Women In Atlanta Research Articles

Applying an Evidence-Based Community Organizing Approach to Strengthen HIV Prevention for Cisgender Women in US South: Protocol for a Mixed Methods Study.

Most new HIV diagnoses among cisgender women in the United States occur in the South. HIV pre-exposure prophylaxis (PrEP), a cornerstone of the federal Ending the HIV Epidemic (EHE) initiative, remains underused by cisgender women who may benefit. Awareness and access to PrEP remain low among cisgender women. Moreover, improving PrEP reach among cisgender women requires effectively engaging communities in the development of appropriate and acceptable patient-centered PrEP care approaches to support uptake. In a community-clinic-academic collaboration, this protocol applies an evidence-based community organizing approach (COA) to increase PrEP awareness and reach among cisgender women in Atlanta. The aim of this study is to use and evaluate a COA for engaging community members across 4 Atlanta counties with high-priority EHE designation, to increase PrEP awareness, interest, and connection to PrEP care among cisgender women. The COA, consisting of 6 stages, will systematically develop the skills of community members to become leaders and advocates for HIV prevention inclusive of PrEP for cisgender women in their communities. We will use the evidence-based COA to develop and implement a PrEP-specific action plan to create broader community change by raising awareness and interest in PrEP, reducing stigma associated with HIV or PrEP, and connecting women to sexual health clinics providing PrEP services. In the first 4 stages, to prepare for and develop action plans, we will gather data from one-on-one interviews with up to 100 individuals across Atlanta to capture attitudes, motivations, and influences related to women's sexual health with a focus on HIV prevention and PrEP. Informed by the community interviews, we will revise a sexual health curriculum inclusive of PrEP and community-centered engagement. We will then recruit and train community action team members to develop action plans to implement the curriculum during community-located events. In the last 2 stages, we will implement and evaluate COA's effect on PrEP awareness, interest, HIV or PrEP stigma, and connection to PrEP care among cisgender women community members. This project was funded by the National Institutes of Health and approved by the Emory University institutional review board in July 2021. Data collection began in December 2021 and is ongoing. COA stage 1 of the study is complete with 70 participants enrolled. Community events commenced in November 2023, and data collection will be completed by November 2025. Stage 1 qualitative data analysis is complete with results to be published in 2024. Full study results are anticipated to be reported in 2026. Through a community-clinic-academic collaboration, this protocol proposes to mount a coordinated approach across diverse Atlanta counties to strengthen HIV prevention for cisgender women and to create a sustainable systems approach to move new sexual health innovations more quickly to cisgender women. DERR1-10.2196/56293.

Cross-Sectional Study: Assessment of Health and Digital Literacy among First-Generation Muslim Immigrant Women in Atlanta City during the Pandemic

Assess health and digital literacy, and to evaluate telehealth awareness after COVID19 of the first-generation Muslim women in Atlanta. Methods: Multi-approach design. Phase I: We assessed health and digital literacy of 42 participants. Phase II: We measured Knowledge, Attitude, and Practice (KAP) of using Telehealth by surveying 45 participated women. We assessed how COVID-19 affected the participants’ KAP to use telehealth services.

Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype.

Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non-sexually active counterparts. The emerging themes from the focus group session were Black women's health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app-based interventions.

Joint effects of individual socioeconomic status and residential neighborhood context on vaginal microbiome composition.

