Metropolitan Atlanta Research Articles

Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level. We sought to determine whether certain sociodemographic neighborhood ecologies were associated with COVID-19 case and death rates in metropolitan Atlanta, Georgia. We used census data and principal-component analysis to identify unique neighborhood ecologies. We then estimated correlation coefficients to determine whether the neighborhood profiles produced by a principal-component analysis were correlated with COVID-19 case and death rates. We conducted geographically weighted regression models to assess how correlation coefficients varied spatially for neighborhood ecologies and COVID-19 outcomes. We identified two unique neighborhood profiles: (1) high percentage of residents, Hispanic ethnicity, without a high school diploma, without health insurance, living in crowded households, and lower percentage older than 65 years; and (2) high percentage of residents, Black race, living in poverty, unemployed, and households receiving Supplemental Nutrition Assistance Program benefits. Profile 1 was associated with COVID-19 case rate (Pearson r = 0.462, P < 0.001) and profile 2 was associated with COVID-19 death rate (Spearman r = 0.279, P < 0.001). Correlations between neighborhood profiles and COVID-19 outcomes varied spatially. Neighborhoods were differentially at risk of COVID-19 cases or deaths depending on their sociodemographic ecology at the beginning of the COVID-19 pandemic. Prevention methods and interventions may need to consider different social determinants of health when addressing potential cases and deaths during future emergent epidemics.

Meeting People Where They Are in the Fight Against COVID-19 and Its Complications.

The COVID-19 pandemic exacerbated socioeconomic and racial disparities. Because of the institution's commitment to health equity, Morehouse School of Medicine, one of four Historically Black College and University (HBCU) medical schools, took the leadership role in addressing disparities by becoming a community vaccination provider. With vaccines registered, ordered, and received from the Georgia Department of Public Health through the mobile community vaccine initiative, the Medical School vaccinated more than 2700 people in the metropolitan Atlanta area. The initiative took place from January 2021, shortly after the COVID-19 vaccines were initially released, until April 2022 when vaccinations became part of routine health maintenance and preventive health measures at the school. Eighty-six percent of the individuals vaccinated were African American or Hispanic/Latino. Our efforts highlighted the importance of addressing vaccine access barriers and providing culturally sensitive care. (Am J Public Health. Published online ahead of print October 15, 2024:e1-e4. https://doi.org/10.2105/AJPH.2024.307768).

Oral Microbiome and Cognition Among Black Cancer Caregivers

Abstract Background Despite known links between oral health and dementia and the growing understanding of the role of the human microbiome in health, few studies have explored the relationship between the oral microbiome and cognition. Additionally, there is a notable absence of research on how the oral microbiome is associated with cognitive function in Black adult caregivers of cancer patients despite their elevated risk for both oral disease and cognitive impairment. Objectives This study aimed to characterize the oral microbiome of Black caregivers of people living with cancer and explore the association of the oral microbiome with cognitive performance. Methods Thirty-one self-identified Black or African American caregivers of cancer patients in the greater metropolitan Atlanta area participated in the study. They provided oral microbiome samples. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), depressive symptoms with the Center for Epidemiological Studies Depression Scale, and individual race-related stress with the Index of Race-Related Stress–Brief. Salivary microbiome diversity was analyzed using alpha and beta diversity metrics, and taxa associated with cognition were identified through differential abundance testing, adjusting for potential confounders. Results The mean age of participants was 54.8 years. MoCA scores ranged from 18 to 30, with a mean of 25. Participants were categorized into normal cognition (MoCA ≥26, n = 12) and low cognition (MoCA &lt;26, n = 16) groups. Education level and individual race-related stress were associated with cognition group and were controlled for in the oral microbiome analysis. Alpha and beta diversity analyses showed no significant overall differences between cognition groups. Differential abundance testing suggested 48 taxa were associated with cognition status, many of which are known to be associated with periodontal disease and cognition. Discussion This study revealed associations between cognition status and specific oral bacteria, many of which are known to be associated with periodontal disease and cognitive impairment. These findings underscore the complex relationship between oral health and cognitive function, suggesting a need for further research to develop oral microbiome profiles capable of identifying individuals at risk for cognitive decline and guiding targeted interventions for promoting overall well-being and cognitive health.

