Socio-environmental Factors Research Articles

Cognitive presentation at psychosis onset through premorbid deterioration and exposure to environmental risk factors.

Previous studies identified clusters of first-episode psychosis (FEP) patients based on cognition and premorbid adjustment. This study examined a range of socio-environmental risk factors associated with clusters of FEP, aiming a) to compare clusters of FEP and community controls using the Maudsley Environmental Risk Score for psychosis (ERS), a weighted sum of the following risks: paternal age, childhood adversities, cannabis use, and ethnic minority membership; b) to explore the putative differences in specific environmental risk factors in distinguishing within patient clusters and from controls. A univariable general linear model (GLS) compared the ERS between 1,263 community controls and clusters derived from 802 FEP patients, namely, low (n = 223) and high-cognitive-functioning (n = 205), intermediate (n = 224) and deteriorating (n = 150), from the EU-GEI study. A multivariable GLS compared clusters and controls by different exposures included in the ERS. The ERS was higher in all clusters compared to controls, mostly in the deteriorating (β=2.8, 95% CI 2.3 3.4, η2 = 0.049) and the low-cognitive-functioning cluster (β=2.4, 95% CI 1.9 2.8, η2 = 0.049) and distinguished them from the cluster with high-cognitive-functioning. The deteriorating cluster had higher cannabis exposure (meandifference = 0.48, 95% CI 0.49 0.91) than the intermediate having identical IQ, and more people from an ethnic minority (meandifference = 0.77, 95% CI 0.24 1.29) compared to the high-cognitive-functioning cluster. High exposure to environmental risk factors might result in cognitive impairment and lower-than-expected functioning in individuals at the onset of psychosis. Some patients' trajectories involved risk factors that could be modified by tailored interventions.

The influence of early life socio-environmental factors on executive performance in a healthy adult sample

Objective Attempts have been made (with research efforts encouraged) to deconstruct the “race” concept into language, cultural, and life experience variables that can help explain performance differences found between ethnic groups (Romero et al., 2009). The extant empirical literature reveals that early environmental factors and life experiences (e.g., socioeconomic status) are related to cognitive test performance in adulthood (Byrd et al., 2006). This study examined the explanatory value of early life childhood resources in the relationship between ethnicity and neuropsychological test performance in adulthood. Participants/ Methods Neurologically and psychologically healthy African American (n = 40), Caucasian (n = 14), and Hispanic (n = 107) college students ranging from 19-38 years of age. On average, participants had completed around 13 years of education, indicating that the majority were in the early stages of their undergraduate studies and mostly consisted of females (72%). Each participant completed a comprehensive neuropsychological battery that included tests of executive function and an extensive background questionnaire. Results A one-way analysis of variance (ANOVA) revealed that the CA group was significantly older (F (2, 160) = 18.38, p = .045) compared to the AA and H groups, but the groups did not differ in terms of number of years of educations or gender. Also, an ANOVA revealed significant group test performance differences on the Stroop-C [F (2, 160) = 1.53, p = .047], but not on the TMT-B and COWAT. Furthermore, a Tukey post hoc revealed that there were no significant differences in test performance on Stroop-C between the groups. Hierarchical multiple regression analyses revealed that group performance differences on executive function tests were medium or non-existent and only partially explained by years of education and early life financial resources. Conclusion The results are discussed in light of the existing literature, study strengths and limitations, as well as directions for future research. This research can aid in pinpointing variables crucial for interpreting differences in neuropsychological assessments among diverse populations, holding potential implications for intervention research and policy settings. It is particularly relevant in the context of the continuously evolving social, political, and economic landscapes of societies.

