Southern US City Research Articles

Associations of Minority Stressors, Alcohol Use Disorder, Resilience, and HIV Testing Self-Efficacy Among Community-Based Black Men Who Have Sex with Men in a Southern U.S. City: A Causal Mediation and Moderation Analysis

Background: Black men who have sex with men (BMSM) face multiple minority stressors (e.g., homophobia, racism, and presumed HIV status) that may indirectly erode their confidence in pursuing HIV testing uptake through exacerbating alcohol use disorder (AUD). Objectives: Using cross-sectional data from 203 community-based BMSM (71.4% as homosexual with a mean age of 26 years) living in a Southern US city, we conducted a causal mediation and moderation analysis to investigate in/direct pathways linking minority stressors, AUD risk, and self-efficacy of HIV testing, including how resilience may moderate these associations. Results: Our mediation analysis revealed that AUD risk accounted for 32.1% of the total effect of internalized homonegativity (βtotal effect = -0.424; SE=0.071; p<0.001), 28.6% of the total effect of experienced homophobia (βtotal effect = -0.684; SE=0.122; p<0.001), and 15.3% of the total effect of perceived HIV stigma (βtotal effect = -0.361; SE=0.164; p<0.05) on HIV testing self-efficacy. Resilience significantly moderated the associations of experienced homophobia (β = -0.049; SE=0.011; p<0.001), internalized homonegativity (β = -0.065; SE=0.027; p<0.01), and perceived HIV stigma (β = -0.034; SE=0.013; p<0.05) with AUD risk. Resilience also significantly moderated the associations of experienced homophobia (β = -0.073; SE=0.021; p<0.01), internalized homonegativity (β = -0.082; SE=0.012; p<0.001), perceived HIV stigma (β = -0.037; SE=0.039; p<0.05), and AUD risk (β = -0.021; SE=0.015; p<0.05) with HIV testing self-efficacy. Conclusions: Our study provides important implications in identifying multilevel sources for building resilience among BMSM to buffer the effects of minority stress on AUD risk and improve HIV testing outcomes.

Influence of Obesity on the Relationship of Cardiometabolic Risks Factors With Cardiovascular Disease in Older African and European Americans.

This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA). A comparative research design evaluated CRF risk profile differences between participant groups. Seven neighborhoods in a southern US city. A sample of 179 older AA (n = 128) and EA (n = 51) adults. Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic -(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function. Data were analysis with descriptive statistics, t-tests, and correlations. AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values. A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

Prevalence of Sexually Transmitted Infections Among Transgender Women With and Without HIV in the Eastern and Southern United States.

Data on the epidemiology of sexually transmitted infections (STIs) among transgender women (TGW) with and without human immunodeficiency virus (HIV) are limited. We analyzed baseline data collected from a cohort of adult TGW across 6 eastern and southern US cities between March 2018 and August 2020 (n = 1018). Participants completed oral HIV screening, provided self-collected rectal and urogenital specimens for chlamydia and gonorrhea testing, and provided sera specimens for syphilis testing. We assessed associations with ≥1 prevalent bacterial STI using modified Poisson regression. Bacterial STI prevalence was high and differed by HIV status: 32% among TGW with HIV and 11% among those without HIV (demographic-adjusted prevalence ratio = 1.91; 95% confidence interval = 1.39-2.62). Among TGW without HIV, bacterial STI prevalence differed by geographic region, race and ethnicity, and gender identity, and was positively associated with reporting >1 sexual partner, hazardous alcohol use, homelessness, having safety concerns regarding transit to health care, and no prior receipt of gender-affirming health services. Among TGW with HIV, older age was inversely associated with bacterial STI. TGW had a high prevalence of bacterial STIs. The prevalence and correlates of bacterial STI differed by HIV status, highlighting the unique needs and risks of TGW with and without HIV. Tailored interventions may reduce sexual health-related inequities.

