Atlanta Area Research Articles

Open Defecation Sites, Unmet Sanitation Needs, and Potential Sanitary Risks in Atlanta, Georgia, 2017-2018.

To survey the spatial distribution and enteric pathogen profile of discarded human feces in the city of Atlanta, Georgia. After defining priority search areas in central Atlanta, we conducted 5 searches of open defecation sites totaling 15 hours during the period from October 2017 to January 2018. We collected fresh stools for analysis via multiplex reverse-transcription polymerase chain reaction to identify presence of 15 common parasitic, bacterial, and viral enteric pathogens. We identified and mapped 39 open defecation sites containing 118 presumptive human stools; 23% of the 26 collected fresh stools tested positive for 1 or more pathogens. An estimated 12% of stools were positive for enterotoxigenic Escherichia coli, 7.7% for Giardia spp., 3.8% for norovirus, and 3.8% for Salmonella spp. The majority (92%) of identified open defecation sites were within 400 meters of a shelter or soup kitchen. Though this study was constrained by a small sample size, results suggest that open defecation in Atlanta is common and may pose risks to public health. Public Health Implications. Open defecation may pose health risks to people experiencing homelessness and the general public.

Pedagogic Paths to Liberation: Personal Struggles, Institution Building and the Rise of the Walter Rodney School of Groundings Praxis in Atlanta

Dr. Seneca Vaught interviewed Dr. Jesse Benjamin about his personal pedagogical background and process, its intersections with activism and scholarship, and how this led him to working with the Walter Rodney Foundation and various associated projects in the Atlanta area. The discussion moves from research at a radical experimental Quaker international college, to activism and research in upstate New York, at Binghamton University, and finally to work as an engaged community professor in Atlanta. Also covered are the establishment of a Coloniality Research Working Group and a Walter Rodney Study Group in New York, and the influence of Sylvia Wynter. The discussion concludes with an overview of institution building activities in Atlanta, conjecturing the rise of Walter Rodney School of Praxis.

Outcomes of and risk factors for presumed canine H3N2 influenza virus infection in a metropolitan outbreak.

OBJECTIVE To determine clinical signs, case fatality rate, and factors associated with positive results of PCR testing for canine influenza virus (CIV) in dogs during an H3N2 CIV outbreak in the Atlanta area. DESIGN Cross-sectional study. ANIMALS 220 dogs with a nasal swab specimen submitted to an Atlanta-area diagnostic laboratory between May 1 and July 2, 2015, for PCR assay detection of CIV specifically or CIV and 5 other respiratory pathogens. PROCEDURES Veterinarians of tested dogs were surveyed by various means to collect information regarding clinical signs, survival status at the time of survey completion, vaccination history (≤ 12 months prior to testing), and travel history (≤ 2 months prior to testing). Data were compared between CIV-positive and CIV-negative dogs. RESULTS Surveys for 120 (55%) dogs were completed. Forty (33%) of these dogs had positive results of CIV testing. No significant differences were identified between CIV-positive and CIV-negative dogs regarding breed, sex, reproductive status, duration of clinical signs prior to testing, other dogs in the household, or travel history. When other factors were controlled for, CIV-positive dogs were more likely to be adult (> 1 year of age) than juvenile (≤ 1 year of age) and to be inappetent. Only 1 (3%) CIV-positive dog died during the study period (shortly after it was evaluated because of respiratory signs). CONCLUSIONS AND CLINICAL RELEVANCE From May 1 to July 2, 2015, the reported clinical signs of dogs tested during the Georgia H3N2 CIV outbreak were similar to those reported for dogs with H3N8 CIV infection, and the case fatality rate was low.

Old Wine in Private Equity Bottles? The Resurgence of Contract‐for‐Deed Home Sales in US Urban Neighborhoods

AbstractThis article describes the reemergence, in the wake of the mortgage crisis, of a predatory financial practice in predominantly black neighborhoods in the US: the contract for deed (CFD). The CFD has a notorious urban history; it was a focus of social justice organizing in 1960s Chicago, which helped lay the groundwork for advocacy that culminated in two important laws in the US: the Home Mortgage Disclosure Act of 1975 and the Community Reinvestment Act of 1977. This article places the reemergence of the CFD in the post‐crisis cycle of housing investment and disinvestment, estimates the minimum scale of CFD ownership, and examines the geography of a well‐known CFD seller in the Atlanta area. As policymakers in the US took efforts to restrict predatory lending fueled by private‐label securitization following the subprime crisis, capital markets shifted toward private equity financiers who provided a new supply of lightly regulated capital for urban housing markets. Predominantly black neighborhoods became prey for high‐return schemes meant to extract as much cash flow out of vulnerable residents as possible, offering them the illusion of homeownership. The findings show that the CFD seller focused on black neighborhoods and suggests that its profits from this activity have been quite lucrative.