P-461. Positive Aging Consultations: A Model for Expanding Geriatric HIV Care

Abstract Background People living with HIV (PWH) experience geriatric syndromes commonly found in much older populations and may benefit from geriatrician consultation. We aim to describe a referral-based model at the University of Colorado. Methods The Positive Aging Consultations, a referral-based model, sought to connect high-risk PWH ≥ 50 years old with geriatric care. High-risk patients (experiencing geriatric syndromes, polypharmacy, multimorbidity, or advance care planning needs) were referred for geriatric consultation at the UCHealth Seniors Clinic; those taking ≥ 10 medications were referred for clinical pharmacy consultation. Patients were screened for functional status, preventative care, socioenvironmental factors (living situation, food access, transportation, social support, and elder abuse), and cognitive/mental health concerns (depression, anxiety, and memory loss). Geriatricians placed orders or communicated recommendations to the patient’s primary HIV provider. HIV providers completed a survey about their experience with the program. Additional data was collected via chart review. Results From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD=7; range 59-80). Geriatricians most often made recommendations regarding referral to other health or community-based services (n=9), medication changes (n=8), osteoporosis screening (n=6), and memory loss management (n=5). Advance directives were discussed in all visits. All but one HIV provider (n=7) said they would refer patients to the program in the future. Conclusion The Positive Aging Consultations program improved access to geriatric care with minimal setup costs, but with limited uptake over a one-year period. Limitations of the program included low utilization, lack of longitudinal geriatric care, geriatrician shortage, and potential financial barriers. Disclosures Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant

Harvesting Underdevelopment: Exploring the Water–Food Nexus in Brazilian Municipalities

Efforts to promote human development through agriculture highlight issues that require balanced approaches, considering socio-environmental factors, including equitable water allocation in regions with significant inequalities. This study aims to assess human development disparities across Brazilian regions, particularly in municipalities with high water consumption for irrigation in agriculture and livestock watering. Using public data from 2007 and 2016, a total of 300 municipalities were selected each year for analysis based on water use types. The study compared groups using the Firjan Index of Municipal Development (FIMD) as a measure of human development, employing the Kruskal–Wallis test with a 95% confidence level. We found statistically significant differences in FIMD distribution across all of the groups studied. We also verified that a set of municipalities in the Southeast did not experience significant advancements in development between 2007 and 2016, despite having high water allocations for livestock watering. Additionally, intense water use for irrigation was insufficient to elevate less advantaged regions, such as the Northeast, where half of the municipalities were classified with moderately low values in both years. The challenges in this water–food nexus study highlight the need for more integrated policies to ensure greater justice in human development and in the distribution of natural resource exploitation for agribusiness income.

Harnessing RSPCA Stakeholder Expertise to Co-Produce a Complex Intervention Addressing Childhood and Adolescent Animal Harm

Childhood and Adolescent Animal Harm (CAAH) is influenced by biological, psychological and socio-environmental risk factors. Interventions to prevent animal harm among children and young people are essential for fostering empathy and reducing future harm. This study explores the perspectives of RSPCA stakeholders, to co-produce a redeveloped version of ‘Breaking the Chain’, an intervention addressing youth animal harm. Semi-structured interviews were conducted with 16 RSPCA employees across a range of departments and geographical locations in England, UK. Thematic analysis was used to identify key insights on target groups, intervention content, delivery methods, and evaluation strategies. Two primary target groups were identified: universal audiences (primary school-aged children) and high-risk youth. Participants advocated for retaining the core content of the existing intervention while modernising resources to address contemporary risk factors, such as online exposure to animal harm while ensuring accessibility for neurodiverse audiences. Face-to-face delivery was favoured, complemented by digital resources. Evaluation was viewed as critical, with a focus on both short-term outcomes and long-term impact. This study highlights the importance of stakeholder involvement in co-producing effective cruelty prevention interventions. Future steps will involve a coproduction study with children and young people to gather their perspectives on the intervention redesign. This will be followed by a pilot and evaluation of the redesigned intervention, incorporating feedback from both the implementers (e.g., teachers, youth offending teams, RSPCA employees) and the recipients (children and young people).

