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Thompson JL, Beltran-Najera I, Johnson B, Morales Y, Woods SP. Evidence for neuropsychological health disparities in Black Americans with HIV disease. Clin Neuropsychol 2022; 36:388-413. [PMID: 35166174 PMCID: PMC8868032 DOI: 10.1080/13854046.2021.1947387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Black Americans are at high risk for HIV disease and associated morbidity. The impact and clinical correlates of HIV-associated neurocognitive impairment among Black Americans is not fully understood. The current study uses a full factorial design to examine the independent and combined effects of race and HIV disease on neurocognitive functioning, including its associations with everyday functioning and clinical disease markers in Black and White persons with HIV (PWH). METHOD Participants included 40 Black PWH, 83 White PWH, 28 Black HIV- and 64 White HIV- individuals. Neurocognition was measured by raw sample-based z-scores from a clinical battery. Everyday functioning was assessed using self- and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were also classified using demographically adjusted normative standards and the Frascati criteria. RESULTS We observed a significant three-way interaction between HIV, race, and domain on raw neurocognitive z-scores. This omnibus effect was driven by medium and large effect size decrements in processing speed and semantic memory, respectively, in Black PWH compared to other study groups. Black PWH also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognitive performance was negatively related to everyday functioning impairments for White PWH, but not for Black PWH. CONCLUSIONS Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this under-served population. Prospective studies are needed to identify better ways to prevent, measure, diagnose, and manage HIV-associated neurocognitive disorders among Black Americans.
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Affiliation(s)
| | | | | | | | - Steven Paul Woods
- Corresponding author: Steven Paul Woods, Psy.D. . Address: 126 Heyne Building, Suite 239D, Houston, TX 77004-5022. Phone: 713-743-6415
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Beltran-Najera I, Thompson JL, Matchanova A, Sullivan KL, Babicz MA, Woods SP. Neurocognitive performance differences between black and white individuals with HIV disease are mediated by health literacy. Clin Neuropsychol 2022; 36:414-430. [PMID: 34311657 PMCID: PMC8789952 DOI: 10.1080/13854046.2021.1953147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective:Health disparities are evident for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the higher rates of neurocognitive impairment in Black Americans with HIV disease may be at least partly attributable to health literacy, which is a potentially modifiable factor. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease who were enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may contribute to the higher rates of neurocognitive impairment for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer broader brain health benefits for Black Americans with HIV disease.
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Affiliation(s)
| | | | | | | | | | - Steven Paul Woods
- Correspondence may be addressed to Steven Paul Woods, Department of Psychology, 126 Heyne Bldg. (Ste. 239d), University of Houston, Houston, Texas, 77004; 713-743-6415;
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Mills A, Myers L, Raudenbush C, Vossen DA, Teppler H, Miteva YR, Seeley S, Homony B, Straus WL. A Health Literate Patient-focused Approach to the Redesign of the Raltegravir (ISENTRESS) Pediatric Kit and Instructions for Use. Pediatr Infect Dis J 2022; 41:51-56. [PMID: 34694252 PMCID: PMC8658952 DOI: 10.1097/inf.0000000000003334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data exist regarding how medications for pediatric use can be developed to minimize medication errors. The integrase inhibitor raltegravir was developed for use in neonates (≥2 kg). Anticipating that neonatal administration would be performed primarily by mothers with varying degrees of health literacy, a health literate, patient-focused, iterative process was conducted to update/redesign the raltegravir granules for oral suspension pediatric kit and instructions for use (IFU) for neonatal use to be ready for regulatory submission. METHODS Prototypes of an updated/redesigned raltegravir IFU were systematically assessed through multi-stage, iterative testing and evaluation involving untrained lay individuals with varying levels of health literacy, healthcare professionals and health literacy experts. RESULTS This iterative process resulted in numerous refinements to the IFU and kit, including wording, layout, presentation, colored syringes and additional instructional steps. The revised raltegravir pediatric kit and IFU (to include neonatal dosing) were approved by the US Food and Drug Administration in 2017 and the European Union in 2018. No reported medication errors related to IFU utilization had been reported as of March 2021, reflecting >3 years of commercial use worldwide. CONCLUSIONS This patient-focused process produced health literate instructions for preparing and administering an antiretroviral for neonatal use with complex dosing requirements. Testing demonstrated that lay users with a range of health literacy levels were able to accurately mix, measure and administer the product. This process demonstrates how a neonatal medication can be optimized for use through collaboration between the infectious disease expert community and a manufacturer.