School principals’ perceptions of their roles and responsibilities in the city of Rzeszów and Atlanta area

School principals’ perceptions of their roles and responsibilities in the city of Rzeszów and Atlanta area

How Contact Experiences Shape Welcoming: Perspectives from U.S.-Born and Immigrant Groups

This research examines how intergroup contact experiences—including both their frequency and their qualities (friendly, discriminatory)—predict indicators of welcoming among U.S.-born and immigrant groups. Analyzing a new survey of U.S.-born groups (whites and blacks) and immigrant groups (Mexicans and Indians) from the Atlanta and Philadelphia metropolitan areas (total N = 2,006), we examine welcoming as a key dimension of social integration. Along with reporting their contact experiences, survey respondents indicated the extent to which they are inclined to welcome and feel welcomed by each of the other groups. Results consistently demonstrated that greater contact frequency predicted greater tendencies to welcome and feel welcomed by each of the other groups. These effects persisted even when demographic characteristics, perceived discrimination, and exposure are included as predictors in the models. Findings also suggested that racial and nativity hierarchies shape how perceived discrimination predicts welcoming others and feeling welcomed by others.

Predictors of Breast Cancer Screening Among Korean American Women: Is Having an Annual Checkup Critical?

Objective:Korean American (KA) immigrant women underutilize breast cancer screening. This study examined factors predicting breast cancer screening behavior among KA women in the United States.Methods:233 KA women aged 19 to 85 were recruited in the metro area of Atlanta, Georgia. Andersen’s behavioral model theoretically guided the study.Result:Of the predisposing factors, age (OR=1.043, p<.01, 95% CI [1.017, 1.069]) and marital status (OR=2.154, p<.05, 95% CI [1.022, 4.539]) were significantly associated with clinical breast exam (CBE), while income (OR=2.289, p<.05, 95% CI [1.060, 4.945]) and annual checkup (OR=2.725, p<.01, 95% CI [1.342, 5.533]) were linked to CBE as enabling factors. For the receipt of mammographic screening, annual checkup was only significantly associated among enabling factors (OR=4.509, p<.05, 95% CI [1.263, 16.102]), while family cancer history was identified as the only significant need factor (OR=.112, p<.01, 95% CI [.023, .552]).Conclusion:Differing factors explained the receipt of CBEs and mammographic use among KA women. Specifically, the findings shed light on the importance of having an annual checkup for the uptake of both CBEs and mammographic use. Intervention strategies should focus on promoting health accessibility for KA women to adhere to recommended breast cancer screening.

Valuation of energy efficient certificates in buildings

Building energy efficiency labeling programs are promising strategies to encourage investments in green buildings. It is necessary to explicitly measure the value of energy efficient labels from an economic perspective that is more understandable to both developers and buyers. This research not only documents evidence on whether a sales premium exists for energy-certified homes but also investigates the effects of market characteristics on the magnitude of the added value of building energy efficiency labeling programs. A hedonic pricing model of 1679 single-family home sales in the metropolitan Atlanta area in the U.S. is developed, with numerous explanatory variables (such as location, time of sale, green features, and other housing characteristics) taken into account. Results indicate that: (i) Homes that earn energy certificates demonstrate a sales price premium of 11.7%, which equates to a dollar value of over $47,000 in Atlanta’s housing market; (ii) The regional energy labels certificated by the EarthCraft House receives higher recognition in the marketplace than that by national Energy Star programs. (iii) The certified homes that are located in the top school districts (i.e., with the top 50 schools) enjoy a substantially higher increase in the home sales premium, compared to green homes in districts with the low-quality schools. A random sampling method is further used to ensure the quality of the regression results with the limited size of the dataset by eliminating stochastic effects of the selected dataset. This research contributes to (i) the body of knowledge by analyzing the market value of building energy efficiency labels in the residential housing market and (ii) the state of practice by shedding light on the information asymmetry problem between home developers and buyers in the housing market to facilitate the adoption of energy labels in building products.