Building the PharmD Pipeline With a Pre-Pharmacy Track for Working Adults Marketed to Pharmacy Technicians

ObjectiveTo describe the activities undertaken at Mercer University (MU) to establish a complete pre-pharmacy curriculum for working adults and market the program to pharmacy technicians in metropolitan Atlanta. To document post-implementation, the yield of students to the pre-pharmacy program and subsequent yield of Doctor of Pharmacy (PharmD) students to the MU College of Pharmacy. MethodsThe level of retrospective interest in the pre-pharmacy program was measured by a survey questionnaire administered to MU PharmD students who had completed their pre-pharmacy courses in metropolitan Atlanta colleges and universities. A traditional marketing funnel approach was used to achieve awareness, interest, desire, and action in the target market: metropolitan Atlanta pharmacy technicians. The pre-pharmacy program was established as a curricular track within the MU College of Professional Advancement for working adults. Enrollment and matriculant data were reported using frequency counts. ResultsA total of 185 pre-pharmacy program matriculants from the Spring semester 2019 through the Summer semester 2023 accounted for 1222 pre-pharmacy course enrollments. Of these students, 38 applied for the PharmD program at the MU College of Pharmacy, and 27 were accepted and matriculated. ConclusionOffering a pre-pharmacy track for working adults marketed to pharmacy technicians is one potential avenue for building the pipeline to pharmacy school while adding to the overall enrollment of the university.

Mapping local suitability for STEM work-related experiential opportunities in Georgia

Internships, job shadows, cooperative education programs, and other forms of experiential education can play a crucial role in students successfully transitioning from their undergraduate program to a career pathway. We collectively term these opportunities as work-related experiential activities (WREAs). While valuable, students’ access to these experiences can vary based on multiple factors, including their own socioeconomic background, access to social networks, university programs, and geographic context. Little research has been done on the last of these factors, and this paper helps fill this gap by developing a geospatial WREA opportunity index for STEM related opportunities, using census and point-of-interest data to identify census tracts with the greatest rate of WREA opportunity and attractive amenities for students. To do so, we draw on surveys and interviews across multiple college campuses in Georgia, both to identify desirable characteristics for students and to catalog the WREAs they have participated in. This index highlights disparities across college campuses, particularly between those located in metropolitan Atlanta compared to those in smaller cities in the state. This tool provides a way to quantify and visualize those differences in ways that can support investment in programs that help bridge opportunity gaps for students.

Ending the HIV Epidemic in Metropolitan Atlanta: a mixed-methods study to support the local HIV/AIDS response.

Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US "Ending the HIV Epidemic" (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative. We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June-December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation. We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA-particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (N = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma. Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery with community input can provide targeted guidance to support local EHE efforts.

First-trimester exposure to newer antiretroviral agents and congenital anomalies in a US cohort.

To characterize associations of exposure to newer antiretroviral medications in the first trimester with congenital anomalies among infants born to persons with HIV in the United States. Longitudinal cohort of infants born 2012-2022 to pregnant persons with HIV enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study. First-trimester exposures to newer antiretrovirals (ARVs) were abstracted from maternal medical records. Trained site staff conducted physical exams and abstracted congenital anomalies from infant medical records. Investigators classified anomalies using the Metropolitan Atlanta Congenital Defects Program classification system. The prevalence of major congenital anomalies identified by age one year was estimated for infants exposed and unexposed to each ARV. Generalized estimating equation models were used to estimate the odds ratio (OR) of major congenital anomalies for each ARV exposure, adjusting for potential confounders. Of 2034 infants, major congenital anomalies were identified in 135 [6.6%; 95% confidence interval (CI): 5.6-7.8%]. Cardiovascular ( n = 43) and musculoskeletal ( n = 37) anomalies were the most common. Adjusted ORs (95% CI) of congenital anomalies were 1.03 (0.62-1.72) for darunavir, 0.91 (0.46-1.81) for raltegravir, 1.04 (0.58-1.85) for rilpivirine, 1.31 (0.71-2.41) for elvitegravir, 0.76 (0.37-1.57) for dolutegravir, and 0.34 (0.05-2.51) for bictegravir, compared to those unexposed to each specific ARV. Findings were similar after adjustment for nucleoside/nucleotide backbones. The odds of congenital anomalies among infants with first-trimester exposure to newer ARVs did not differ substantially from those unexposed to these specific ARVs, which is reassuring. Continued evaluation of these ARVs with larger studies will be needed to confirm these findings.