Transposing of the Cognitive-Centered Space to Marginal in Mohsin Hamid’s The Last White Man

Cognition always mirrors human psychology; the more it is acknowledged, the more it highlights human behavior. The individual's ‘cognitive space’ in Western society is entangled and has broken away to worsen. People of color in the West are going through the stereotypical pandemonium of racially discriminatory remarks. The bewilderingly baffled racial incidents jeopardize the identity of the people of color. Each day in the West, people are curious about their survival. It seems all the circumstances after each turmoil incident threaten the foundations of humanity. The human cognitive space stance insists on acquiring, systematizing, utilizing, and revising the environmentally received knowledge, but this outer space-societal received knowledge imprints various psychosis. The paper hits the nail on the head that socioenvironmental factors directly challenge the embodied human mind. Evidence that overshadowed racial incidents aligned in the present commenced in the past. Then, the study gives various examples of postcolonial binaries to examine how the individual-centered space is marginal. The study provides multiple possible solutions and crucial rules to educate societies on geopolitical tolerance and individual freedom. In conclusion, the article critically highlights a white man who has witnessed misfortune after turning black one morning in Mohsin Hamid's The Last White Man.

Barriers to and Facilitators of Implementing Team-Based Extracorporeal Membrane Oxygenation Simulation Study: Exploratory Analysis.

Extracorporeal membrane oxygenation (ECMO) is a critical tool in the care of severe cardiorespiratory dysfunction. Simulation training for ECMO has become standard practice. Therefore, Keck Medicine of the University of California (USC) holds simulation-training sessions to reinforce and improve providers knowledge. This study aimed to understand the impact of simulation training approaches on interprofessional collaboration. We believed simulation-based ECMO training would improve interprofessional collaboration through increased communication and enhance teamwork. This was a single-center, mixed methods study of the Cardiac and Vascular Institute Intensive Care Unit at Keck Medicine of USC conducted from September 2021 to April 2023. Simulation training was offered for 1 hour monthly to the clinical team focused on the collaboration and decision-making needed to evaluate the initiation of ECMO therapy. Electronic surveys were distributed before, after, and 3 months post training. The survey evaluated teamwork and the effectiveness of training, and focus groups were held to understand social environment factors. Additionally, trainee and peer evaluation focus groups were held to understand socioenvironmental factors. In total, 37 trainees attended the training simulation from August 2021 to August 2022. Using 27 records for exploratory factor analysis, the standardized Cronbach α was 0.717. The survey results descriptively demonstrated a positive shift in teamwork ability. Qualitative themes identified improved confidence and decision-making. The study design was flawed, indicating improvement opportunities for future research on simulation training in the clinical setting. The paper outlines what to avoid when designing and implementing studies that assess an educational intervention in a complex clinical setting. The hypothesis deserves further exploration and is supported by the results of this study.

Parental stress and mental health among transgender parents

Background Parental stress impacts individual health and the development of the next generation, but there is a lack of comprehensive research on parental stress among transgender parents in China. This study is the first to investigate parental stress and mental health among transgender parents and identify potential influencing factors. Methods We designed a cross-sectional survey that recruited a representative sample of 647 transgender parents. A validated questionnaire was used to investigate parental stress, depression, anxiety, and their associated factors, including parent factors (gender dysphoria, time of coming out, depression, and anxiety) and situational factors (family violence, partner violence, relationship with partner, discrimination and family income). Linear regression models were used to explore the influencing factors of parental stress among transgender parents, a structural equation model (SEM) was established to explore the possible pathways between these factors and parental stress, and network analysis was conducted to determine primary symptoms and central risk factors. Results The average parental stress score was 50.4 ± 8.02. 92.7% of participants exhibited depressive tendencies and 73.7% showed anxiety tendencies. Lower family income (p < 0.001), coming out after having a child (Coefficient (Coef.) = 2.6, 95% confidential interval (CI) = 1.174 ∼ 4.027), family violence (Coef. = 3.582, 95%CI = 2.372 ∼ 4.791), partner violence (Coef. = 4.199, 95%CI = 2.998 ∼ 5.401), being discriminated during seeking of childbearing health care (Coef. = 3.29, 95%CI = 2.054 ∼ 4.526), poor relationship with partner (fair relationship: coef. = −3.205, 95%CI = −4.86∼−1.551; good relationship: coef. = −5.372, 95%CI = −6.886∼−3.858), depression (Coef. = 5.873, 95%CI = 3.557 ∼ 8.189), and anxiety (Coef. = 5.705, 95%CI = 4.368 ∼ 7.042) were significantly associated with higher parental stress. Through the pathway analysis, the direct or indirect effects of parent factors and situational factors on parental stress were observed. Additionally, network analysis revealed that gender dysphoria, family violence, psychological abuse, and various anxiety types as central risk factors, with two gender dysphoria symptoms showing the strongest direct relationship to stress. Conclusions Transgender parents experience significant parental stress influenced by mental health, sociodemographic, transgender-specific, family, and socio-environmental factors. Enhanced family support and a more inclusive social environment are crucial for reducing stress and improving the well-being of transgender parents and their children.