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Affiliation(s)
- Alexander Mills
- From the Devices and Combination Product Technology, Merck & Co., Inc., Kenilworth, New Jersey
| | - Laurie Myers
- Health Equity, Merck & Co., Inc., Kenilworth, New Jersey
| | | | - David A Vossen
- From the Devices and Combination Product Technology, Merck & Co., Inc., Kenilworth, New Jersey
| | - Hedy Teppler
- Clinical Research, Infectious Disease, Merck & Co., Inc., Kenilworth, New Jersey
| | - Yanna R Miteva
- Clinical Safety and Risk Management, Merck & Co., Inc., Kenilworth, New Jersey
| | - Suzanne Seeley
- Packaging Commercialization and Manufacturing Technology, Merck & Co., Inc., Kenilworth, New Jersey
| | - Brenda Homony
- Clinical Sciences and Study Management (CSSM), Merck & Co., Inc., Kenilworth, New Jersey
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Cachay ER, Torriani FJ, Hill L, Rajagopal A, Yin J, Bamford L, Mathews WC. Hepatitis C Knowledge and Recent Diagnosis Affect Hepatitis C Treatment Willingness in Persons Living With HIV. J Acquir Immune Defic Syndr 2021; 87:e159-e166. [PMID: 33587504 DOI: 10.1097/qai.0000000000002643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We assessed the impact of health literacy and hepatitis C (HCV) knowledge on HCV treatment willingness among people living with HIV (PLWH) at an academic HIV clinic. METHODS Cross-sectional analysis of PLWH coinfected with HCV who completed health literacy, HIV literacy, and HCV knowledge inventories. We estimated the prevalence of low health literacy, HIV knowledge, and HCV knowledge sampled from 3-comparison groups: PLWH not referred for HCV, referred but who "not showed" to the HCV clinic, and referred and attended the HCV clinic. We used mixed-model linear and logistic regression to ascertain predictors of low health literacy, HIV knowledge, HCV knowledge, and predictors of willingness to start HCV treatment. RESULTS We enrolled 151 PLWH; 17% were female, 38% non-White, and 60% without a high-school education. Approximately, 68% were men who have sex with men, of whom 62% used intravenous drugs. The prevalence of low health, HIV knowledge, and HCV knowledge was 10%, 32%, and 29%, respectively. Predictors of low health literacy were being Hispanic, cirrhotic, and not completing high-school education. Low HCV knowledge was observed in female, non-White, and those diagnosed with HCV for a decade. In adjusted analyses, PLWH living with HCV for a decade (OR: 0.23) were less likely to be very willing to be treated for HCV. By contrast, those with high HCV knowledge were more likely to be very willing to receive treatment (OR: 1.27). CONCLUSION Low HCV knowledge and living with HCV for at least a decade are under-recognized negative predictors for PLWH's willingness to receive HCV treatment. CLINICAL TRIALS REGISTRATION ClinicaTrials.gov identifier: NCT20170991.
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Affiliation(s)
- Edward R Cachay
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Francesca J Torriani
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Lucas Hill
- Owen Clinic Unit, Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA; and
| | - Amutha Rajagopal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Jeffrey Yin
- Owen Clinic Unit, Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA; and
| | - Laura Bamford
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
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Matchanova A, Babicz M, Medina LD, Fazeli PL, Vance DE, Woods SP. Latent structure of health literacy and its association with health-related management and decision-making in HIV. Psychol Health 2020; 36:985-1002. [PMID: 32897101 DOI: 10.1080/08870446.2020.1817453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Determine the latent structure of health literacy in persons living with HIV (PLWH) and its association with health management and decision-making. Method: Participants included 220 PLWH and 123 seronegative participants from Southern California and Alabama who completed a battery of well-validated health literacy measures, along with assessments of health management self-efficacy, health-related decision-making, depression, and basic clinical laboratory measures. Results: Exploratory factor analysis in HIV - participants showed that the shared variance between a battery of health literacy measures, including health word reading, verbal comprehension, numeracy, and self-reported problems was best explained by a single factor. Similarly, a confirmatory factor analysis in PLWH also supported a single factor structure, but for a re-specified four-test solution based on the core performance-based measures of health literacy. In analyses adjusting for demographics, PLWH demonstrated significantly lower health literacy composite scores as compared to their HIV - counterparts. Among PLWH, lower health literacy was independently associated with lower self-efficacy for health management and poorer health-related decision-making. Conclusions: Findings suggest that numeracy, word recognition, and verbal comprehension and reasoning comprise a unitary construct of health literacy that is lower in PLWH as compared to seronegatives and is independently associated with important downstream aspects of health management and decision-making.
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Affiliation(s)
| | - Michelle Babicz
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA
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Yoo-Jeong M, Schnall R. Accuracy of Self-Reports of HIV Viral Load Status and Risk Factors for Inaccurate Reporting of Viral Suppression Among Racial/Ethnic Minority Persons Living with HIV. AIDS Patient Care STDS 2020; 34:369-372. [PMID: 32822244 DOI: 10.1089/apc.2020.0099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Moka Yoo-Jeong
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, Massachusetts, USA
| | - Rebecca Schnall
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, Massachusetts, USA
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Goldstein D, Hardy WD, Monroe A, Hou Q, Hart R, Terzian A. Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis. BMC Public Health 2020; 20:509. [PMID: 32299421 PMCID: PMC7164348 DOI: 10.1186/s12889-020-08631-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011 and 2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, > 30 days apart) and durable viral suppression (VS; HIV RNA < 50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors. Results Among 3908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p = 0.03; ART-experienced: private 80.2% vs public 69.4%, p < 0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR = 1.59, 95% CI: 1.20, 2.12; p = 0.001). Conclusions Paradoxical differences between HIV monitoring and durable VS exist among publicly and privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.
