitamin D was linked to slower rate of decline in verbal memory among younger women, and a slower rate of decline in visual memory/visuoconstructive abilities among white adults. All other associations were inconsistent. Vitamin D status and intakes were inversely related to domain-specific cognitive decline in US urban adults.

Using Sensitivity Analyses for Unobserved Confounding to Address Covariate Measurement Error in Propensity Score Methods.

Propensity score methods are a popular tool with which to control for confounding in observational data, but their bias-reduction properties-as well as internal validity, generally-are threatened by covariate measurement error. There are few easy-to-implement methods of correcting for such bias. In this paper, we describe and demonstrate how existing sensitivity analyses for unobserved confounding-propensity score calibration, VanderWeele and Arah's bias formulas, and Rosenbaum's sensitivity analysis-can be adapted to address this problem. In a simulation study, we examine the extent to which these sensitivity analyses can correct for several measurement error structures: classical, systematic differential, and heteroscedastic covariate measurement error. We then apply these approaches to address covariate measurement error in estimating the association between depression and weight gain in a cohort of adults in Baltimore, Maryland. We recommend the use of VanderWeele and Arah's bias formulas and propensity score calibration (assuming it is adapted appropriately for the measurement error structure), as both approaches perform well for a variety of propensity score estimators and measurement error structures.

“They Just Say Organic Food Is Healthier”: Perceptions of Healthy Food among Supermarket Shoppers in Southwest Baltimore

AbstractTo discover how organic food factors into low‐income consumers’ overall understanding of healthy eating, we analyzed 36 in‐depth interviews with adults in Baltimore, Maryland. We asked participants to discuss their understanding of healthy eating. Unprompted, many participants discussed organic food or attributes commonly understood to define organic food. Some participants believed health issues including cancer, weight gain, and allergies can arise from consuming nonorganic foods. Participants expressed that organic competes with other food attributes such as nutrient content in informing their perception of whether a food is healthy. Several voiced concern that nonorganic foods are responsible for weight gain and abnormal development. Our results show that despite limited access, organic is an important factor in some consumers’ understanding of healthy food. Consumers’ perceptions of organic can swamp or compete with other messages about healthy eating. Therefore, consumers’ understanding of organic should be considered in developing diet‐related messages and programs.

Gender-based screening for chlamydial infection and divergent infection trends in men and women.

ObjectivesTo assess the potential impact of chlamydial screening policy that recommends routine screening of women but not men.MethodsPopulation surveys of probability samples of Baltimore adults aged 18 to 35 years in 1997–1998 and 2006–2009 collected biospecimens to estimate trends in undiagnosed chlamydial infection. Survey estimates are compared to surveillance data on diagnosed chlamydial infections reported to the Health Department.ResultsPrevalence of undiagnosed chlamydial infection among men increased from 1.6% to 4.0%, but it declined from 4.3% to 3.1% among women (p = 0.028 for test of interaction). The annual (average) number of diagnosed infections was substantially higher among women than men in both time periods and increased among both men and women. Undiagnosed infection prevalence was substantially higher among black than non-black adults (4.0% vs 1.2%, p = 0.042 in 1997–98 and 5.5% vs 0.7%, p<0.001 in 2006–09).ConclusionDivergent trends in undiagnosed chlamydial infection by gender parallel divergent screening recommendations that encourage chlamydial testing for women but not for men.

Building a Navigation System to Reduce Cancer Disparities Among Urban Black Older Adults

Although cancer outcomes have improved in recent decades, substantial disparities by race, ethnicity, income, and education persist. Increasingly, patient navigation services are demonstrating success in improving cancer detection, treatment, and care and in reducing cancer health disparities. To advance progress in developing patient navigation programs, extensive descriptions of each component of the program must be made available to researchers and health service providers. We sought to describe the components of a patient navigation program designed to improve cancer screening based on informed decision making on cancer screening and cancer treatment services among predominantly Black older adults in Baltimore City. A community-academic participatory approach was used to develop a patient navigation program in Baltimore, Maryland. The components of the patient navigation system included the development of a community academic (advisory) committee (CAC); recruitment and selection of community health workers (CHWs)/navigators and supervisory staff, initial training and continuing education of the CHWs/navigators, and evaluation of CHWs/navigators. The study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. The incorporation of community-based participatory research principles into each facet of this patient navigation program facilitated the attainment of the intervention's objectives. This patient navigation program successfully delivered cancer navigation services to 1,302 urban Black older adults. Appropriately recruited, selected and trained CHWs monitored by an experienced supervisor and investigators are the key elements in a patient navigation program. This model has the potential to be adapted by research and health service providers.

Natural History of Anal vs Oral HPV Infection in HIV-Infected Men and Women

Human immunodeficiency virus (HIV)-infected individuals are at greater risk for human papillomavirus (HPV)-associated anal than oropharyngeal cancers. The prevalence of anal vs oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown. Oral rinse and anal swab samples were collected semiannually from 404 HIV-infected adults in Baltimore, Maryland. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models. The prevalence (84% vs 28%), incidence (145 vs 31 per 1000 person-months), and 12-month persistence (54% vs 29%) were higher for anal vs oral HPV infections, respectively (each P < .001). Heterosexual men had lower incidence of anal HPV than men who have sex with men and women, but a higher incidence of oral HPV infection (test of interaction P < 0.001). In adjusted analyses, risk factors for HPV persistence included prevalent vs incident (adjusted hazard ratio [aHR] = 4.0; 95% confidence interval [CI], 3.5-4.8) and anal vs oral HPV infections (aHR = 1.5; 95% CI, 1.2-1.9). The higher incidence and persistence of anal vs oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV-infected individuals.

Intraindividual variability in psychometrically defined mild cognitive impairment status in older African Americans.

This study examines day-to-day variability in psychometrically defined mild cognitive impairment (MCI) status and potential predictors of changes in MCI status in an independent-living sample of urban dwelling older adults in Baltimore, Maryland. The participant sample consisted of 50 older adults, ranging in age from 50 to 80 years. Participants completed health and cognitive measures (i.e., executive function, language, memory, and global cognition) over 8 occasions within a 2-3-week period. After each testing occasion, a post hoc classification of MCI status was determined using psychometrically defined criteria based on cognitive performance. Participants who classified as MCI after one assessment often did not meet MCI criteria at subsequent occasions. Daily fluctuations in sleep duration were associated with an increased risk for MCI classification. These results demonstrate that changes in sleep may explain changes in MCI status, particularly for African Americans.