Association between performance of basic movements at admission and socioenvironmental factors and returning home following inpatient stroke rehabilitation

[Purpose] The aim of this study was to investigate the association between the ability to perform basic movements at admission and returning home from convalescent rehabilitation in patients with subacute stroke after adjusting for socioenvironmental factors. [Participants and Methods] This retrospective cohort study used data from the medical records. The primary outcome was returning home, and the associated factors were basic movement ability and socioenvironmental factors. Basic movement ability was assessed using the revised version of the Ability for Basic Movement Scale. Socioenvironmental factors included pre-stroke cohabitation status, support at home, and marital status. [Results] Of the 480 participants included in the analysis, 380 had returned home. The revised version of the Ability for Basic Movement Scale scores were found to be significantly associated with returning home, even after adjusting for socioenvironmental factors. Among the various influencing socioenvironmental factors, only pre-stroke cohabitation status remained significant after adjustment. [Conclusion] Even after adjusting for socioenvironmental factors, basic movement abilities were found to be associated with returning home. Assessing the revised version of the Ability for Basic Movement Scale scores at admission and pre-stroke cohabitation status may be useful for reasonable hospitalization planning to return home after subacute stroke.

Environmental justice mapping tools in the United States: A review of national and state tools.

Environmental justice (EJ) mapping tools are geographic information system (GIS)-based digital maps that integrate environmental, socioeconomic, health, and demographic data to identify areas experiencing environmental injustices. These tools are increasingly used to guide investments toward disadvantaged communities. This review examines 25 EJ tools, describing their functionalities, coverage, and indicator types, ranging from biological susceptibilities to socioeconomic and environmental factors. We discuss the tools' resolutions, update frequencies, and data breadth, emphasizing their role in informing EJ interventions. However, gaps exist, particularly in the underrepresentation of U.S. territories and the limited inclusion of communicable diseases and climate impacts. This underscores the need for more comprehensive tools that consider diverse health risks and socio-environmental factors. Cumulative impact assessments should be integrated into EJ tools, incorporating a broad spectrum of indicators to capture the multifaceted nature of environmental injustices. Community engagement is also crucial in developing and updating EJ tools to ensure they accurately reflect community needs and conditions. By addressing these recommendations, EJ tools can better serve as effective instruments for highlighting and mitigating environmental disparities, supporting broader environmental justice and health equity goals.

The Concept of Pain in Children Attending Primary School: Implications for School-Based Pain Education.

Introduction: A child's concept of pain comprises their understanding of what pain is, the purpose of pain, and biological processes underpinning pain. The concept of pain can influence pain experiences, pain beliefs, and pain-related behaviour. This study aimed to assess the concept of pain among children attending primary schools in Gqeberha in the Eastern Cape of South Africa. A secondary aim was to explore demographic and pain-related information that may contribute to a child's concept of pain. Materials and Methods: A cross-sectional study with an analytic component was used. The cross-culturally adapted Concept of Pain Inventory (COPI) was used to assess the concept of pain amongst 12-year-old school-attending children. Children from seven primary schools that were selected via stratified random sampling participated. Participants completed the adapted COPI and a sociodemographic questionnaire. Descriptive statistics and inferential analysis were used to analyse the data. Results: There were 119 participants. Participants' concept of pain partially aligned with contemporary pain science (mean = 34.39 out of 56; standard deviation = 6.49), indicating a partial understanding of the factors influencing pain. Demographic factors and pain-related information investigated did not influence participants' concept of pain. However, differences in the concept of pain were observed amongst participants from different schools. Conclusions: Participants had a developing concept of pain that was partially aligned with contemporary pain science. Participants had pain knowledge strengths and gaps that can be used to develop a tailored school-based pain education intervention for them. There were indications that contextual factors may have influenced the participants' concept of pain. Further studies to explore socioenvironmental factors that influence pain knowledge in children are recommended.