Spatial dynamic analysis and thematic mapping of vulnerable communities to urban floods

Natural disasters, particularly floods, have increasingly impacted urban areas globally. Previous research has not adequately analyzed the vulnerability to floods of populations based on race and ethnicity. This study aims to examine demographic changes over the past two decades in five southern US cities and determine whether minority and non-minority populations have moved closer to or farther from flood-prone areas. Using a spatial clustering approach, the study identifies geographical clusters of the white and minority populations within the 100-year floodplain. In general, the white people are moving away from floodplain areas in Birmingham and Jackson. Except for Charleston, the highest populations clustered in floodplains were minority communities (the African American and Hispanic). In Birmingham, both the White and the African American populations in floodplains have decreased due to the federal and local governments' relocating populations through acquisition projects. The African American in Jackson, Birmingham, and New Orleans were particularly vulnerable to flooding. Houston and New Orleans had also significant increases in the Hispanic and Asian populations within floodplains. The findings can help federal and local governments and communities understand spatial and temporal pattern dynamics between minorities and the White, which assists for effective decision making and equitable solutions to vulnerable communities.

Global connections from the second-tier: The trade performance of smaller southern US cities

After years of relative neglect, renewed attention has been paid to smaller, “ordinary” cities. The distinctiveness of these cities is often found in their economic development paths, which, can encompass their roles in international trade. Many locations have included exports as part of their economic growth strategies, yet the effectiveness of export strategies varies by location. This is in addition to varying components of exports for these cities, including the destination geographies and reliance on particular markets. In order to contribute to the growing literature on ordinary cities, this paper examines the export performance of smaller metropolitan areas across the southern United States. In recent decades, the South has been a region marked by robust economic performance, both overall and in terms of exporting; the region’s smaller cities are an especially notable case in terms of export performance and structure. While goods-related exports from the smaller cities across this region have tended to trend upward, export performance has been spatially uneven, with export markets and key export industries varying widely. The article concludes with an exploration and discussion of possible export trajectories for these urban areas in the post-pandemic and potentially, post-globalization, environments, particularly in terms of development-related outcomes.

HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study

Epidemiological monitoring of HIV among transgender women is minimal despite prioritisation of this group in the US National HIV/AIDS Strategy (2022-2025). We aimed to estimate HIV incidence in a multisite cohort of transgender women in the eastern and southern USA. Participant deaths were identified during follow-up; thus, we felt it was an ethical imperative to report mortality alongside HIV incidence. In this study, we established a multisite cohort across two modes: a site-based, technology-enhanced mode in six cities (Atlanta, Baltimore, Boston, Miami, New York City, and Washington, DC) and an exclusively digital mode that spanned 72 eastern and southern US cities that matched the six site-based cities based on population size and demographics. Trans feminine adults (≥18 years) who were not living with HIV were eligible and followed up for at least 24 months. Participants completed surveys and oral fluid HIV testing with clinical confirmation. We ascertained deaths through community and clinical sources. We estimated HIV incidence and mortality using the number of HIV seroconversions and deaths, respectively, divided by person-years accumulated from enrolment. Logistic regression models were used to identify predictors of HIV seroconversion (primary outcome) or death. Between March 22, 2018, and Aug 31, 2020, we enrolled 1312 participants with 734 (56%) in site-based and 578 (44%) in digital modes. At the 24-month assessment, 633 (59%) of 1076 eligible participants consented to extending participation. 1084 (83%) of 1312 participants were retained at this analysis based on the study definition of loss to follow-up. As of May 25, 2022, the cohort participants had contributed 2730 accumulated person-years to the analytical dataset. Overall HIV incidence was 5·5 (95% CI 2·7-8·3) per 1000 person-years and incidence was higher among Black participants and those living in the south. Nine participants died during the study. The overall mortality rate was 3·3 (95% CI 1·5-6·3) per 1000 person-years, and the rate was higher among Latinx participants. Identical predictors of HIV seroconversion and death included residence in southern cities, sexual partnerships with cisgender men, and use of stimulants. Participation in the digital cohort and seeking care for gender transition were inversely associated with both outcomes. As HIV research and interventions are increasingly delivered online, differences by mode highlight the need for continued community and location-based efforts to reach the most marginalised transgender women. Our findings underscore community calls for interventions that address social and structural contexts that affect survival and other health concerns alongside HIV prevention. National Institutes of Health. For the Spanish translation of the abstract see Supplementary Materials section.

Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US.

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women's HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. From April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18-45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher's exact test, studentized t-test, and multivariate logistic regression (MLR). A total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators. Findings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake.