The Antiretroviral Pregnancy Registry: Three decades of prospective monitoring for birth defects.

Antiretrovirals (ARVs) are life-saving drugs used for the treatment and prevention of HIV infection and antiviral drugs (AVs) for the treatment of chronic HBV infection. ARVs have proven highly effective in reducing perinatal HIV transmission, however the risk of birth defects from prenatal exposure to ARVs/AVs is an ongoing concern. The Antiretroviral Pregnancy Registry (APR), an international, prospective exposure-registration cohort study, monitors ARV and AV use in pregnancy for early signals of teratogenicity. This communication reports results of 30-years' experience of ARV/AV exposure during pregnancy and lessons learned through continuous quality improvement. Birth defect prevalence is estimated and compared to internal and external groups. Statistical inference is based on exact methods for binomial proportions. Between 2006 and 2023, cumulative enrollment more than tripled from 6893 to 25 960 pregnancies and ARVs/AVs monitored increased from 29 to 222. Through January 2023, there were 21 636 live births and 631 outcomes with birth defects, for overall prevalence of 2.9/100 live births (95% CI 2.7, 3.2). The birth defect prevalence was 3.0% (95% CI 2.7%, 3.3%) among first trimester exposures and 2.8% (95% CI 2.5%, 3.2%) among second/third trimester exposures (prevalence ratio 1.04 [95% CI 0.89, 1.21]). Birth defect prevalence is not statistically significantly different between first trimester ARV/AV pregnancy exposures compared to second/third trimester exposures and is also not different from two population-based surveillance systems: 2.72/100 live births reported in the Metropolitan Atlanta Congenital Defects Program (MACDP); and 4.17/100 live births from the Texas Birth Defects Registry (TBDR).

"And then the person sort of just drops off the radar…": barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta.

Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta. We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022. Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts. Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.

Pregnancy and fetal outcomes following paternal exposure to glatiramer acetate

Objectives This study aimed to examine pregnancy and fetal outcomes following paternal exposure to glatiramer acetate (GA). Methods Pregnancy reports of paternal GA-exposure at time of conception from 2001 to 2022 were extracted from Teva Global Pharmacovigilance database. Pregnancy reports obtained prior to (prospective) or after (retrospective) knowledge of the pregnancy outcome were included. The primary endpoint was major congenital malformation (MCM) in the offspring according to the US Metropolitan Atlanta Congenital Defects Program (MACDP) and European Surveillance of Congenital Anomalies and Twins (EUROCAT) classification. Other pregnancy and fetal outcomes, including spontaneous abortion, pregnancy termination, fetal death, preterm birth, and low birth weight, were assessed. Results A total of 466 paternal GA-exposed pregnancies were retrieved, 232 prospective cases and 234 retrospective cases. Of 349 (74.9%) pregnancies with known outcomes, 316 (90.5%) were live births, 28 (8.0%) were spontaneous abortions, 3 (0.9%) were elective pregnancy terminations, and 2 (0.6%) were stillbirths. In prospective live birth cases, there were 7/111 (6.3%) preterm births and 5/115 (4.3%) neonates with a low birth weight. The prevalence of total MCM among prospective cases was 1.7% (2 cases of 116 live births and fetal death/stillbirth), which is slightly lower than the background rates from MACDP (3%) and EUROCAT (2.1%). Conclusions This study did not indicate an increase in the rate of adverse pregnancy and fetal outcomes after paternal exposure to GA. These results provide additional information regarding pregnancy outcomes following paternal exposure to GA for healthcare professionals, male patients and their female partners who are considering pregnancy while their male partner is using GA.