The vaginal microbiome is a dynamic ecosystem that is important for women's health. Its composition has been associated with risk for menopausal symptoms, sexually transmitted infections, gynecologic cancer, and preterm birth. Conventional risk factors for a vaginal microbiome linked with these adverse health outcomes include sexual behaviors, hygiene practices, individual social factors, and stress levels. However, there has been limited research on socio-contextual determinants, and whether neighborhood context modifies the association with individual socioeconomic factors. Socioeconomically diverse pregnant African American women in Atlanta, Georgia (n = 439) provided residential addresses and first trimester vaginal swab samples, which underwent sequencing, taxonomic classification, and assignment into mutually exclusive CST (community state types) via hierarchical clustering. Linear probability models were used to estimate prevalence differences (PD) for the associations of neighborhood factors with vaginal microbiome CST and to evaluate for additive interaction with maternal level of education, health insurance type, and recruitment hospital. Factors such as higher (vs. lower) maternal education, private (vs. public) insurance, and private (vs. public) hospital were associated with higher prevalence of Lactobacillus-dominant vaginal microbiome CSTs typically associated with better health outcomes. When considering the joint effects of these individual socioeconomic status and residential neighborhood factors on vaginal microbiome CST, most combinations showed a greater than additive effect among the doubly exposed; however, in the case of local income homogeneity and local racial homogeneity, there was evidence of a crossover effect between those with less-advantaged individual socioeconomic status and those with more-advantaged individual socioeconomic status. Compared to women at the public hospital who lived in economically diverse neighborhoods, women at the private hospital who lived in economically diverse neighborhoods had a 21.9% higher prevalence of Lactobacillus-dominant CSTs, while women at the private hospital who lived in less economically diverse neighborhoods (the doubly exposed) had only an 11.7% higher prevalence of Lactobacillus-dominant CSTs, showing a crossover effect (interaction term p-value = 0.004). In this study, aspects of residential neighborhood context were experienced differently by women on the basis of their individual resources, and the joint effects of these exposures on vaginal microbiome CST showed a departure from simple additivity for some factors.

Barriers to breast cancer screening in Atlanta, GA: results from the Pink Panel survey at faith-based institutions.

PurposeOur research sought to describe barriers to mammography screening among a sample of predominantly Black women in metropolitan Atlanta, Georgia.MethodsThe Pink Panel project convened community leaders from faith-based institutions to administer an offline survey to women via convenience sampling at fourteen churches in Atlanta in late 2019 and early 2020. With the COVID-19 pandemic, the research team switched to an online survey. The survey included seven questions about breast cancer awareness, barriers to breast cancer screening, and screening status. We used residence information to attain the 9-digit zip code to link to the Area Deprivation Index at the Census Block Group neighborhood level. We report results as descriptive statistics of the barriers to mammography screening.ResultsThe 643 women represented 21 counties in Georgia, predominantly from metropolitan Atlanta, and 86% identified as Black. Among women aged 40 and older, 90% have ever had a mammogram. Among all women, 79% have ever had a mammogram, and 86% indicated that they would get a mammogram if offered in their neighborhood. The top barriers to mammography screening were lack of health insurance and high cost. Barriers to mammography screening did not differ substantially by Area Deprivation Index.ConclusionAmong metropolitan Atlanta women aged 40+ , nearly all reported ever having a mammogram. However, addressing the barriers, including lack of health insurance and high cost, that women reported may further improve mammography screening rates.

Incarceration and Sexual Risk Behavior and Incident Sexually Transmitted Infection/HIV in HIV Prevention Trials Network 061: Differences by Study City and Among Black Sexual Minority Men Who Have Sex With Men, Black Sexual Minority Men Who Have Sex With Men and Women, and Black Transgender Women.

Black sexual minority men (BSMM) and Black transgender women face a disproportionate risk of incarceration and sexually transmitted infection (STI)/HIV, yet research on the longitudinal association between incarceration and STI/HIV risk in these groups is limited. We used data from the HIV Prevention Trials Network (HPTN) 061 study conducted among BSMM and Black transgender women in Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington, DC, restricting analyses to those who returned for the 6-month follow-up visit when recent incarceration was measured (n = 1169). Using inverse probability of treatment weighting, we measured associations between incarceration and next 6-month multiple partnerships; selling or buying sex; condomless anal intercourse; and incident chlamydia, gonorrhea, syphilis, and HIV. We explored differences by study city, and among BSMM who had sex with men only, BSMM who had sex with men and women, and Black transgender women. Approximately 14% reported past 6-month incarceration. Incarceration was associated with next 6-month selling sex (adjusted risk ratio [ARR], 1.80; 95% confidence interval [CI], 1.12-2.87) in the overall sample and multiple partnerships among BSMM who had sex with men and women (ARR, 1.34; 95% CI, 1.10-1.63) and transgender women (ARR, 1.77; 95% CI, 1.22-2.57). There is evidence suggesting that incarceration may predict gonorrhea (ARR, 2.35; 95% CI, 0.95-5.77), with particularly strong associations observed in Los Angeles (ARR, 6.48; 95% CI, 1.48-28.38). Incarceration may increase STI/HIV risk among BSMM and Black transgender women. Additional mixed-methods research is needed to validate associations and understand pathways.

Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic.

During the pandemic, the overall mental health of the US population declined. Given higher rates of COVID-19 infections and deaths experienced by communities of color along with greater exposure to pandemic-related stressors (e.g., unemployment, food insecurity), we expect that the decline in mental health during the pandemic was more pronounced among Black, Hispanic, and Asian adults, with these groups also having less access to mental health services. We examine two nationally representative US surveys: the 2019 National Household Interview Survey (NHIS; N = 30,368) and the 2020–2021 Household Pulse Survey (HPS; N = 1,677,238). We find mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, with significant increases in depression and anxiety among racialized minorities compared to Whites. There is also evidence of especially high mental health burden for Black adults around the murder of George Floyd by police and for Asian adults around the murder of six Asian women in Atlanta. White respondents are most likely to receive professional mental health care before and during the pandemic, and Black, Hispanic, and Asian respondents demonstrate higher levels of unmet mental health care needs during the pandemic than White respondents. Our results indicate that within the current environment, White adults are at a large and systemic advantage buffering them from unexpected crises—like the COVID-19 pandemic. Without targeted interventions, the long-term social consequences of the pandemic and other co-occurring events (e.g., death of Black and Hispanic people by police) will likely include widening mental health disparities between racial/ethnic groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-022-01284-9.

Abstract P094: Awareness Of Cardiovascular Disease Is Low Among Young Women And Varies By Region

Background: Prior research has shown that awareness of cardiovascular disease (CVD) and its risk factors is low among young women. The present study used preliminary data to compare the awareness of CVD in young women seen in primary care clinics in the Northeastern and Southeastern United States. Methods: We recruited 370 females ages 15-24 years from two primary care clinics located in Boston, MA (n=331) and Atlanta, GA (n=39). Recruitment in Atlanta, GA is ongoing. Participants completed a modified version of the AHA Women’s Health Survey. We examined the relationship between location and 1) knowledge about CVD and 2) engagement in preventive behaviors, while controlling for race/ethnicity, age group, and primary caregiver education. Results: Sixty-two percent (n=23) of young women in Atlanta reported feeling informed about CVD, while 53% (n=163) of young women in Boston reported feeling informed about CVD. Only 13% (n=34) of participants in Boston and 6% (n=2) of participants in Atlanta correctly identified CVD as the leading cause of death for women. Participants in Atlanta were less likely to report engagement in CVD preventive behaviors such as exercising (OR: 0.32, 95% CI: 0.12, 0.91), maintaining a healthy cholesterol (OR: 0.13, 95% CI: 0.04, 0.50) or blood pressure level (OR: 0.24, 95% CI: 0.08, 0.74), and reducing sugar in their diet (OR: 0.33, 95% CI: 0.12, 0.91). Moreover, young women in Atlanta were more than twice as likely to report having never discussed CVD-related health topics such as family history of CVD, blood pressure, and cholesterol with their health care provider (OR: 2.46, 95% CI: 0.86, 7.02). Conclusion: CVD awareness is low among young women and varies by region. Despite living in a region where CVD is highly prevalent, young women in Atlanta were less likely to engage in preventive behaviors and less likely to discuss CVD-related topics with their health care provider. In this region where cardiovascular health disparities are common, opportunities remain to promote heart healthy behavior among young women to reduce CVD risk.

Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA.

We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11-8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.