The Wako Cohort Study: Design and Profile of Participants at Baseline

We launched the Wako Cohort Study in 2023 to identify individual and socio-environmental factors related to the extension of healthy life expectancy and the reduction of health disparities among community-dwelling adults and to develop health promotion and care prevention strategies. This study profile aims to describe the study design and participants' profile at baseline. The Wako Cohort Study is a prospective study of community-dwelling adults aged ≥ 40 years living in Wako City, Saitama Prefecture, Japan. The Wako Cohort Study consists of two surveys: a mail-in survey for persons aged ≥ 40 years and a face-to-face assessment (on-site survey) for those aged ≥ 65 years. The survey items were designed considering the following points: 1) life course perspective (transition from middle to old age in the life course), 2) health indifference, and 3) employment in older age. A total of 8,824 individuals participated in the mail-in survey (2,395 persons aged 40-64 years and 6,429 aged ≥ 65 years). Of those aged ≥ 65 years who returned the mail survey, 1,004 participated in the subsequent on-site survey. Men aged ≥ 65 years tended to have higher health interests than those aged 40-64 years; however, this was not true for women. In the mail-in survey, 30.4 % of those aged ≥ 65 years were employed. The Wako Cohort Study is expected to provide new insights into the development of strategies to extend healthy life expectancy and reduce health disparities in Japan.

Social Progress and Environmental Performance as Boosters for Innovation in LAC: an Econometric Analysis

Abstract Numerous studies have explored the role of technological innovation in the development of nations. However, these studies often focus predominantly on countries in the Global North, overlooking the interplay between government, industry and university – the Triple Helix helices, and socioenvironmental factors. Even scarcer are studies that examine specifically Latin American and Caribbean countries (LAC). In this quantitative study, we apply linear discriminant analysis and panel data analysis to the scores of the GII, EPI, and SPI indices for 127 countries since 2012. Focusing on the results for LAC, our findings highlight the cohesion in innovation among the countries in the region and indicate a positive relationship between innovation and environmental performance. However, conversely, an increase in innovation scores tends to correlate with a reduction in social progress scores. This study contributes to providing a basis for political decisions that consider the Triple Helix thinking, incorporating academia, companies, and the government to better allocate resources towards designing policies to alleviate social and environmental challenges.

The Impact of Vitamin D Supplementation Duration on Early Childhood Developmental Milestones: A Retrospective Study.

Vitamin D plays a pivotal role in early childhood development, influencing skeletal strength, neuromuscular coordination, and neurodevelopment. This study aimed to evaluate the impact of different durations of Vitamin D supplementation on achieving developmental milestones. A retrospective study was conducted on 209 children, divided into two cohorts based on Vitamin D supplementation duration: six months (n = 102) and twelve months (n = 107). Developmental milestones were assessed across motor (sitting, walking), fine motor (object tracking, grasping), and social (smiling, speech) domains. Statistical analyses, including t-tests and effect size calculations, were performed to compare the mean ages of milestone achievement. The 12-month group achieved several milestones significantly earlier than the 6-month group. These included walking, object tracking, and combining words into phrases. Differences in other milestones, such as sitting and smiling, were not statistically significant. Effect sizes ranged from small to moderate. Extended Vitamin D supplementation is associated with modest yet significant advancements in key developmental milestones. However, socio-environmental factors, including parental involvement, likely contributed to these differences. This study's retrospective design limits causal interpretation, emphasizing the need for prospective, randomized studies to validate findings. These results support the potential benefits of extending Vitamin D supplementation beyond six months to optimize developmental outcomes in infants.