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Affiliation(s)
- Deborah Goldstein
- Whitman-Walker Institute, 1525 14th Street, NW, Washington, DC, 20005, USA. .,Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Monroe
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Arpi Terzian
- Patient-centered Outcomes Research Institute, Washington, DC, USA
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Reynolds R, Smoller S, Allen A, Nicholas PK. Health Literacy and Health Outcomes in Persons Living with HIV Disease: A Systematic Review. AIDS Behav 2019; 23:3024-3043. [PMID: 30783871 DOI: 10.1007/s10461-019-02432-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Low health literacy is associated with challenges for those living with HIV including medication non-adherence and poorer health outcomes. The aim of this study was to systematically review the literature on health literacy and health outcomes in persons living with HIV. The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were utilized to guide the approach to the review. A variety of electronic databases including PubMed, CINAHL, PsychInfo, and Cochrane Library were searched. Additional literature available on U.S. government websites was also included in the search. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. Forty-eight studies were identified that addressed health literacy and health outcomes in HIV. Although several studies in this review did not provide robust results of statistical significance linking health literacy with health outcomes, all of the studies addressed the key significance of health literacy within the scope of living with HIV disease. The relationship between health literacy and the identified health outcomes requires further research and explication.
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9
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Fazeli PL, Woods SP, Gakumo CA, Mugavero MJ, Vance DE. Critical, and not functional, health literacy is associated with missed HIV clinic visits in adults and older adults living with HIV in the Deep South. AIDS Care 2019; 32:694-700. [PMID: 31137958 DOI: 10.1080/09540121.2019.1622641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Engagement in care is a key component of the HIV treatment cascade and is influenced by biopsychosocial factors. Little is known about the association of health literacy with this impactful outcome in people living with HIV (PLWH). Ninety-five PLWH completed a comprehensive battery including health literacy measures covering several domains (i.e., numeracy, reading, self-efficacy, and ability to appraise and access health information). Engagement in care was operationalized as missed clinic visits (i.e., proportion of clinic visits in the prior 24 months where the participant did not attend and did not cancel or reschedule). The ability to appraise health information (measured by the Newest Vital Sign [NVS]) was the only significant health literacy predictor of missed clinic visits. Hierarchical linear regression including clinico-demographics and all health literacy variables showed that age, depression, neurocognition, and NVS were significant (p < 0.05) correlates of missed clinic visits. The ability to appraise health information was a strong and independent predictor of missed clinic visits in PLWH, even in the context of traditional correlates. Such measures may be useful in identifying PLWH with low health literacy who may be at risk for poorer engagement in care. Future research developing interventions targeting this health literacy dimension are warranted.
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Affiliation(s)
- Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - C Ann Gakumo
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston
| | - Michael J Mugavero
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Sharma A, Kahle EM, Sullivan SP, Stephenson R. Birth Cohort Variations Across Functional Knowledge of HIV Prevention Strategies, Perceived Risk, and HIV-Associated Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States. Am J Mens Health 2018; 12:1824-1834. [PMID: 30051744 PMCID: PMC6199423 DOI: 10.1177/1557988318790875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain heavily impacted by HIV. The purpose of this study was to describe intergenerational differences in functional knowledge of HIV prevention strategies, perceived risk, recent condomless anal sex (CAS), and HIV testing behavior. Eight hundred sexually active GBMSM were recruited via Facebook from August to September 2015, and administered a Web-based survey which included 12 multiple-choice questions to elicit data regarding functional knowledge of different HIV prevention approaches (e.g., condom use, pre-exposure prophylaxis post-exposure prophylaxis, treatment as prevention, circumcision). Cumulative logit and multivariable logistic models were formulated to examine birth cohort variations across four analytic outcomes. Younger generations were significantly more knowledgeable, as were GBMSM with higher education. Non-Hispanic non-White GBMSM and those reporting a bisexual/other sexual orientation had lower functional knowledge. Younger generations were equally concerned about contracting HIV as their older counterparts. Perceived risk was significantly higher among non-Hispanic non-White and Hispanic GBMSM, but lower among those with higher education and those in a relationship. Finally, birth cohort variations with respect to engaging in CAS with ≥2 men in the past 3 months and testing for HIV in the past year were not markedly pronounced. Younger GBMSM might be more knowledgeable about HIV prevention strategies compared to their predecessors, but are equally concerned about contracting HIV. Researchers and practitioners should consider intergenerational and other demographic differences while designing multifaceted HIV prevention programs for GBMSM.
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Affiliation(s)
- Akshay Sharma
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Erin M Kahle
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Sullivan
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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