Addressing Maternal Mental Health among Black Perinatal Women in Atlanta, Georgia: a CBPR approach

Addressing Maternal Mental Health among Black Perinatal Women in Atlanta, Georgia: a CBPR approach

Knowledge of Fertility and Perception of Fertility Treatment Among Adults with Sickle Cell Disease (KNOW FERTILITY)

BackgroundAdults with sickle cell disease (SCD) face unique fertility risks due to SCD and use of disease modifying therapies (DMTs). Concerns about compromising fertility may inform patients' therapy choices, but little is known about fertility knowledge in adults with SCD. The Cardiff Fertility Knowledge Scale (CFKS) and Fertility Treatment Perception Survey have been studied in international and national cohorts 1,2. The purpose of this study was to administer these surveys to adults with SCD and compare responses to previously studied populations.MethodsOur IRB approved this cross-sectional study of adults with SCD (≥18YO) cared for at our Sickle Cell Center for Adults. Due to the COVID-19 pandemic, eligible subjects were recruited during routine telemedicine clinic visits and by invitation via electronic medical record. We collected demographic information (sex, age (≥/< 31YO), educational attainment, and use of DMTs). The CFKS is a 13-question survey that measures knowledge of causes of reduced fertility, common misconceptions about fertility, and infertility facts. Questions are answered True/False/Don't know and equally weighted; the cumulative score is 0-100%. We compared the mean CFKS scores to the scores from two published cohorts 1,2. The fertility treatment perception survey consists of two positive and four negative statements about fertility treatment with responses given on a five-point Likert scale (1= strongly disagree to 5= strongly agree). Responses are calculated by number of respondents with an agreement score of 4 and/or 5 divided by total number of respondents per sub-group; higher scores indicate stronger agreement. Analysis included summary statistics with means and standard deviations and independent student's T-test to compare the mean fertility knowledge scores.ResultsWe contacted 435 subjects; 91 respondents were enrolled (21% response rate). Respondents were 77% female [median age 33 years (IQR 23, 50)]. 51% completed high school or less and 18% used one or more DMTs, with 65% taking hydroxyurea. Table 1 shows the CFKS results. The average CFKS score was 50%, lower than the international cohort (50% vs. 57%, p<0.001) and higher than a cohort of Black women in Atlanta, GA (50% vs. 38%, p<0.001). Respondents with higher educational attainment had a higher score (55% secondary education vs. 44% primary education, p=0.04). The questions most answered correctly addressed the lack of correlation between erectile function and fertility (79%) and smoking's risk to fertility in men (69%) and women (71%). The questions least answered correctly were about classifying infertility (32%) and the impact of age effect (34%), overweight effect (25%), and sexually transmitted infections' effect on fertility (36%). There was no difference in knowledge scores by age, sex, or SCD treatment. Table 2 shows fertility treatment perception survey results. Some respondents (34%) agreed that fertility treatments are safe. Almost half (46%) agreed that fertility treatments are effective. Over 60% of respondents agreed that fertility treatments are scary and/or cause emotional problems, while 48% agreed that fertility treatments may have short-term physical effects. There was no difference in responses by sex, age, or SCD treatment.ConclusionIn this study, we identify that higher educational attainment in adults with SCD is associated with better fertility knowledge. All subjects had low knowledge of sexually transmitted infections, weight gain, and older age as infertility risks. Although there is concern that hydroxyurea may compromise fertility, its use was not associated with greater fertility knowledge in this study. Given concerns about fertility in the SCD community, we identify an opportunity to support patients concerned about fertility by contextualizing real or theorized SCD-specific fertility risks within a broader set of established fertility risks.

Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women.

Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.

Prenatal per- and polyfluoroalkyl substance (PFAS) exposure, metabolomic perturbation, and lower birth weight in African American women: a meet-in-the-middle approach