Inflammatory responses to secondary organic aerosols (SOA) generated from biogenic and anthropogenic precursors

Abstract. Cardiopulmonary health implications resulting from exposure to secondary organic aerosols (SOA), which comprise a significant fraction of ambient particulate matter (PM), have received increasing interest in recent years. In this study, alveolar macrophages were exposed to SOA generated from the photooxidation of biogenic and anthropogenic precursors (isoprene, α-pinene, β-caryophyllene, pentadecane, m-xylene, and naphthalene) under different formation conditions (RO2 + HO2 vs. RO2 + NO dominant, dry vs. humid). Various cellular responses were measured, including reactive oxygen and nitrogen species (ROS/RNS) production and secreted levels of cytokines, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). SOA precursor identity and formation condition affected all measured responses in a hydrocarbon-specific manner. With the exception of naphthalene SOA, cellular responses followed a trend where TNF-α levels reached a plateau with increasing IL-6 levels. ROS/RNS levels were consistent with relative levels of TNF-α and IL-6, due to their respective inflammatory and anti-inflammatory effects. Exposure to naphthalene SOA, whose aromatic-ring-containing products may trigger different cellular pathways, induced higher levels of TNF-α and ROS/RNS than suggested by the trend. Distinct cellular response patterns were identified for hydrocarbons whose photooxidation products shared similar chemical functionalities and structures, which suggests that the chemical structure (carbon chain length and functionalities) of photooxidation products may be important for determining cellular effects. A positive nonlinear correlation was also detected between ROS/RNS levels and previously measured DTT (dithiothreitol) activities for SOA samples. In the context of ambient samples collected during summer and winter in the greater Atlanta area, all laboratory-generated SOA produced similar or higher levels of ROS/RNS and DTT activities. These results suggest that the health effects of SOA are important considerations for understanding the health implications of ambient aerosols.

Demand for new cities: Property value capitalization of municipal incorporation

This paper investigates property value capitalization of municipal incorporation. Using detailed data from the metropolitan Atlanta area, our empirical strategy combines difference-in-differences hedonics with a relatively underutilized matching method from the class of monotonic imbalance bounding methods that approximates a fully blocked randomized experiment. We find that new city formation is positively capitalized into property values within the new city, increasing 4–5% in the two years following new city formation compared to the two years prior and 12–13% over the entire analysis period. The results also indicate that capitalization is stronger for parcels with greater potential for redistribution.

Contract for Deed: Trends in Atlanta and Other Southeastern Metropolitan Areas

Contract for Deed: Trends in Atlanta and Other Southeastern Metropolitan Areas

The Link Between Local Comprehensive Plans and Housing Affordability: A Comparative Study of the Atlanta and Detroit Metropolitan Areas

Problem, research strategy, and findings: I question whether the strength of affordable housing policies in local comprehensive plans is associated with better affordable housing outcomes, which I measure as a decrease in the share of low-income households who spend more than 30% of their income for housing, otherwise known as cost-burdened households. I first assess the strength of affordable housing policies in 58 local comprehensive plans, counting the number of—and degree of coercion in—those affordable housing policies. I then analyze the relationship between the strength of affordable housing policies and changes in the share of low-income households with cost burden. I find that the strength of affordable housing policies is higher in the Atlanta (GA) metropolitan area than in the Detroit (MI) metropolitan area. I also find that the strength of affordable housing policies is positively associated with a decrease in the share of low-income households paying more than 30% of their income for housing in the Atlanta metropolitan area. I do not find a comparable relationship between plan strength and housing outcomes in the Detroit metropolitan area. I also find that the state role matters: Georgia provides more support and guidance for local comprehensive planning, and for affordable housing policies in those plans, than does Michigan.Takeaway for practice: Planners should continually promote local comprehensive plans that include more and stronger affordable housing policies and advocate for greater state support for comprehensive planning and affordable housing policies because these appear to lead to a greater likelihood of implementing stronger plans.

Heat in the southeastern United States: Characteristics, trends, and potential health impact.

