Women In Chicago Research Articles

Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women.

Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remain rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. Data for this study were obtained from a longitudinal cohort study of young men who have sex with men and transgender women in Chicago. Participants provided sexual network data every 6 months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. Results indicated substantial between-person and within-person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively associated with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young men who have sex with men and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should use these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.

“Where is the Safe Haven?” Transgender Women’s Experiences of Victimization and Help-Seeking across the Life Course

Transgender women report high rates of interpersonal victimization, including child abuse and maltreatment, intimate partner violence and sexual assault, and community and bias-related violence. Transgender individuals experience distinct barriers to help-seeking, including fear of discrimination, harassment, or violence by police, being outed as transgender by partners, and discrimination by social services for survivors of violence. The present study explores experiences of cumulative victimization across the life course and barriers to help-seeking behaviors among a sample of 21 transgender women in Chicago. Study findings can be used to inform interventions that are inclusive of transgender women survivors.

Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient’s preferences and the health provider’s medical recommendations. It is one approach to reducing healthcare disparities by improving patient-provider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n = 24) and focus groups (2; n = 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

"This Pussy Actually Grabs Back": A Trans Latina Expansion of "Pussy"

During the 2017 Women's March, there was a sea of "pussyhats," worn in rebuke of the president's cocky statement that he can freely "grab" women "by the pussy." Critiques emerged from various communities marginalized within the Women's March and the Pussyhat Project, by women of color, transgender folks, and sex workers. I engage with these important critiques. However, in an attempt to push the scholarly conversation beyond calls for increased intersectionality and inclusivity that I argue may rest on cisgenderist and transnormative assumptions in regard to pussyhats, I offer a trans of color critique of pussyhats based on ethnographic research with sex-working transgender Latina women in Chicago. The women, who have not received genital reconstructive surgery, freely and frequently talk about their pussies. Moreover, they creatively utilize their pussies to survive and at times thrive in Chicago's sexual economy of labor. Centering their experiences and epistemologies, I argue for a trans of color expansion of "pussy," "woman," and thus feminism. In response to the critiques, the Women's March banned the pussyhat after the first year. I argue that the vague pleas for intersectionality and inclusivity and the ban on the pussyhat are based in binaristic and additive understandings of gender, race, and feminism. I hope to move beyond binaristic and additive assumptions and toward a logic of expansion that allows for unlimited possibilities for women, transgender people, and feminists. Furthermore, I argue that centering the resistance of sex-working transgender Latinas is imperative for feminist change in the post-Trump era.

Abstract PO-170: Associations of residential disadvantage and Hispanicity with important breast cancer risk factors among Hispanic women in Chicago

Abstract Background: Hispanics are the second largest and fastest growing ethnic minority population in the United States (US). Hispanic women experience worse breast cancer (BC) outcomes when compared to non-Hispanic Whites. In the United States, obesity and breast density are established risk factors for BC in general and for Hispanic women specifically. We sought to evaluate associations of residential disadvantage and Hispanicity with two established BC risk factors (obesity and breast density) among Hispanic women in Metro Chicago. Methods: We included 13,816 Hispanic women from the Metro Chicago Breast Cancer Registry. Obesity was defined as body mass index, categorized as: normal weight (18.5–24.9kg/m2), overweight (25–29.9 kg/m2), obese (>=30–24.9kg/m2), and morbidly obese (>= 35kg/m2). Breast density was reported by the interpreting radiologist at mammography using the BIRADS categories which were dichotomized for this analysis as dense (heterogeneously or extremely dense) vs. not dense (fatty or scattered fibroglandular). Characteristics of residential census tracts at diagnosis were obtained from the 2010 U.S. Census. Hispanicity was defined using: percent Hispanic, percent foreign-born and percent Hispanics that speak English not well and not at all. Each variable was standardized and summed to create a score (inter-item reliability=0.76), which was dichotomized at the median for some analyses. Two established tract level measures of neighborhood socioeconomic status were defined. Neighborhood disadvantage was an equally weighted sum of the proportions of families with incomes below the poverty line, families receiving public assistance, persons unemployed, and female-headed households with children. Neighborhood affluence was an equally weighted sum of the proportions of families with income of $75,000 or more, adults with college education or more, and civilian labor force employed in professional and managerial occupations score. Results: Overall, 36%, 26% and 18% of women were overweight, obese and morbidly obese, respectively, and roughly 50% had dense breasts. Women living in high hispanicity neighborhoods tended to live in more disadvantaged neighborhoods, to lack private health insurance, and to be obese (p> 0.0001 for all). Hispanicity was not associated with breast density. After adjusting by age, parity, age, health insurance, age at first birth, parity, menopause, age at menarche, we observed that greater hispanicity was associated with increased prevalence of overweight and obesity, but the association of Hispanicity with obesity was largely explained by the addition of tract disadvantage into the model. Conclusions: Our results are consistent with previous cross-sectional studies and further suggest that neighborhood disadvantage accounts for most of the association of hispanicity with being overweight. Future studies could link residential histories to evaluate the role of cumulative, longer-term residence in high Hispanicity areas on these risk factors. Citation Format: Carola T. Sanchez Diaz, Garth H. Rauscher. Associations of residential disadvantage and Hispanicity with important breast cancer risk factors among Hispanic women in Chicago [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-170.