113. Knowledge, Attitudes, and Practices towards HPV vaccination among reproductive-age women in an HIV hotspot in the US

Abstract Background Human papillomavirus (HPV) is the most common STI in the US, responsible for cervical cancer and increased risk of HIV acquisition. Despite an effective HPV vaccine, women’s HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, screening, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. Methods In April 2022, HIV-negative, cisgender, sexually active women aged 18-45 years were referred from a study evaluating HIV risks. Surveys assessed socio-demographics and sexual behaviors. Validated questionnaires assessed HPV knowledge, screening, and vaccination practices. A cumulative HPV knowledge score was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher’s exact test, studentized t-test, and multivariate logistic regression (MLR). Results A total of 67 participants were enrolled, and 54 who knew their vaccination status were included in the analysis: median age was 26 (IQR 22-34.5) years; 50% were White, 26% Black, and 33% were Hispanic. Median age at first sexual encounter was 18 (16-18) years, the mean number of sexual partners in the previous month was 1.45 (±1.44), and 33% had previous pregnancies. Mean HPV score was 13.4 (±8.84) out of 29, 43% reported a history of HPV/Pap smear screening. Barriers to HPV vaccination included: 28% low-risk perception, 24% healthcare barriers, and 41% vaccine hesitancy. In MLR, a one-point increase in HPV knowledge score increased the odds of vaccination by 21.5% (0.8-3.67%; p&amp;lt; 0.01). Age, number of sexual partners, and pregnancy history were not significant predictors of HPV vaccination. Conclusion Findings suggest low HPV knowledge among women of reproductive age in a high-risk area, and suggest that increasing knowledge may reduce barriers to HPV vaccination and increase vaccine uptake. Disclosures Maria L L. Alcaide, MD, Gilead: Advisor/Consultant.

Equitable, inclusive and sustainable public transit mobility through mobility on demand? A critical perspective

In recent decades, public transit authorities have increasingly opted to invest in commuter transit that caters to a whiter, wealthier demographic as opposed to lower-income transit-dependent populations. In addition, urban-suburban population shifts caused by central-city gentrification has meant that those who depend on public transit the most have been forced to move outside the city center. This presents challenges for transit-dependent riders, particularly in sprawling, car-dependent Southern US cities where transit agencies are spatially constrained and underfunded. Quite simply, the transit does not reach the destinations where the people who need it most are moving. Mobility-on-demand (MOD) has emerged in recent years as an innovative approach to sustainability through mobility. Increasingly, scholars are exploring its ability to increase access to opportunity areas (i.e., shopping, employment, social commitments) previously disconnected because of transit spatial mismatching. In this paper, we situate the discussion of MODs within the larger context of the unequal development in cities. We discuss extant research on MODs, and an initiative being piloted in a medium-sized Southern US city, Chattanooga, Tennessee. Using a transit equity lens we explore, within the context of historical and present uneven development, whether MODs are truly disruptive in reducing transit disadvantage, can address the limits of the “city-centric” nature of fixed and sparse public transit in areas of the country with a poor history of public transit investment (e.g., the US South), and respond to the dynamic nature of regional migration that constitute cities in the 21st century.

Does Procedural Justice Reduce the Harmful Effects of Perceived Ineffectiveness on Police Legitimacy?

Objectives: Judgments about police procedural fairness consistently have a stronger influence on how the public ascribes legitimacy to the police than evaluations of police effectiveness. What remains largely underexplored, however, is the potential moderating effect of procedural justice on the relationship between effectiveness and legitimacy and whether this moderation varies by citizen race. Method: We administered two separate surveys to determine whether procedural justice's moderating effect on the relationship between police ineffectiveness and legitimacy varies by citizen race. The first was a mail survey of a random sample of citizens in a southern US city (N = 1,681) conducted in 2013; the second, a national survey of adults (N = 972) administered via Qualtrics in 2022. Results: We found that procedural justice could help protect against the harmful influence of perceived ineffectiveness on police legitimacy in Study 2. However, contrary to expectations, this moderation effect held only for White Americans. Conclusions: The effect of perceived ineffectiveness on legitimacy evaluations does not vary depending on citizens’ perceptions of procedural justice. Yet, police still do have control over how they treat people with whom they interact, which is one mechanism that can improve citizens’ views on police legitimacy.