High summer temperatures in extratropical areas have an impact on the public’s health, mainly through heat stress, high air pollution concentrations, and the transmission of tropical diseases. The purpose of this study is to examine the current characteristics of heat events and future projections of summer apparent temperature (AT)–and associated health concerns–throughout the southeastern United States. Synoptic climatology was used to assess the atmospheric characteristics of extreme heat days (EHDs) from 1979–2015. Ozone concentrations also were examined during EHDs. Trends in summer-season AT over the 37-year period and correlations between AT and atmospheric circulation were determined. Mid-century estimates of summer AT were calculated using downscaled data from an ensemble of global climate models. EHDs throughout the Southeast were characterized by ridging and anticyclones over the Southeast and the presence of moist tropical air masses. Exceedingly high ozone concentrations occurred on EHDs in the Atlanta area and throughout central North Carolina. While summer ATs did not increase significantly from 1979–2015, summer ATs are projected to increase substantially by mid-century, with most the Southeast having ATs similar to that of present-day southern Florida (i.e., a tropical climate). High ozone concentrations should continue to occur during future heat events. Large urban areas are expected to be the most affected by the future warming, resulting from intensifying and expanding urban heat islands, a large increase in heat-vulnerable populations, and climate conditions that will be highly suitable for tropical-disease transmission by the Aedes aegypti mosquito. This nexus of vulnerability creates the potential for heat-related morbidity and mortality, as well as the appearance of disease not previously seen in the region. These effects can be attenuated by policies that reduce urban heat (e.g., cool roofs and green roofs) and that improve infrastructure (e.g. emergency services, conditioned space).

Spatio-temporal rainfall patterns around Atlanta, Georgia and possible relationships to urban land cover

Spatio-temporal patterns in mean and extreme rainfall are examined around the city of Atlanta, Georgia using the Multi-sensor Precipitation Estimates (MPE) and ERA-Interim reanalysis datasets. The analysis spans the period 2002 to 2015 and employs a 9-cell gridded framework centered on downtown Atlanta. Statistically significant anomalies in daily precipitation were found over and downwind (predominately east to northeast) of Atlanta. The pattern of rainfall anomalies is most evident in the early evening hours of the day and is hypothesized to be related to the evolution of the skin or surface urban heat island (UHI), rather than the canopy layer UHI. The study formally proposes the term “flow regime dependent” downwind anomaly regions. Like previous results, the study reveals that downwind anomaly regions can vary as a function of prevailing wind regime. Using a metric called the Wet Millimeter Day (WMD), the study also finds that there is a tendency for extreme rainfall to cluster in the climatological downwind area of Atlanta. The work builds upon previous findings while employing different datasets to provide novel additional contributions related to the temporal evolution of the “urban rainfall effect” and the patterns of extreme rainfall.

Paying for priority in school choice: Capitalization effects of charter school admission zones

We exploit a unique characteristic of some charter schools in the metropolitan Atlanta area to identify property value capitalization of access to charter schools. The charter schools in this study designate small geographic areas within their attendance areas as priority zones. Each of the study charter schools has at least two priority zones: households located in priority one zones have a higher probability of admission than households located in priority two zones. We use this spatial variation in the likelihood of attending a charter school to identify the capitalization effect of increased charter school admission probabilities as the difference-in-differences within priority zone one and two border areas. Our results indicate that prices increased by six to eight percent for priority one zone homes compared to priority two zone homes after the opening of a new charter school. We also find that capitalization is stronger for homes with underperforming traditional public schools.

Abstract 03: High Neighborhood Incarceration Rate is Associated With Poor Cardiovascular Risk Profiles in Non-incarcerated Black Individual

Introduction: Over 7 million Americans are current or former prisoners. Blacks are imprisoned at rates 4 to 10 times greater than Whites. While personal incarceration history is associated with greater all-cause mortality and incident cardiovascular disease (CVD), the impact of high neighborhood rates of incarceration on CVD risk in non-incarcerated individuals is unknown. Hypothesis: High neighborhood incarceration rate, defined as the upper quartile, is associated with poor individual CVD risk profile. Methods: A total of 1368 subjects from the Atlanta area (mean age 49 ± 10 years, 62% female [n=850], 41% Black [n=560]) were recruited from two community cohorts. Zip codes were used to link neighborhood incarceration and crime rates to individual pooled risk scores (ASCVD), risk factors for CVD including hypertension, dyslipidemia and impaired fasting glucose (IFG), and biomarkers including high-sensitivity C-reactive protein (hsCRP) and the homeostatic model assessment for insulin resistance (HOMA-IR). Results: High neighborhood incarceration rate was associated with high ASCVD risk score (OR=1.41, 95% CI=1.02, 1.95), hypertension (OR=1.48, 95% CI=1.05, 2.07) and dyslipidemia (OR=1.45, 95% CI=1.04, 2.04), after controlling for relevant demographic, socioeconomic and behavioral covariates. Tests for interaction with race were significant: Black individuals living in areas with high incarceration rates were more likely to have hypertension (OR=1.63, 95% CI=1.03, 2.58), dyslipidemia (OR=1.80, 95% CI=1.15, 2.83), IFG (OR=1.77, 95% CI=1.04, 3.03), and elevated HOMA-IR (OR=2.04, 95% CI=1.20, 3.47); Whites were more likely to have an elevated hsCRP (OR=1.81, 95% CI=1.02, 3.22). Conclusions: In conclusion, high neighborhood incarceration rate is associated with a worse CVD risk profile; this effect was more pronounced in Blacks. Neighborhood exposure to increased incarceration rates, particularly in Black communities, represents an additional health disparity that warrants further investigation.