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.

Black Cisgender Women's PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago.

Although black cisgender women in Chicago continue to disproportionally account for new HIV diagnoses, few are on pre-exposure prophylaxis (PrEP). We used concurrent mixed-methods to understand women's PrEP knowledge, attitudes, experience, and preferences in Chicago. We surveyed 370 HIV(-) cisgender women visiting a sexually transmitted infection clinic (n = 120) or emergency department (n = 250). Two focus groups were conducted with PrEP-naive women, and interviews were conducted with 7 PrEP-experienced women. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, and qualitative data using thematic analysis. Majority of women identified as black (83.0%) and had a regular source of health care (70.0%). In the past 6 months, 84.1% had vaginal or anal sex, most with inconsistent condom use (94.2%). Only 30.3% had heard of PrEP, but once explained, one-quarter considered starting PrEP, with protecting health (76.4%) and reducing HIV worry (58.1%) the most common reasons. Factors associated with considering PrEP included being Latina [adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): (1.21 to 8.99)], recent sexually transmitted infection [aOR: 2.39, 95% CI: (1.25 to 4.59)], and higher belief in PrEP effectiveness [aOR: 1.85, 95% CI: (1.22 to 2.82)]. Most (81.1%) had concerns about taking PrEP with side effects a common concern. Qualitative themes aligned with survey results, revealing a disconnection from current PrEP marketing, need for community-level PrEP education/outreach, and importance of provider trust. Despite significant PrEP implementation work in Chicago, less than one-third of women in our study had heard of PrEP. Once informed, PrEP attitudes and interest were positive. Translating these results into interventions reflecting women's preferences and barriers is critical to increase PrEP uptake by cisgender women in Chicago and elsewhere.

Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago

Abstract Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers. Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital & Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services. Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing. Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance. Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities. Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.

Abstract B104: [Advocate Abstract] Evaluating the impact of strategic partnerships

Abstract Despite progress in reducing racial disparities in breast cancer mortality, black women in Chicago are still more than twice as likely to die from the disease than white women. For sixteen years, Sisters Working It Out (SWIO), a 501c3 nonprofit, has utilized peer education and patient navigation as evidence-based methods to increase breast cancer knowledge and access to and utilization of quality breast health care for underserved women across the city. Strategic partnerships have been an invaluable resource for the organization. The aim of this study is to evaluate the programmatic impact of an academic-nonprofit partnership in improving breast health knowledge for women on Chicago's Southside. Citation Format: Beaulah Brent. [Advocate Abstract] Evaluating the impact of strategic partnerships [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B104.

Using Peer Health Educators to Conduct Community Level Surveillance of HPV Vaccination Status: Findings Among Women Who Live in Medically Underserved Areas of Chicago.