Patricia Silver, Sunbelt Diaspora: Race, Class, and Latino Politics in Puerto Rican Orlando

Reviewed by: Sunbelt Diaspora: Race, Class, and Latino Politics in Puerto Rican Orlando by Patricia Silver Guillermo Rebollo Gil (bio) Patricia Silver, Sunbelt Diaspora: Race, Class, and Latino Politics in Puerto Rican Orlando. University of Texas Press, 2020. Pp. 299. Patricia Silver's Sunbelt Diaspora: Race, Class, and Latino Politics in Puerto Rican Orlando offers a critical history of Puerto Ricans' decades-long struggle to form a community in this southern US city, where the legacy of Jim Crow sustains the dominant ideology as to who belongs and who gets to represent, and be represented, in local politics. Silver guides readers, in deft and engaging prose, across the shifting and combated sociopolitical terrain of Orange County, where Puerto Ricans, and Latinx peoples in general, have been subjected to discriminatory policies and regulations, which look to curtail their viability and vibrancy as a political force. [End Page 115] The triumph of this book, however, is that while, yes, Sunbelt Diaspora is very much a study into the intricacies of community building and political mobilization, the author has made the astute decision to focus on the ideological fault lines among Puerto Ricans in Orlando. Specifically, Silver examines how birthplace, race, and class function as criteria of belonging. Since the region has become the primary destination for Puerto Ricans from the island and the diaspora, the matter of perceived national or cultural authenticity garners special significance. While Puerto Ricans from New York tend to be perceived as less authentic, darker and/or more unruly, arrivals from the island—especially those who identify as white and are part of the "professional class"—look to distinguish themselves from the former, even if it means surrendering the possibility to organize around a shared Puerto Rican identity. Silver explains: "Puerto Ricans who have spent much or all of their lives as a US minority in diaspora bring to their relations in Orlando a nonwhite race consciousness that is often at odds with racial perspectives of those who have only ever lived in Puerto Rico and identify as white" (10). Aspirations toward whiteness thus become salient as barriers toward greater and more impactful political mobilization: Some Puerto Ricans in Orlando will strive toward achieving an honorary white status in America, generating social and geographical distance from their fellow Puerto Ricans. Others—the more precarious—will look to organize within the confines of a shared Puerto Rican identity but will remain wary of the more combative positions and actions of "immature Puerto Ricans from New York" (115). Then there are the ones who will be willing to engage the complexity and contradictions of living and building together. Reading Silver's book, it's hard not to be reminded of how Orlando figures in the island imagination of today as the place to which the supposed "best of who and what we are" leave in times of growing economic and political crisis in Puerto Rico; in a time where the tone of the public discourse about the sustainability of life in Puerto Rico becomes heavy with the fear of an impending substitution of population, with foreign investors buying up the land, driving people out. The solution, according to Puerto Rico's elected representatives, is to sit tight until "the best of us" decide to come back. Silver's book, in a way, offers an alternative: to commit to the seemingly obvious, but no less radical, proposition that who Puerto Ricans are in the island is also who they are in Orlando—a people subjected to a history of colonization and displacements, struggling to claim any space they inhabit as rightly theirs, all the while besieged by a pernicious ideology regarding the one true type of Puerto Rican. This book makes clear that for Puerto Rican life to be dignified and just, and sustainable anywhere, this ideology must continuously be discredited and defeated. [End Page 116] Guillermo Rebollo Gil Universidad Ana G. Méndez Guillermo Rebollo Gil Guillermo Rebollo Gil is a writer, sociologist, translator, and attorney. Recent publications include poetry in Pacifica Literary Review, Trampset, and HAD; prose in Sleet and Jellyfish Review; scholarly articles in Journal of Autoethnography and Liminalities. His book-length essay Writing Puerto Rico: Our Decolonial...

The association between food insecurity and gun violence in a major metropolitan city.

Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence. Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses. Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19). Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism. Prognostic and Epidemiologic; Level IV.