BACKGROUND AND AIM: Prenatal exposures to per- and polyfluoroalkyl substances (PFAS) have been linked to restricted fetal growth. Pregnant African American (AA) women are disproportionately exposed to higher levels of select PFAS and experience higher rates of low birth weight than other races/ethnicities. However, the detailed molecular mechanisms underlying these disparities remain largely unknown. The purpose of this study is to investigate biological pathways and intermediate biomarkers underlying association between prenatal PFAS exposure and lower birth weight using high resolution plasma metabolomics among pregnant AA cohort. METHODS: Serum perfluorohexane sulfonic acid, perfluorooctane sulfonic acid, perfluorooctanoic acid, and perfluorononanoic acid meaurements, and untargeted plasma metabolomics profiling were conducted in 312 pregnant AA women in Atlanta, Georgia at 8-14 weeks of gestation using fasting blood samples. We utilized a high-resolution metabolomics workflow, including Metabolome-Wide Association Studies (MWAS), enriched pathway analyses, and chemical annotations, with the ‘meet-in-the-middle’ approach to identify the potential biological pathways and intermediate biomarkers of the PFAS-birth weight relationship. RESULTS:Among 25,516 metabolomic features extracted from the polar and nonpolar analytical columns, 320 features were significantly associated with serum PFAS and birth weight in the MWAS. After further validation using online databases or authentic chemical standards in the laboratory, we found 8 confirmed biomarkers including glycine, α-ketoisovalerate, uric acid, monoradylglycerol, and some polyunsaturated fatty acids and steroid hormones. In addition, 17 biological pathways associated with serum PFAS and birth weight were identified, including linoleate, vitamin D3, branched-chain amino acid, and fatty acid metabolism. The significant biomarkers and biological pathways identified were mostly involved in amino acid, lipid, and fatty acid metabolism or inflammation and oxidative stress. CONCLUSIONS:This study among pregnant AA found several maternal metabolic perturbations associated with serum PFAS concentrations and birth weight. Future studies are warranted to validate these findings and completely apprehend the underlying biological mechanisms. KEYWORDS: PFAS, metabolomics, birth weight

Associations of single and multiple per- and polyfluoroalkyl substance (PFAS) exposure with vitamin D biomarkers in African American women during pregnancy

Vitamin D has been linked to various physiological functions in pregnant women and their fetuses. Previous studies have suggested that some per- and polyfluoroalkyl substances (PFAS) may alter serum vitamin D concentrations. However, no study has investigated the relationship between PFAS and vitamin D in pregnant women. This study aims to evaluate the associations of serum PFAS with serum total and free 25-hydroxyvitamin D (25(OH)D) during pregnancy in a cohort of African American women in Atlanta, GA. Blood samples from 442 participants were collected in early pregnancy (8-14 weeks of gestation) for PFAS and 25(OH)D measurements, and additional samples were collected in late pregnancy (24-30 weeks) for the second 25(OH)D measurements. We fit multivariable linear regressions and weighted quantile sum (WQS) regressions to estimate the associations of individual PFAS and their mixtures with 25(OH)D concentrations. We found mostly positive associations of total 25(OH)D with PFHxS (perfluorohexane sulfonic acid), PFOS (perfluorooctane sulfonic acid), PFDA (perfluorodecanoic acid), and NMeFOSAA (N-methyl perfluorooctane sulfonamido acetic acid), and negative associations with PFPeA (perfluoropentanoic acid). For free 25(OH)D, positive associations were observed with PFHxS, PFOS, PFOA (perfluorooctanoic acid), and PFDA, and a negative association with PFPeA among the women with male fetuses in the models using 25(OH)D measured in late pregnancy. In mixture models, a quartile increase in WQS index was associated with 2.88ng/mL (95%CI 1.14-4.59) and 5.68ng/mL (95%CI 3.31-8.04) increases in total 25(OH)D measured in the early and late pregnancy, respectively. NMeFOSAA, PFDA, and PFOS contributed the most to the overall effects among the eight PFAS. No association was found between free 25(OH)D and the PFAS mixture. These results suggest that PFAS may affect vitamin D biomarker concentrations in pregnant African American women, and some of the associations were modified by fetal sex.

Stress and coping amongst cisgender male partners of transgender women

The cisgender male partners of transgender women have received little attention beyond their sexual behaviour. This is an issue, as marginalisation and social environments determine sexual behaviour and subsequent health outcomes. This article assesses in-depth interviews with cisgender male partners of transgender women in Atlanta and Baltimore, USA. Analysis suggests men experience minority stress that may lead to ameliorative coping processes such as coming out and LGBTQ group affiliation. Specifically, the interviews identify stressful, marginalising reactions from family and friends concerning men’s relationships with transgender women. In turn, men described uniquely supportive ties to LGBTQ communities, which included ongoing relationships with transgender women, having close sexual and gender minority friends, and occupying notably LGBTQ spaces such as Pride events. The LGBTQ social connectivity of the cisgender male partners of transgender women could prove critical to future targeted HIV prevention efforts.