Young women are key stakeholders in efforts to increase human papillomavirus (HPV) vaccination uptake. Community health workers who engage with young women can provide valuable information to inform intervention strategies to increase vaccine uptake. We aimed to determine HPV vaccination and sexually transmitted infection (STI) rates among urban women and to identify barriers to vaccination. A trained health educator collaborated with community-based organizations to host health education and STI testing sessions for women in Chicago, Illinois. Forty-nine sessions took place at 15 sites over two years. Each attendee met with the educator about sexual health and HPV vaccination, and completed a health survey. We used contingency tables and logistic regression to determine factors associated with HPV vaccination using the cross-sectional survey data. Of the 292 women who answered questions about history of HPV vaccination, the average age was 17 (SD 2.3) years old, 63% (n = 184) were African American, and 33% (n = 98) Hispanic. Only 13.4% (n = 39) previously received the vaccine, and 6.2% (n = 18) received two to three doses. After adjustment, prior HIV testing was associated with 4.6 times higher odds (95% CI 1.71, 12.53, p = 0.002) of being vaccinated compared to women without prior testing. Our study provides evidence that young African American and Hispanic women living in Chicago may have low HPV vaccination rates. Women who received prior STI testing (i.e., sought healthcare) were more likely to be vaccinated relative to their peers who did not, indicating that racial/ethnic or socioeconomic disparities may inhibit utilization of preventative services.

What's After Good?: The Burden of Post-Incarceration Life

In the current era of mass incarceration, an increasing number of people face the challenge of transitioning from prison to society. Researchers of post-incarceration life have produced a detailed account of the collateral consequences of incarceration, noting the numerous barriers people must overcome as they try to return to society. In this paper, we show how stigma continues to be a structuring force in the lives of the formerly incarcerated. We develop the concept of the burden of post-incarceration life, meaning the structural constraints formerly incarcerated people face and the constant work they undertake to demonstrate and attempt to receive recognition for their rehabilitation. We argue that this burden is a critical though understudied aspect of life after prison. To develop this argument, we draw upon ethnographic and qualitative interview data from two distinct research projects with formerly incarcerated men and women in Chicago and highlight three interrelated themes that emerged from our data: judgment, exploitation, and competing demands. By centering burden in our analysis, we conclude that a focus on overcoming barriers may obfuscate the ongoing challenges formerly incarcerated people face.

Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women.

Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.

Association between Food Deserts and Gestational Diabetes Mellitus in a Large Metropolitan Area

The aim of this study is to determine the relationship between urban food deserts and frequency and obstetric outcomes related to gestational diabetes. We conducted a retrospective cohort study of singleton births in Chicago from 2010 to 2014. Birth certificate data were analyzed and geomapped by census tract. Census tracts were categorized as "food deserts" according to the USDA Food Access Research Atlas. The primary outcome was frequency of gestational diabetes. Secondary outcomes were assessed among women with gestational diabetes and their neonates. Of the 191,947 eligible women, 8,709 (4.5%) were diagnosed with gestational diabetes. Those in food deserts were more likely to be younger, obese, minority race/ethnicity, and multiparous. Women in food deserts were less likely to develop gestational diabetes (3.8 vs. 4.8%, p < 0.01; adjusted odds ratio 0.91, 95% confidence interval 0.86-0.96). Women with gestational diabetes did not experience worse maternal and neonatal outcomes after controlling for potential confounders. In contrast to prior work, women in Chicago living within food deserts were less likely to develop gestational diabetes and did not experience poorer outcomes, suggesting environmental factors other than food access contribute to perinatal outcomes.

Evaluating the use of data-based offender profiling by researchers, practitioners and investigative journalists to address unresolved serial homicides