Urban wastewater bacterial communities assemble into seasonal steady states

BackgroundMicroorganisms in urban sanitary sewers exhibit community properties that suggest sewers are a novel ecosystem. Sewer microorganisms present both an opportunity as a control point for wastewater treatment and a risk to human health. If treatment processes are to be improved and health risks quantified, then it is necessary to understand microbial distributions and dynamics within this community. Here, we use 16S rRNA gene sequencing to characterize raw influent wastewater bacterial communities in a 5-year time series from two wastewater treatment plants in Milwaukee, WI; influent wastewater from 77 treatment plants across the USA; and wastewater in 12 Milwaukee residential sewers.ResultsIn Milwaukee, we find that in transit from residences to treatment plants, the human bacterial component of wastewater decreases in proportion and exhibits stochastic temporal variation. In contrast, the resident sewer community increases in abundance during transit and cycles seasonally according to changes in wastewater temperature. The result is a bacterial community that assembles into two distinct community states each year according to the extremes in wastewater temperature. Wastewater bacterial communities from other northern US cities follow temporal trends that mirror those in Milwaukee, but southern US cities have distinct community compositions and differ in their seasonal patterns.ConclusionsOur findings provide evidence that environmental conditions associated with seasonal change and climatic differences related to geography predictably structure the bacterial communities residing in below-ground sewer pipes.DoZVvrVoCyPBLkvDJ_Cd4MVideo abstract

Digital Epidemiologic Research on Multilevel Risks for HIV Acquisition and Other Health Outcomes Among Transgender Women in Eastern and Southern United States: Protocol for an Online Cohort.

BackgroundThe HIV epidemic disproportionately impacts transgender women in the United States. Cohort studies identify unique risks for affected populations, but use of facility-based methods may bias findings towards individuals living in research catchment areas, more engaged in health services, or, in the case of transgender populations, those who are open about their transgender identity. Digital clinical trials and other online research methods are increasingly common, providing opportunity to reach those not commonly engaged in research. Simultaneously, there is a need to understand potential biases associated with digital research, how these methods perform, and whether they are accepted across populations.ObjectiveThis study aims to assess the feasibility of developing and implementing an online cohort of transgender women to assess risks for HIV acquisition and other health experiences. Further, this study aims to evaluate how an online cohort compares to a site-based, technology-enhanced cohort for epidemiologic research. The overarching goal is to estimate incidence of HIV and other health outcomes among transgender women in eastern and southern United States.MethodsThis substudy is part of a larger multisite prospective cohort (LITE) conducted among transgender women, which also includes a site-based, technology-enhanced cohort in 6 eastern and southern US cities. The online cohort was launched to enroll and follow participants across 72 cities in the same region and with similar demographic characteristics as the site-based cohort. Participants are followed for 24 months. Adult transgender women are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants reporting negative or unknown HIV status are enrolled in a baseline study visit, complete a sociobehavioral survey, and provide oral fluid specimens to test for HIV. Participants not living with HIV (lab-confirmed) at baseline are offered enrollment into the cohort; follow-up assessments occur every 6 months.ResultsEnrollment into the online cohort launched in January 2019. Active recruitment stopped in May 2019, and enrollment officially closed in August 2020. A total of 580 participants enrolled into and are followed in the cohort. A recruitment-enrollment cascade was observed across screening, consent, and completion of study activities. Implementation experiences with HIV test kits highlight the need for heavy staff engagement to support participant engagement, visit completion, and retention, even with automated digital procedures.ConclusionsThis study is responsive to increasing research interest in digital observational and intervention research, particularly for populations who are most affected by the HIV epidemic and for those who may otherwise not participate in person. The progression across stages of the recruitment-enrollment cascade provides useful insight for implementation of cohort studies in the online environment.International Registered Report Identifier (IRRID)DERR1-10.2196/29152