Environmental Injustice Is Associated With Poorer Asthma Outcomes in School-Age Children With Asthma in Metropolitan Atlanta, Georgia

BackgroundEnvironmental justice mandates that no person suffers disproportionately from environmental exposures. The Environmental Justice Index (EJI) provides an estimate of the environmental burden for each census tract but has not yet been utilized in asthma populations. ObjectiveWe hypothesized that children from census tracts with high environmental injustice determined by the EJI would have a greater burden of asthma exacerbations, poorer asthma control, and poorer lung function over 12 months. MethodsChildren 6-18 years with asthma (N=575) from metropolitan Atlanta, Georgia, completed a baseline research visit. Participant addresses were geocoded to obtain the EJI Social-Environmental ranking for each participant’s census tract, which was divided into tertiles. Medical records were reviewed for 12 months for asthma exacerbations. A subset of participants completed a second research visit involving spirometry and questionnaires. ResultsCensus tracts with the greatest environmental injustice had more racial/ethnic minorities, lower socioeconomic status, more hazardous exposures (particularly to airborne pollutants), and greater proximity to railroads and heavily trafficked roadways. Children with asthma residing in high injustice census tracts had a longer duration of asthma, greater historical asthma-related healthcare utilization, poorer asthma symptom control and quality of life, and more impaired lung function. By 12 months, children from high injustice census tracts also had more asthma exacerbations with a shorter time to exacerbation and persistently more symptoms, poorer asthma control, and reduced lung function. ConclusionDisparities in environmental justice are present in metropolitan Atlanta that may contribute to asthma outcomes in children. These findings require additional study and action to improve health equity.

Addressing the challenge of wildlife conservation in urban landscapes by increasing human tolerance for wildlife

Abstract Urbanization is a key driver of global environmental change and is adversely impacting wildlife populations. Human tolerance for wildlife is critical to wildlife conservation in urban areas. Using metropolitan Atlanta, Georgia, United States, as a case study, we investigated human tolerance for a range of different wildlife species. Almost half of the human–wildlife interactions that are reported to the state wildlife agency originate from metropolitan Atlanta, which is one of the fastest growing metropolises in the United States. We surveyed a representative sample of 1006 residents of metropolitan Atlanta in 2022. We found heterogeneity in respondents' tolerance for various species, although most respondents were intolerant of bobcats, coyotes, opossums and snakes. Respondents' tolerance for different species largely depended on their attitudes and emotions towards species, and their basic beliefs pertaining to wildlife and the relationships between humans and wildlife. We found some evidence that tolerance also depended on people's prior interactions with wildlife, their beliefs that they can mitigate conflicts with wildlife and their demographic characteristics. Our results suggest that communication that improves urban residents' attitudes towards wildlife and/or reinforces positive emotions towards wildlife may increase wildlife tolerance in urban areas. Read the free Plain Language Summary for this article on the Journal blog.

Physical Performance in a Diverse, Population-Based Cohort of Individuals With Systemic Lupus Erythematosus.

To report the burden and correlates of poor physical performance in a diverse cohort of individuals with systemic lupus erythematosus (SLE). In this single-visit study of 446 individuals with SLE from a population-based metropolitan Atlanta cohort, we measured physical performance via the Short Physical Performance Battery (score range 0-12; intermediate-low [<10] vs high [≥10]). We also collected demographic, clinical, and psychosocial variables and examined the associations (adjusted odds ratios [aORs]) of intermediate-low versus high physical performance with these characteristics via multivariable logistic regression. We found that more than half (59.6%) of our participants had poorer (intermediate-low) overall physical performance. Only 7% of the cohort received the maximum score on the lower body strength task versus 90% and 76% receiving the maximum scores on balance and gait speed tasks. Current employment status (aOR 0.69, 95% confidence interval [CI] 0.45-1.05) and higher cognitive functioning (aOR 0.57, 95% CI 0.42-0.77) were strongly associated with lower odds of intermediate-low physical performance. Higher body mass index (aOR 1.25, 95% CI 1.01-1.56), disease activity (aOR 1.59, 95% CI 1.27-1.98), and disease burden (aOR 1.38, 95% CI 1.08-1.77) were associated with poorer performance, as were higher depressive symptoms, perceived stress scores, and lower educational attainment (not statistically significant). In our population-based, primarily Black cohort, we found that individuals with SLE commonly had poor physical performance. We identified both SLE- and non-SLE-specific factors that could help clinicians identify those most at risk for poor physical performance and intervene to improve, maintain, and support physical performance among those with SLE.