Abstract P021: Association of AHA Cardiovascular Health Metrics With Cognitive Function, Depression, and Anxiety: The Emory Healthy Aging Study

Background: The American Heart Association (AHA) has developed the Life’s Simple 7 metric (no smoking, high levels of physical activity, normal body mass index, no hypertension, no diabetes, no hyperlipidemia, healthy diet) to track behaviors and risk factors associated with cardiovascular health (CVH). Given the potential role that CVH has in cognition and psychological well-being, we aimed to study the association of the Life’s Simple 7 with cognitive function, anxiety, and depressive symptoms in the Emory Health Aging Study (EHAS). Methods: EHAS is an ongoing cohort study with the overall goal of understanding determinants of healthy aging in the general population. Participants 18 years of age or older are recruited at primary care clinics, community events, and through social media, primarily from the Atlanta (GA) area. Information on sociodemographic variables (age, sex, race, education, income), anthropometrics (weight, height), lifestyles (smoking, physical activity), and clinical variables (history of hypertension, diabetes, hypercholesterolemia, cardiovascular disease [CVD]) was collected through online questionnaires. Life’s Simple 7 score (excluding diet; information not available) was defined based on self-reported data, giving 1 point per achieved metric [range 0 (lowest)-6(highest CVH)]. Neurobehavioral variables were measured using validated scales (Cognitive Function Instrument (CFI), range 0-14, for cognition; Patient Health Questionnaire (PHQ)-8, range 0-24, for depressive symptoms; Generalized Anxiety Disorder (GAD) questionnaire, range 0-21, for anxiety; higher scores represent worse function/symptoms). Cross-sectional associations between Life’s Simple 7 score and these scales were assessed using multivariable linear regression adjusting for sociodemographic variables. Results: We included 3,774 participants [mean age (standard deviation, SD) 58 (13), 79% women, 84% white, 9% African American, 7% other) free of self-reported CVD, recruited between October 2015 and October 2016. Levels of CVH in the cohort were relatively high, with 62% participants meeting at least 4 health criteria [mean (SD) score 3.9 (1.3)]. The mean (SD) of CFI, PHQ-8, and GAD were 1.9 (2.1), 3.2 (3.8), 2.4 (3.4), respectively. In analyses adjusted for age, sex, race, education, and income, higher values of Life’s Simple 7 score were related to better cognitive function and lower levels of depressive symptoms and anxiety: estimates (95% confidence interval) per 1-point in Life’s Simple 7 score were -0.16 (-0.22, -0.11) for CFI, -0.5 (-0.6, -0.4) for PHQ-8, and -0.3 (-0.4, -0.2) for GAD. Conclusion: Higher levels of CVH, as assessed with the AHA Life’s Simple 7, were cross-sectionally associated with a beneficial neurobehavioral profile. Prospective studies should evaluate the impact of improving CVH on cognitive and emotional health.