Microbiological characterization of drinking water and socio-environmental study in the peri-urban area of La Plata, Buenos Aires, Argentina

ABSTRACT The aim was to analyze the groundwater quality and evaluate the socio-environmental factors associated with the indicators of environmental contamination in the peri-urban area of La Plata. A descriptive cross-sectional study was conducted between 2013 and 2023, and six neighborhoods were selected. Water samples were taken according to the Argentine Food Code and a parasitological analysis of the water was performed using ultrafiltration. Socio-environmental analyses were carried out with semi-structured questionnaires and a generalized linear model was used considering a binomial distribution. Of the total water samples, 70% (75/106) indicated that the water is not suitable for consumption. The highest contamination by total coliforms was observed in Abasto, and the risk of contamination by this indicator was higher (odds ratio &amp;gt; 5) compared to other neighborhoods. A moderate percentage of fecal coliforms and Escherichia coli was found in Melchor Romero and El Peligro, although it was higher than that detected in the other neighborhoods. Pseudomonas spp. was observed in all the samples in Arana and in moderate amounts in Abasto and Lisandro Olmos. Entamoeba spp. and Blastocystis spp. were found in a quarter of the water samples. It is essential to manage environmental sanitation and family health access policies.

Impact of Body Image Perception on Behavioral Outcomes in Chinese Adolescent and Young Adult Survivors of Sarcoma.

To identify the prevalence and predictive factors of body image dissatisfaction among Chinese adolescent and young adult (AYA) survivors of sarcoma and to evaluate its associations with behavioral outcomes. In total, 116 AYA survivors (response rate: 88%; 48.3% female; mean age 28.2 years, SD = 8.2 years) of osteosarcoma (49.1%) or soft-tissue sarcoma (50.9%) were recruited from an academic hospital. The survivors self-reported their perceived body image using the Body Image Scale. Behavioral outcomes were assessed using DSM-oriented scales of the ASEBA Adult Self-Report checklist. Multivariable linear regression was conducted to identify predictors of body image perception and to investigate the association between body image dissatisfaction and behavioral outcomes (adjusted for clinically relevant variables and corrected for false discovery rate). Mediation analyses were performed to examine the mediating effects of body image perception between clinical, treatment, or socioenvironmental risk factors and behavioral outcomes. At 15 years post-cancer diagnosis, one-third of the cohort (39.7%) reported dissatisfaction with their body image. The significant risk factors associated with body image dissatisfaction were being female (standardized coefficient estimate [Est] = 0.21, SE = 0.10; p = 0.047), surgery treatment (Est = 0.19, SE = 0.09; p = 0.046), and worse family functioning (Est = 0.27, SE = 0.10, p = 0.013). Body image dissatisfaction was associated with symptoms of depression (Est = 0.30, SE = 0.10; p = 0.005) and avoidant personality problems (Est = 0.37, SE = 0.11; p < 0.001). Negative body image perception significantly mediated the association between poor family functioning and avoidant personality problems (proportion-mediated 26.3%, p = 0.038). Body image dissatisfaction was associated with more significant internalizing symptoms of depression, anxiety, and avoidant personality. A negative body image perception may mediate the association between poor family functioning and psychological distress among adult survivors. The provision of psychosocial intervention early during the cancer care continuum may mitigate the negative impact of body image distress in Chinese AYA survivors.

Individual and socio-environmental factors associated with active transport to school among adolescents in yaoundé

Individual and socio-environmental factors associated with active transport to school among adolescents in yaoundé

EPH41 Incremental Burden Attributable to Exposure to Socio-Environmental Factors on Patients With Lung Cancer in France

EPH41 Incremental Burden Attributable to Exposure to Socio-Environmental Factors on Patients With Lung Cancer in France

HIV risk perception and PrEP uptake among black MSM in Mississippi.