An activity space approach to understanding how food access is associated with dietary intake and BMI among urban, low-income African American women.

Inconclusive evidence for how food environments affect health may result from an emphasis on residential neighborhood-based measures of exposure. We used an activity space approach to examine whether 1) measures of food access and 2) associations with diet and BMI differ between residential and activity space food environments among low-income African American women in Atlanta, Georgia (n=199). Although residential and activity space environments differed across all dimensions of food access, being located farther away from 'unhealthy' outlets was associated with lower BMI in both environments. Future research should move beyond asking whether residential and activity space environments differ, toward examining if, how, and under what conditions these differences impact the estimation of health effects.

Black Transgender Women and the School-to-Prison Pipeline: Exploring the Relationship Between Anti-trans Experiences in School and Adverse Criminal-Legal System Outcomes

The school-to-prison pipeline (STPP), a framework which describes mechanisms and pathways within the education system that drive students toward involvement in the criminal-legal system, has seen increasing attention from youth researchers, professionals, and advocates in recent years. However, the experiences of transgender individuals and trans-related policies in schools have largely been absent from explorations of the STPP. To begin addressing this gap, this study explores the relationship between anti-trans experiences in school and adverse criminal-legal system outcomes among a sample of 138 Black/African American transgender women (ages 18–65). Data were derived from a life course survey of transgender women in Atlanta and Chicago conducted between August 2014 and September 2017. Only participants who were Black/African American were included in the analytic sample (n = 138). Bivariate and logistic regression analyses were conducted to explore the relationship between education factors (high school/GED completion, anti-trans school victimization, anti-trans school expulsion/denial of enrollment, and denial of gender-appropriate facilities) and criminal-legal system factors (incarceration, anti-trans police mistreatment, and discomfort seeking police assistance). Analyses were conducted for both the full sample and youth subsample of 83 participants (age 30 or younger). Among the overall sample, logistic regression models revealed that anti-trans school expulsion/denial of enrollment was associated with a greater odds of anti-trans mistreatment by police (p = .026, OR = 5.091). Denial of gender-appropriate facilities in school was also associated with anti-trans mistreatment by police (p = .034, OR = 3.873). Among the youth subsample, anti-trans victimization in school was associated with a greater odds of incarceration (p = .021, OR = 3.717). Anti-trans school expulsion/denial of enrollment was also associated with a greater odds of incarceration (p = .046, OR = 9.460). These associations suggest that anti-trans school experiences warrant consideration as factors in the school-to-prison pipeline. Future research that traces the pathways between anti-trans school environments and outcomes in the criminal-legal system would be valuable. Policy interventions that combat anti-trans school victimization and institutional discrimination may be critical to disrupting the STPP for Black/African American transgender women.

Abstract P533: Food Shopping Practices of Low-income African American Women: Associations With Features of the Food Environment

Introduction: The food environment has received considerable attention as a potential correlate of diet-related CV health. Features of the food environment are assumed to influence the places where people shop, which in turn affect the types of foods purchased and ultimately consumed. However, this assumption remains largely untested due to limited data on where people actually shop. Leveraging unique spatial data on food shopping destinations, we examine whether features of the food environment are associated with the food shopping practices of low-income African American women in Atlanta, Georgia (n=199). Hypothesis: Access to food retailers will be positively associated with their use. Methods: We collected spatial data on locations visited in the past month using a Google Maps-driven questionnaire. Food shopping practices, including the number of retailers, trip frequency, and average distance traveled from home, were assessed separately for supermarkets, convenience stores, and discount (e.g. dollar) stores. We used secondary data on retail food outlets to calculate three measures of food access: density, proximity, and quality. GEE estimated adjusted associations between food access and food shopping practices, controlling for correlation within census tracts. Adjusted models examined supermarket shopping practices, the only outlet used by a majority of women. Results: Only 12.1% of women had a supermarket located within 1 mile of home, compared to 53.8% for convenience and 22.6% for discount stores. Women lived farthest from supermarkets ( Mdn =1.6 mi, IQR =0.9-2.3), followed by discount ( Mdn =1.0 mi, IQR =0.6-1.3) and convenience ( Mdn =0.4 mi, IQR =0.2-0.7) stores. Women also traveled farthest to shop at supermarkets ( Mdn =3.6 mi, IQR =2.5-5.3), traveling over twice the distance of the closest outlet. Nearly all women (97%) shopped at supermarkets, 33% at discount stores, and 25% at convenience stores. In adjusted models, exposure to higher supermarket density was associated with a 13% decrease in distance traveled from home to utilized supermarkets ( e β =0.87, 95% CI : 0.80-0.94). Living farther away from a supermarket was weakly associated with distance traveled from home to utilized supermarkets ( e β =1.04, 95% CI : 1.03-1.06). Conclusions: Women may seek to overcome limited access to supermarkets, rather than rely on more accessible, but less healthy retailers. While women exposed to a higher density of supermarkets used supermarkets closer to home, living in closer proximity to a supermarket minimally affected how close to home they shopped. Higher retail density offers a greater number of supermarket choices, making it more likely that women will find one closer to home aligned with their personal preferences (e.g. affordability, hours, access from public transport). Interventions to improve food access must acknowledge that proximity alone may not drive outlet use.