Predictors of school mobility from public school pre-K to kindergarten

• We investigated switching schools between public school pre-k and kindergarten. • In a sample from a southern US city, 20.7% of children switched schools at this time. • Black children and those receiving free or reduced lunch were more likely to switch. • Lower school quality in public school pre-k increased the odds of switching. Public school pre-k programs are not only effective in promoting children’s school readiness but are also potentially useful for easing the transition from pre-k to kindergarten. One possible reason for this ease of transition is eliminating the need for children to change schools when starting kindergarten. However, little is known about whether children actually stay at the same school for kindergarten that they attended for pre-k and what predicts school mobility between pre-k and kindergarten. Using data from a large ( N = 18,775) and ethnically diverse (34.7% Black, 54.9% Latino, 10.3% White/other) sample of predominantly low-income children attending public school pre-k in Miami, we describe the prevalence, nature, and predictors of school mobility between the pre-k and kindergarten years. We found that 20.7% of students who attended public-school pre-k switched schools in the transition from preschool to kindergarten. Logistic regression analyses indicated that, before accounting for school quality, Black and Latino children (compared to White children) had higher odds of switching schools, as did children receiving free or reduced-price lunch. After accounting for school quality, Black children and children receiving free or reduced-price lunch no longer had higher odds of switching schools. Children attending lower-performing schools (compared to higher-performing schools) in pre-k had higher odds of switching schools. We also describe pre- and post-move school quality for different groups of children. Implications of school mobility between public school pre-k and kindergarten are discussed.

The Influence of Canopy Cover on Property Values in a Small Southern US City

Urban forests have been shown to impact residential property values in the United States and other countries. This study demonstrates a hedonic pricing analysis estimating the impact of urban forest canopy cover on single-family residential property values using Lakeland, Tennessee, during the period of 2001 to 2005 as a typical study area for the southern United States. Canopy cover on the lot was not a significant contributor to property values. However, a 1.0% increase in canopy within buffers of 100 m, 500 m, and 1 km surrounding the lot was associated with a 0.12%, 0.17%, and 0.21% increase in home sales prices, respectively. Although the percentage increases were small, given the price of a home in areas like these, the dollar values were high. These results can be used to assist urban planners and policy makers in prioritizing forested lands for conservation and to evaluate economic effects of urban forestry policies and programs.

Distance from a comprehensive cancer center: A poor proxy for serous endometrial cancer outcomes?

e19084 Background: To compare the relationship between outcomes in serous endometrial cancer patients based on distance from a tertiary referral center in the Southern US. Methods: A retrospective cohort study among all women diagnosed with serous endometrial cancer between 2009 to 2018 was completed at a tertiary referral center in a low socioeconomic Southern US city with a predominately African American population. The primary exposure variable was the distance traveled by the patient to the treatment center. This distance was calculated using Google Maps from the patients’ home addresses to the cancer center. Abstracted data from each patient included patient demographics of home address, BMI at time of first visit, race, transportation method to the cancer center, and presence of primary care provider (PCP). Clinical variables of stage at diagnosis and pathology, treatment, and outcomes were included. Chi square analysis and log-rank analysis were completed. Data was analyzed by SPSS software. Results: In total, 202 patients were living a median distance of 31.4miles (range of 0.9mi to 194mi) from the cancer center. Of this cohort, the median age at time of diagnosis was 67 years old with a median BMI of 31.4kg/m2. The most common stage at diagnosis was stage 1A (26.7%). Using log rank analysis, there was no difference in overall survival when compared based on age, race, BMI and access to transportation. 92% (n=185) of the cohort had immediate access to a transportation method via personal car or family car, the remaining patients relied on other methods of transport. The total distance from treatment center was significant when compared with stage at diagnosis (p=0.011) portending greater stage at diagnosis with further distance. However, this did not correlate to progression free or overall survival (p = 0.83) in the cohort. Patients with a PCP were likely to be diagnosed at an earlier stage (Stage IA or Stage IB) compared to those without a PCP with a p=0.003, mean of 0.93, 95% CI (0.89 – 0.97). Conclusions: Living closer to a cancer center and having a PCP were associated with earlier stage at diagnosis in patients with serous endometrial cancer. Distance from the cancer center did not affect overall survival when adequate transportation methods were available.