Rates for HIV are disproportionately higher for Black men who have sex with men (MSM) compared to other MSM in the U.S. While there is evidence that low perceived risk of HIV infection may increase HIV vulnerability, few studies have examined this relationship among Black MSM in the Southern U.S. where the HIV rates are the highest in the country. This study examined the association between perceived HIV risk and PrEP adoption among Black MSM in a medium-size city in Mississippi. Data were drawn from a subsample of the "ACCELERATE!" intervention, an innovative and sustainable community-driven project to improve health outcomes among Black MSM. The outcome of interest was PrEP uptake, a binary variable derived from responses to the question "Have you taken PrEP in the last year?". The perceived risk of HIV, an independent variable, is measured by self-report of an individual's assessment of their vulnerability of contracting HIV defined as low versus high risk. Covariates included age and socio-environmental factors (health insurance, incarceration and discrimination) Sample characteristics were provided using means and standard deviations for continuous variables and proportions for categorical variables. Exact logistic regression was used to assess the association between perceived HIV risk and PrEP adoption, adjusting for covariates. A total of 84 HIV negative Black men with a median age of 30 (min = 18, max = 69) years were available for analyses. Approximately 16% of participants reported experiencing incarceration and 57% reported experiencing discrimination. Seven out of ten respondents reported having low perceived risk, and 28.6% (24/84) reported having high perceived risk for HIV. There were 73 participants (86.9%) who reported PrEP use in the last year. We observed a higher proportion of participants with high perceived risk that reported lower uptake of PrEP. After adjusting for age, socioeconomic variables, and risky sexual behaviors, higher levels of perceived risk of HIV were associated with decreased odds of PrEP uptake (OR = 0.20, 95% CI: 0.04-0.94, p = 0.040). The role of HIV risk perception on PrEP adoption is complex among Black MSM in Mississippi. Higher levels of perceived risk of HIV were associated with lower odds of PrEP adoption among Black MSM. This inverse relationship between HIV risk perception and PrEP adoption suggests social- and structural- factors play a critical role in decision-making on PrEP initiation among Black MSM in Jackson. In addition, further longitudinal studies are needed to understand the complex interactions between perceived risk and PrEP use.

Modification of asthma treatment efficacy by healthcare access: A reanalysis of AsthmaNet Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) clinical trial

BackgroundWhile randomized controlled trials (RCTs) in asthma management are designed to balance known and unknown variables across treatment groups, including social and environmental co-exposures, it remains important to consider how these co-exposures influence disease progression and treatment outcomes. The importance of considering socio-environmental co-exposures in the context of asthma is twofold: 1) asthma disproportionately affects low-income urban communities, where air pollution and chronic stress are pervasive; and 2) despite the wide range of asthma treatments, inadequate disease control persists. MethodsIn the present ancillary study of the Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) RCT, we investigated how socio-environmental factors, such as air pollution exposure and healthcare access, modify the effect of inhaled corticosteroid (ICS) therapy in children with asthma. The original STICS RCT evaluated the efficacy and safety of increasing the dose of inhaled glucocorticoids from a baseline daily low dose to five times the daily dose for 7 days in school-age children with mild -to-moderate persistent asthma who began to have short-term loss of asthma control (Jackson et al., 2018 Mar 8) [1]. Our study adds onto those findings by incorporating residential level particulate matter 2.5 μg/m3 (PM2.5) and geographic health provider shortage areas (HPSA) as potential modifiers. ResultsConsistent with the main trial results, we did not find a difference in the number of exacerbations between treatment arms. However, we found the effect of receiving 5xICS, as compared with 1xICS on the time to prednisone was significantly different for children living in areas a shortage of health professionals (HR: 2.09; 95 % CI: 0.74, 5.95) than for children living in no shortage areas (HR: 0.40; 95 % CI: 0.21, 0.77). ConclusionThis finding underscores the importance of considering environmental and social factors in asthma treatment. Trial registrationClinicalTrials.gov ID NCT02066129 https://clinicaltrials.gov/study/NCT02066129.