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Flores JM, Moline T, Regan SD, Chen YT, Shrader CH, Schneider JA, Duncan DT, Kim B. Neighborhood violent crime exposure is associated with PrEP non-use among black sexually minoritized men and transgender women: A GPS Study. AIDS 2024:00002030-990000000-00476. [PMID: 38608005 DOI: 10.1097/qad.0000000000003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The objective of this study is to use GPS technology to determine if violent and property crime exposure to participants activity spaces affect outcomes of the HIV prevention and care continuum (PCC) among Young Black sexually minoritized men (YBSMM) and Transgender women (TW), a subgroup at high vulnerability for new HIV diagnoses. Exposure to violent and property crime adversely affects a variety of acute and chronic medical conditions; however the relationship between exposure to violent and property crime and HIV risk (e.g., PrEP non use) is unknown. Spatial analytic analysis using dynamic Global Position Systems (GPS) technology can accurately detect geospatial associations between the crime exposure and objective HIV related outcomes. METHODS With the Neighborhoods and Networks (N2) Cohort Study, GPS technology to identify the activity space of 286 (123 PLWH and 163 PWoH) YBSMM & TW living in Chicago, IL, to identified spatial associations between violent and property crime exposures with HIV PCC outcomes. RESULTS We found that YBSMM & TGW with higher exposure areas with higher levels of violent crime were less likely to use HIV preexposure prophylaxis (PrEP) therapy (aOR 0.76, 95% CI 0.63-0.91, p = 0.03). CONCLUSION This study demonstrates the importance of clinical providers to consider violent crime as a potential sociostructural barrier that may impact medication adherence and health care outcomes among vulnerable populations. Additionally, GPS technology offers an alternative data analytic process that may be used to future studies to assist in identifying barriers to ending the HIV epidemic.
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Affiliation(s)
- John M Flores
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Tyrone Moline
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yen-Tyng Chen
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | | | - John A Schneider
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Byoungjun Kim
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
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Alphonso SR, Andrews MR, Regan SD, Shishkov A, Cantor JH, Powell-Wiley TM, Tamura K. Geospatially clustered low COVID-19 vaccine rates among adolescents in socially vulnerable US counties. Prev Med Rep 2024; 37:102545. [PMID: 38186659 PMCID: PMC10767486 DOI: 10.1016/j.pmedr.2023.102545] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
COVID-19 vaccinations are widely available across the United States (U.S.), yet little is known about the spatial clustering of COVID-19 vaccinations. This study aimed to test for geospatial clustering of COVID-19 vaccine rates among adolescents aged 12-17 across the U.S. counties and to compare these clustering patterns by sociodemographic characteristics. County-level data on COVID-19 vaccinations and sociodemographic characteristics were obtained from the COVID-19 Community Profile Report up to April 14, 2022. A total of 3,108 counties were included in the analysis. Global Moran's I statistic and Anselin Local Moran's analysis were used, and clustering patterns were compared to sociodemographic variables using t-tests. Counties with low COVID-19 vaccinated clusters were more likely, when compared to unclustered counties, to have higher numbers of individuals in poverty and uninsured individuals, and higher values of Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI). While high COVID-19 vaccinated clusters, compared to neighboring counties, had lower numbers of Black population, individuals in poverty, and uninsured individuals, and lower values of SVI and CCVI, but a higher number of Hispanic population. This study emphasizes the importance of addressing systemic barriers, such as poverty and lack of health insurance, which were found to be associated with low COVID-19 vaccination coverage.
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Affiliation(s)
- Sophie R. Alphonso
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Marcus R. Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Seann D. Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alyssa Shishkov
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | | | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Duncan DT, Cook SH, Wood EP, Regan SD, Chaix B, Tian Y, Chunara R. Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men. Soc Sci Med 2023; 320:115755. [PMID: 36739708 PMCID: PMC10014849 DOI: 10.1016/j.socscimed.2023.115755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Stephanie H Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA; Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Erica P Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Basile Chaix
- French National Institute of Health and Medical Research (INSERM), Sorbonne Université, Institut Pierre Louis D'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Yijun Tian
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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Huber BD, Kim B, Chaix B, Regan SD, Duncan DT. Objective and Subjective Neighborhood Crime Associated with Poor Sleep among Young Sexual Minority Men: a GPS Study. J Urban Health 2022; 99:1115-1126. [PMID: 35931941 PMCID: PMC9727059 DOI: 10.1007/s11524-022-00674-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 01/14/2023]
Abstract
Sleep disparities in sexual minority male (SMM) populations have received relatively little attention but they may be critical to explaining other health disparities seen among SMM, via neural or hormonal pathways. Recent research suggests that crime may be a psychosocial stressor that contributes to sleep disparities but that finding has been based on subjective measures of crime. We conducted the P18 Neighborhood Study of 250 SMM in New York City, including 211 with adequate GPS tracking data. We used the GPS tracking data to define daily path area activity spaces and tested the associations of violent crime in those activity spaces and in the subject's residential neighborhood, perceived neighborhood safety, and witnessing crime with a subjective measure of sleep. Using quasi-Poisson regression, adjusted for individual and neighborhood socio-demographics, we found that SMM who witnessed more types of crime experienced significantly more nights of poor sleep over the course of a month (RR: 1.16, 95%CI: 1.05-1.27, p-value: < 0.01). We did not find any associations between violent crime rates in either the activity area or residential area and sleep. Our findings support the conclusion that personal exposure to crime is associated with sleep problems and provide further evidence for the pathway between stress and sleep. The lack of association between neighborhood crime levels and sleep suggests that there must be personal experience with crime and ambient presence is insufficient to produce an effect.