A Theoretically Based Mobile App to Increase Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

BackgroundHealthMindr is a mobile phone HIV prevention app for men who have sex with men (MSM). In a previous pilot study, HealthMindr was found to be acceptable among users and to demonstrate preliminary effectiveness for increasing pre-exposure prophylaxis (PrEP) uptake among MSM. PrEP is a highly effective HIV prevention intervention; however, uptake remains low.ObjectiveThe aim of this study will be to assess the efficacy of a mobile app for increasing PrEP uptake among MSM in the southern United States.MethodsIn this randomized controlled trial, we will assess the efficacy of HealthMindr for increasing PrEP uptake among MSM in the following three southern US cities: Atlanta, Georgia; Jackson, Mississippi; and Washington, DC. In total, 657 men will be recruited and randomized to intervention and control arms in a 2:1 ratio. Participants in the intervention arm will receive access to the full HealthMindr app, with information and resources about PrEP (eg, frequently asked questions, risk assessment tool, and PrEP provider locator), other HIV prevention information, ability to order free HIV/sexually transmitted infection test kits, and additional resources related to substance use and mental health. Participants in the control arm will use the HealthMindr app but will only have access to the study timeline and a message center to communicate with study staff. Participants will complete quarterly surveys to assess self-reported PrEP uptake over 12 months of follow-up. Self-reported PrEP uptake will be verified by dried blood spot testing and/or uploading a photograph of a PrEP prescription.ResultsParticipant recruitment began in January 2020.ConclusionsThis trial will determine whether the HealthMindr app can increase PrEP uptake among MSM in the southern United States.Trial RegistrationClinicalTrials.gov NCT03763942; https://clinicaltrials.gov/ct2/show/NCT03763942International Registered Report Identifier (IRRID)PRR1-10.2196/16231

Substance use, intimate partner violence, history of incarceration and vulnerability to HIV among young Black men who have sex with men in a Southern US city

In this longitudinal qualitative study we explored the lived experiences of young Black men who have sex with men in Dallas, Texas in relation to methamphetamine use, intimate partner violence and a history of incarceration as syndemic conditions that may contribute to their risk of transmitting or acquiring HIV. We conducted a total of 106 interviews (four repeat interviews every six months) with a cohort of 30 participants. Some reported condomless sex and no discussion about condom use or HIV status with sexual partners. Fifteen participants reported that they were living with HIV. Methamphetamine use contributed to participants’ unstable housing, job loss, destructive relationships and HIV risk. One third of participants reported a history of intimate partner violence. About half had a history of incarceration resulting from intimate partner violence, substance use/dealing and/or other activities. Post-release, having a criminal record limited job opportunities and impacted financial stability. Consequently, some men engaged in survival work involving HIV risk (sex work, organising/participating in sex parties). Methamphetamine use, intimate partner violence and incarceration may constitute syndemic conditions that increase young Black men who have sex with men’s risk for HIV acquisition and transmission. HIV prevention interventions must address syndemics and include structural factors and the wider social environment.

American Cohort to Study HIV Acquisition Among Transgender Women in High-Risk Areas (The LITE Study): Protocol for a Multisite Prospective Cohort Study in the Eastern and Southern United States.

BackgroundIn the United States, transgender women (TW) are disproportionately burdened by HIV infection. Cohort studies are needed to evaluate factors driving HIV acquisition among TW over time. These will require implementation strategies that are acceptable to the TW community and feasible to implement.ObjectiveThis study aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern United States.MethodsLITE is a multisite prospective cohort in 6 eastern and southern US cities, which will be followed across 24 months of technology-enhanced biobehavioral follow-up. Adult TW, regardless of HIV status, are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants are enrolled in a baseline study visit, complete a sociobehavioral survey, and test for HIV and sexually transmitted infections. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1100); follow-up assessments occur quarterly.ResultsCohort assembly was informed by synchronous Web-based focus group discussions with TW (n=41) and by continuing engagement with community advisory board members from each site. Enrollment launched in March 2018. The study is underway in the Atlanta; Baltimore; Boston; Miami; New York City; and Washington, DC, metro areas. As of March 2019, 795 TW completed a baseline visit (mean age 35 years). The majority of the participants are racial/ethnic minorities, with 45% of the TW identifying as black and 28% of the TW identifying as Hispanic/Latinx. More than one-quarter (28%) of the TW are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, although peer referral and referral through trusted health facilities and organizations remain most effective.ConclusionsThis study is responsive to increasing research interest in technology-enhanced methods for cohort research, particularly for hard-to-reach populations. Importantly, the diversity of literacy, technology use, and overall socioeconomic situations in this sample of TW highlights the need to leverage technology to permit a flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design.International Registered Report Identifier (IRRID)DERR1-10.2196/14704