Abstract P019: Family History of Cardiovascular Disease is Associated With Cognitive Function: The Emory Healthy Aging Study

Background: Family history of cardiovascular disease (CVD) is a readily available risk indicator of future CVD, combining the influence of shared genetic, environmental and behavioral risk factors. Though CVD risk factors have been associated with an increased risk of cognitive impairment and decline, less is known about the association between family history of CVD and cognitive function. Evaluating this association may further elucidate the role of cardiovascular health in cognitive health. Methods: The Emory Healthy Aging Study isan ongoing prospective cohort study aimed at identifying predictors of healthy aging and age-related diseases. Participants are primarily residents of the Atlanta area, at least 18 years old, who completed an online baseline health survey. Multiple recruitment forums were used, including clinic waiting rooms, informational letters and emails, community events and online recruitment. Baseline information about demographic (age, race, gender), socioeconomic (education, household income), and health behavior factors (physical activity, smoking) as well as personal health (diabetes, hyperlipidemia, and hypertension) and family health history were collected by online survey. Family history of CVD was defined as self-reported history for any parent or sibling of coronary artery disease, myocardial infarction, or stroke. Cognitive function was measured using the validated Cognitive Function Instrument (CFI) with scores ranging between 0-14 (lower is better). The association between family history of CVD and CFI score was assessed using multivariable linear regression, adjusting for demographic, socioeconomic, lifestyle and CVD risk factors, as well as family history of mild cognitive impairment (MCI) or Alzheimer’s disease (AD). Results: We studied 3801 participants (75% female, 85% white, 10% black, and 5% other), recruited between October 2015 and October 2016. Mean age was 59±13 years and 61% reported a family history of CVD. Adjusting for age, gender, race, education, household income, exercise habits, smoking status and family history of MCI or AD, family history of CVD was associated with poorer cognitive performance (β=0.26; 95% CI (0.12, 0.41)). Additional adjustment for hypertension, hyperlipidemia, diabetes and BMI only slightly attenuated estimates (β=0.22; 95% CI (0.08, 0.41)). In the same model, the estimated β for family history of cognitive impairment was similar: 0.22 (0.07, 0.37). Conclusion: In this cross-sectional study of people from the community, family history of CVD was associated with poorer cognitive function, and this association was of the same magnitude as having a first-degree family member with a history of cognitive impairment. Although longitudinal data are needed, these results underscore the link between cardiovascular and neurocognitive health and potential role of shared genetic and behavioral factors.

Kerby-Fulton, Kathryn, John J. Thompson, and Sarah Baechle, eds. New Directions in Medieval Manuscript Studies and Reading Practices: Essays in Honor of Derek Pearsall. South Bend, IN: University of Notre Dame Press, 2014. Hardback, 576 pp. $66.00. (ISBN: 978-0-268-03327-9).

Kerby-Fulton, Kathryn, John J. Thompson, and Sarah Baechle, eds. <i>New Directions in Medieval Manuscript Studies and Reading Practices: Essays in Honor of Derek Pearsall</i>. South Bend, IN: University of Notre Dame Press, 2014. Hardback, 576 pp. $66.00. (ISBN: 978-0-268-03327-9).

Fear and Uncertainty Do Not Influence Reported Willingness to Undergo Lumbar Punctures in a U.S. Multi-Cultural Cohort.

Cerebrospinal fluid (CSF) biomarkers for Alzheimer’s disease and related disorders can provide early and accurate prediction of underlying neuropathology even when the clinical symptoms are mild, but lumbar punctures (LP) to obtain CSF can be perceived as frightening and invasive. We previously demonstrated that this negative perception of the LP is strongly associated with a negative LP experience in terms of discomfort and complications, but it is not known what factors can lead to a negative perception of the LP. It has also been proposed that LP is less well-perceived by adults in the U.S. compared to Europe and elsewhere, although there is a paucity of primary data to support this. To address these knowledge gaps, we conducted a survey of 237 younger and older adults in the Atlanta area including a significant number born outside of the U.S. (n = 82, 34%) to determine demographic, medical, and experiential factors associated with the perception of LP as well as the willingness to undergo LP for medical or research purposes. Our results show that one in four respondents in this cohort with limited first-hand LP experience viewed the LP as a frightening invasive procedure, but the majority (89%) were willing to undergo LP for medical reasons. General awareness of the LP was associated with both standard and negative views of the LP, but perception did not influence willingness to undergo the procedure. Multi-variate models showed that higher annual household income, not place of birth or past experience, was associated with greater willingness to undergo LPs. We conclude that Americans (born in the U.S. or abroad) are not resistant to LPs if there is useful information to improve their health, although there is limited enthusiasm to undergo LPs solely for research purposes. At the same time, we failed to find modifiable factors to improve the perception of LP among those who already perceive it as frightening and invasive. Future recruitment effort should target adults with no preconceived notion of the LP with emphasis on data related to safety and tolerability.