Engaging urban residents in the appropriate actions to mitigate human–wildlife conflicts

AbstractMitigating human–wildlife conflicts by altering human behaviors is critical to urban wildlife conservation. We investigated what actions urban residents are willing to take to mitigate human–wildlife conflicts in metropolitan Atlanta, one of the fastest growing metropolises in the United States (~6.1 million people, 21,690 km2). In 2022, we administered online surveys to 1006 residents of metropolitan Atlanta to determine which measures they had adopted to mitigate conflicts with urban wildlife, elicit their stated willingness to adopt additional conflict mitigation measures, and identify determinants of current or potential implementation of mitigation measures. Respondents most frequently reported watching urban wildlife (63.0% of respondents). The most frequently reported conflicts were wildlife raiding trash cans (14.8%) and damaging landscaping (20.8%). In total, 342 respondents (34.0%) had not taken any action to mitigate conflicts with wildlife. Respondents who had taken action to prevent conflicts most often secured their trash by keeping cans indoors or locking the lid of the can (28.7%), kept pets (20.5%) and pet food (20.3%) indoors, and took trash out on the morning of collection (19.6%). Respondents who had not adopted conflict mitigation measures stated that they were likely to secure their trash or keep pets and pet food indoors if they considered these measures to be necessary. Prior conflicts with wildlife influenced both respondents' current efforts to mitigate conflicts with wildlife, and their stated willingness to adopt additional measures to mitigate human–wildlife conflicts. Risk sensitivity to zoonotic pathogen transmission increased both actual and intended adoption of conflict mitigation measures. Respondents' self‐efficacy, beliefs about wildlife, and age also influenced their willingness to adopt conflict mitigation measures. Our results suggest that education and outreach about the need for conflict mitigation measures should highlight the importance and effectiveness of these measures in conserving wildlife, while also securing the well‐being of humans and pets.

Tobacco in hotels: A study of smoke exposure and resident risk.

Extended-stay hotels (ESH) are a reliable and accessible housing option for low-income, minoritized renters, who are disproportionately exposed to secondhand and thirdhand cigarette smoke (SHS and THS). This study explores ESH residents' perceptions of their SHS and THS exposure, harms related to this exposure, their willingness to mitigate these harms, and the contextual factors associated with smoking in hotels. Eighty ESH renters from the metropolitan Atlanta region were recruited to complete a survey about the perceived harm and persistence of tobacco smoke, exposure experiences, knowledge, attitudes, self-efficacy, and intentions to protect oneself. Eleven of these participants completed semi-structured interviews, during which they discussed their daily SHS and THS exposure at their ESHs in greater detail. Of the survey respondents, 62% reported being bothered by their level of smoke exposure, and 77% said they believed smoke particulates remained in their rooms even after housekeeping cleaned them. Approximately half of survey respondents had attempted to stop smoking in the 3 months prior to the study, and 29 of these individuals were still on their smoking cessation journeys. Most interview participants agreed that SHS and THS exposure exacerbated their existing chronic illnesses and could possibly result in death in the long term. Participants agreed with the benefits of smoke-free policies, but also acknowledged other priorities for ESH living-affordability, safety, and proximity to the workplace-that overshadowed their desires for such policies. Overall, study findings suggest that ESH renters understand the dangers of smoking and SHS/THS and want to decrease their exposure, but the persistence of cultural and contextual factors prevents them from fully engaging with 100% smoke-free policies.

Quantifying racial disparities in risk of invasive Staphylococcus aureus infection in Metropolitan Atlanta, Georgia, during the 2020-2021 coronavirus disease 2019 (COVID-19) pandemic.