PurposeThe purpose of this article is to improve the use of evidence-based practice and research utilization in the offender profiling process. The use of offender profiling has been met with increasing resistance given its exaggerated accuracy. The “Investigative Journalist/Expert Field Micro Task Force” model, a collaborative method that incorporates offender profiling and is designed to address unresolved serial homicides, is introduced and evaluated alongside recommendations on attaining adherence.Design/methodology/approachThe model was field tested in 17 instances. The measures used by the Federal Bureau of Investigation to gauge the usefulness of their case consultations, whether their input helped catch the offender, offer new leads, move the case forward, provide new avenues or give new ideas, were used to evaluate the model.FindingsThe model established likely patterns of serial murder activity among strangulations of women in Chicago, Cleveland, and Panama and resulted in convictions of suspects in Louisiana and Kansas City. This model is valuable when used to parse modern-day offenders from those who committed unresolved homicides as the latter display different behaviors that can make investigations difficult endeavors. Results from the field tests mirror those from the literature in that profiling alone did not result in the capture of serial killers. Instead, profiling was used in conjunction with other efforts and mainly as a means to keep the investigation moving forward.Originality/valueUnresolved homicides are at a point of crisis and represent a significant but largely unaddressed societal problem. The success of this model may compel law enforcement to restore faith in offender profiling.

Deconstructing PTSD: Trauma and emotion among Mexican immigrant women.

The symptomatology for Post-Traumatic Stress Disorder (PTSD) narrowly focuses on particular diagnostic frames and a single triggering event. Such narrow definitions of trauma and recovery have been heavily critiqued by anthropologists and cultural psychiatrists for overlooking cultural complexity as well as the effects of multiple and overlapping events that may cause someone to become "traumatized" and thereby affect recovery. This article investigates how subjective reporting of traumatic experience in life history narratives relates to depressive and PTSD symptomatology, cultural idioms, and repeated traumatic experiences among low-income Mexican immigrant women in Chicago. We interviewed 121 Mexican immigrant women and collected life history narratives and psychiatric scales for depression and PTSD. Most women spoke of the detrimental effects of repeated traumatic experiences, reported depressive (49%) and PTSD (38%) symptoms, and described these experiences through cultural idioms. These data complicate the PTSD diagnosis as a discrete entity that occurs in relation to a single acute event. Most importantly, these findings reveal the importance of cumulative trauma and cultural idioms for the recognition of suffering and the limitation of diagnostic categories for identifying the needs of those who experience multiple social and psychological stressors.

A community-based model of HIV care for men who have sex with men and transgender women in Chicago

Socioeconomically disadvantaged men who have sex with men (MSM) and transgender women (TGW) share a disproportionate burden of the HIV epidemic. Providing care in the community may help improve retention and treatment outcomes of these clients. Our objective was to compare HIV outcomes between a community-based model (CBM) and a hospital-based model (HBM) of HIV care. This was a retrospective cohort study of MSM and TGW with HIV treated at community clinics or at a hospital-based clinic. The primary outcome was the cumulative probability of virologic failure (HIV viral load ≥200 copies/ml). We conducted multivariable Cox proportional hazard regression to identify differences in outcome by care setting. Of 258 MSM and TGW, approximately half received care in the CBM. They were more likely to be African American (71% versus 59%), uninsured (48% versus 39%), and used illicit drugs (40% versus 25%). There was no difference in virologic failure by setting (58% CBM, 53% HBM; cumulative incidence of virologic failure: 35% CBM, 25% HBM; adjusted HR = 1.11; 95% CI: 0.88–1.39). Despite serving clients at greater risk for failure, virologic failure in our CBM was similar to a traditional HBM for MSM and TGW living with HIV.

Neighborhood Physical Disorder and Adverse Pregnancy Outcomes among Women in Chicago: a Cross-Sectional Analysis of Electronic Health Record Data.