Moving the body: physical activity among Barbadians

Purpose The purpose of this paper is to examine the beliefs, self-perceptions, and self-reported behaviors around physical activity among Barbadian women on the Caribbean island of Barbados, and among Barbadian migrant women in Atlanta, Georgia. It investigates their perceptions and practices of physical activity and its relationship to health, and how these ideas and practices differ between the two sites. Design/methodology/approach Situated within long-term ethnographic research conducted in both study sites, this paper focuses on qualitative interview data and quantitative physical activity logs from 31 Barbadian women. Findings Most study subjects expressed belief that physical activity is valuable to their health. Women in Barbados described their own lives as active, and documented this activity in their physical activity logs. However, women in Atlanta described patterns of limited activity that were evidenced in their logs. Qualitative interviews determined that the overarching reasons for this inactivity are the structural confines of wage labor and the built environment. Social implications These findings indicate that rather than health promotions that emphasize individual responsibility, physical activity levels in US migrant populations may more likely be altered by addressing the structural limitations of the American work day or the ubiquitous urban commute time. Originality/value This paper is unique in its contribution of dual-sited qualitative research that explores the motivations and limitations of physical activity in a migrant population. In addition, it enhances the existing literature by examining a native-English-speaking, middle-class population in migration.

GENDER-SPECIFIC APPROACHES TO HEALTHY AGING WITH HIV

Older adults with HIV (OAH) evidence a significant burden of disease, characterized by high frequencies of non-HIV related comorbidities that result in multimorbidity and polypharmacy decades earlier than non-HIV infected older adults. Commonly observed comorbidities among OAH 50 years and older include cardiovascular disease, hypertension, diabetes, osteoporosis, and cancers. Geriatric conditions such as frailty, functional impairment, chronic inflammation, and cognitive dysfunction are also prevalent. Poverty, unemployment, housing, and food insecurity, as well as stigma-driven discrimination, persistent social isolation and high rates of depression, can make health-related challenges associated with aging overwhelming, resulting in a diminished capacity for self-care. Older men and women with HIV; however, are aging differently due to gender-specific differences in comorbidity profiles, polypharmacy burden, social networks, and intersectional stigmas (HIV/AIDS, ageism, racism, sexism, classism, homophobia, and transphobia). This symposium explores the impact of gender on healthy aging among OAH. Dr. Brennan-Ing and colleagues describe specific strategies for achieving healthy aging among female OAH in NYC and Oakland, CA. Dr. Rubtsova and colleagues explore multiple meanings of “successful aging” among older women in Atlanta and Brooklyn, and the role of resilience that empowers them as long-term HIV survivors. Dr. Taylor qualitatively examines the impact of biopsychosocial factors on notions of “Healthy HIV Aging” among older gay, bisexual and heterosexual men with HIV. Dr. Ruth Finkelstein will discuss the public health implications for developing equitable and gender-specific and intersectional HIV prevention and wellness interventions and suggest future areas of inquiry to improve HIV outcomes across the care continuum.