We estimated the racial disparity in rates of invasive S. aureus infections based on community coronavirus disease 2019 (COVID-19) rates at the county level. Our data suggest that COVID-19 infection burden (1) affects not only hospital-onset MRSA invasive infection risk but also community-onset S. aureus invasive infection risk and (2) affects Black residents ∼60% more than White residents.

Disparities in city-wide park use before and during the COVID-19 pandemic: A case study of Atlanta, Georgia

Access to parks is important for a population's mental, physical, and social health. The importance of parks became even more apparent during the COVID-19 pandemic when publicly accessible outdoor spaces were needed to relax, exercise, and socialize. Using metropolitan Atlanta, Georgia as a case study, this study employs 207,785 rows of park visitation data to assess the spatial distribution of park users within 109 Atlanta parks for the year before and after the initial COVID-19 shutdown, focusing on the length of time spent in parks, distance of travel to get there, and quantity of visits. These facets are compared to the socio-demographic information of the park users to assess how different populations benefited from greenspace use. Furthermore, we compared site usage to park typologies to understand changes in park use. Results reveal that after the COVID-19 declaration, parks were more likely to be used among local block group populations, and the time spent in parks slightly decreased. Yet, the impact of COVID-19 on park use was less strong for lower income groups. Findings reveal the important role of parks during the pandemic and may guide future efforts to develop these public greenspace facilities.

TOBACCO IN HOTELS: A STUDY OF NICOTINE EXPOSURE AND RESIDENT RISK

Abstract Secondhand smoke (SHS) exposure exacts considerable health and financial impact on thousands of Americans yearly. One in four nonsmokers (about 58 million people) is routinely exposed to SHS, primarily at home. There is wide variability in smoke-free home policy adoption, leading to sociodemographic disparities in tobacco exposure and adverse health effects among low-income renters. Although there is no safe level of tobacco smoke exposure, varying perceptions about exposure effects and risks contribute to inconsistent use of harm-reduction strategies such as smoke-free home policies in private dwellings. Therefore, we surveyed and interviewed low-income extended-stay hotel renters (n=77) to learn about their perceptions of tobacco exposure. We also measured participants’ willingness to self-monitor these risks and adopt at-home smoke-free interventions. Most survey participants identified as nonsmokers (56.8%) exposed to tobacco smoke regularly. However, both nonsmokers and smokers preferred smoke-free rooms and indicated they would likely participate in personal health research by sharing air and biosamples to measure their exposure. We will present survey results of tobacco exposure knowledge and attitudes among long-term renters in Metropolitan Atlanta extended-stay hotels, perceptions of exposure risk, and self-efficacy beliefs. From our interview findings, we share renter and hotel manager readiness perceptions for implementing at-home smoke-free interventions. Lastly, we will share the results of integrating community-engaged partnerships with local organizations and respondent-driven sampling methods to build trust and aid renter recruitment.

Environmental press of urban greenspace pre-post COVID on older adults: A big data study in metropolitan Atlanta

The Coronavirus Disease 2019 (COVID-19) impacted the use of urban green spaces. For older adults who are vulnerable to environmental press, there were more concerns with being outside after COVID-19, especially in metropolitan areas with a high population density. Reframing urban greenspaces to encourage older adults to spend time outdoors requires further consideration. Using block groups and park POI data from the Atlanta metropolitan area retrieved from SafeGraph, this study assesses the types of urban greens spaces that fit the needs of older adults pre and post COVID-19 and how park features influenced their use of the parks. The results indicate a high decrease in park visitation after COVID-19 for visitors from block groups with a higher aging population. The preferences of older adults visiting urban greenspaces changed from small scale parks pre-pandemic to large scale parks post start of the pandemic. Park visitations of older adults were impacted by park sizes, locations, environmental variables, and park features, which contribute to the shift of environmental press. Paths and trails are the primary park feature attracting older adults pre-post COVID-19. Findings can inform future design and research of urban greenspaces accommodating the competence of older adults.

Barriers and Facilitators to HIV Service Access among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in Metropolitan Atlanta-a Qualitative Analysis.

Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.