Adverse pregnancy outcomes increase infants' risk for mortality and future health problems. Neighborhood physical disorder may contribute to adverse pregnancy outcomes by increasing maternal chronic stress. Google Street View technology presents a novel method for assessing neighborhood physical disorder but has not been previously examined in the context of birth outcomes. In this cross-sectional study, trained raters used Google's Street View imagery to virtually audit a randomly sampled block within each Chicago census tract (n = 809) for nine indicators of physical disorder. We used an item-response theory model and spatial interpolation to calculate tract-level neighborhood physical disorder scores across Chicago. We linked these data with geocoded electronic health record data from a large, academic women's hospital in Chicago (2015-2017, n = 14,309 births). We used three-level hierarchical Poisson regression to estimate prevalence ratios for the associations of neighborhood physical disorder with preterm birth (overall and spontaneous), small for gestational age (SGA), and hypertensive disorder of pregnancy (HDP). After adjustment for maternal sociodemographics, multiparity, and season of birth, living in a neighborhood with high physical disorder was associated with higher prevalence of PTB, SGA, and HDP (prevalence ratios and 95% confidence intervals 1.21 (1.06, 1.39) for PTB, 1.13 (1.01, 1.37) for SGA, and 1.23 (1.07, 1.42) for HDP). Adjustment for neighborhood poverty and maternal health conditions (e.g., hypertension, diabetes, asthma, substance use) attenuated associations. Results suggest that an adverse neighborhood physical environment may contribute to adverse pregnancy outcomes. However, future work is needed to disentangle the unique contribution of physical disorder from other characteristics of disadvantaged neighborhoods.

PrEP Use and Sexually Transmitted Infections Are Not Associated Longitudinally in a Cohort Study of Young Men Who Have Sex with Men and Transgender Women in Chicago.

Our goal was to understand whether PrEP users are at increased risk for STIs, a key target in prevention efforts aimed at disrupting the spread of STIs and likely downstream HIV infection risk. Data were collected as part of RADAR, a cohort study of young men who have sex with men and transgender women (YMSM/TW) (aged 16-29) in Chicago. Longitudinal lagged regression models were utilized to assess the relationship between PrEP use and odds of rectal STI acquisition. Mediation models were also utilized to consider the potential pathway between PrEP use, condomless anal sex (CAS), and rectal STI. One hundred eighty-seven (16.2%) participants had a rectal STI at baseline. In both cross-sectional and longitudinal models, no significant association was observed between PrEP use and STI. In mediation models, PrEP use was significantly associated with increased CAS, however, CAS was not associated with STI status. We demonstrated that, overall, PrEP use was not associated with STIs among YMSM/TW but did observe that PrEP users were more likely to report increased participation in CAS at the subsequent study visit.

Mortgage discrimination and preterm birth among African American women: An exploratory study

To examine whether mortgage discrimination, or redlining, is a risk factor for preterm birth among African American women in Chicago, and how it is related to racial residential segregation. This was a retrospective cross-sectional study in Chicago, Illinois, 1989-1991. African American mothers (n = 33,586) in the Illinois Transgenerational Birth File were linked to the 1990 census and the 1990-1995 Home Mortgage Disclosure Act database. Logistic regression models assessed the relationship between redlining and preterm birth rates. Preterm birth rates were higher among African American women in redlined areas (18.5%) vs. non-redlined areas (17.1%). Unadjusted and adjusted odds ratio for preterm birth among African American women in redlined neighborhoods, compared to non-redlined neighborhoods, were 1.08 (95% CI 1.03-1.14) and 1.12 (1.04-1.20), respectively. By level of racial residential segregation, preterm birth rate was elevated (18.2%) in redlined, high-proportion African American areas compared to non-redlined high-proportion African American areas (16.7%), redlined low- (16.2%) and mid-proportion (16.1%) African American areas. Mortgage discrimination may be an important measure of institutional racism to be used in understanding racial disparities in preterm birth.

Evaluation of SISTA and Safety Counts in “real-world” settings with African American women in Chicago

This evaluation examined (a) the feasibility of recruiting 500 African American women and implementing a novel integration of Sisters Informing Sisters about Topics on AIDS (SISTA) and Safety Counts in “real-world” settings; and (b) improvements in HIV knowledge, sexual risk behaviors, substance use, and exposure to abuse among participants. Participants were recruited from agency services, community-based organizations, and street outreach. A total of 522 women completed the program, 357 women completed all three waves of Government Performance and Results Act Surveys. Descriptive and bivariate analyses were conducted. Participants experienced improvements related to HIV knowledge, protected vaginal sex, use of crack or cocaine, and exposure to emotional or physical abuse; however, reported rates of unprotected vaginal, anal, and oral sex remained high. There is a continued need for development and evaluation of HIV risk reduction interventions and engagement strategies to effectively reach women experiencing multiple risk factors.