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Affiliation(s)
- Benjamin D Huber
- Department of Epidemiology, Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - Byoungjun Kim
- Department of Epidemiology, Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
- Department of Population Health, New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique IPLESP, Nemesis team, F75012, Paris, France
| | - Seann D Regan
- Department of Epidemiology, Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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Chen TA, Smith NG, Regan SD, Obasi EM, Anderson KF, Reitzel LR. Combining Global Positioning System (GPS) with saliva collection among sexual minority adults: A feasibility study. PLoS One 2021; 16:e0250333. [PMID: 33956852 PMCID: PMC8101753 DOI: 10.1371/journal.pone.0250333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This is the first study, of which we are aware, to evaluate the feasibility and accessibility of simultaneous use of Global Positioning System (GPS) and saliva collection for biomarker assessment as an objective measure of stress physiology among sexual minority (lesbian, gay, bisexual, queer, and other non-heterosexual identities) individuals. The principal motivation for pairing GPS and saliva collection was to investigate how characteristics of the built and social environments along with participants' daily activity paths affect stress. This can contribute to a better understanding of health and health behaviors in the sexual minority community. METHODS A convenience sample of enrolled participants (N = 124) from Houston, Texas was asked to complete questionnaires, carry with them a GPS unit daily, and collect and store 6 samples of saliva at specific times across the span of a day prior to a second visit around one week later. RESULTS Of 124 participants, 16 participants (12.90%) provided no useable GPS data and 98 (79.03%) provided at least 4 days of data. More than three-fourths (n = 98, 79.03%) also provided complete saliva samples. CONCLUSIONS Our results show that the simultaneous use of GPS and saliva collection to assess sexual minority individuals' activity paths and stress level is feasible.
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Affiliation(s)
- Tzuan A. Chen
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Nathan Grant Smith
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Seann D. Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Ezemenari M. Obasi
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Kathryn Freeman Anderson
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Sociology, University of Houston, Houston, Texas, United States of America
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
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Kim B, Regan SD, Callander D, Goedel WC, Chaix B, Duncan DT. Associations of spatial mobility with sexual risk behaviors among young men who have sex with men in New York City: A global positioning system (GPS) study. Soc Sci Med 2020; 258:113060. [PMID: 32473485 DOI: 10.1016/j.socscimed.2020.113060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Spatial contexts and spatial mobility are important factors of the HIV epidemic and sexually transmitted infections. Using global positioning system (GPS) devices, we examined the associations of objectively measured spatial mobility with sexual risk behaviors among gay, bisexual and other men who have sex with men (MSM) in New York City. This observational study included a subgroup of 253 HIV-negative MSM from the Project 18 Cohort Study, who participated in the GPS monitoring sub-study. Spatial mobility was measured as (1) distance traveled and (2) activity space size defined as daily path area during 2-week of GPS tracking. We examined the associations of these measures with numbers of male sexual partners and condomless anal intercourse (CAI) acts during last six months using quasi-Poisson models, adjusting for socio-demographics. Results demonstrated that spatial mobility was positively associated with sexual risk behaviors, for example, with CAI (incidence rate ratio [IRR] = 1.01 for a 10 km increase in distance traveled and IRR = 1.04 for a 1 km2 increase in 50 m-buffer activity space size). Our findings may enhance the understanding of spatial contexts of HIV risk. Future studies should be conducted to examine the mechanisms for the associations between spatial mobility behaviors with sexual risk behaviors as well as the influence of neighborhood characteristics in various neighborhood contexts, which may guide the place-based HIV prevention services.
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Affiliation(s)
- Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
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Callander D, Schneider JA, Radix A, Chaix B, Scheinmann R, Love G, Smith J, Regan SD, Kawachi I, St James K, Ransome Y, Herrera C, Reisner SL, Doroshow C, Poteat T, Watson K, Bluebond-Langner R, Toussaint N, Garofalo R, Sevelius J, Duncan DT. Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. BMJ Open 2020; 10:e032876. [PMID: 32241785 PMCID: PMC7170618 DOI: 10.1136/bmjopen-2019-032876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. METHODS AND ANALYSES TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. ETHICS AND DISSEMINATION The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.
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Affiliation(s)
- Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - John A Schneider
- Department of Public Health Sciences, University of Chicago School of Medicine, Chicago, Illinois, USA
- Howard Brown Health Center, Chicago, Illinois, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Basile Chaix
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, Île-de-France, France
| | - Roberta Scheinmann
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gia Love
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jordyn Smith
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kiara St James
- New York Transgender Advocacy Group, New York, New York, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Sari L Reisner
- Harvard Medical School, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
| | - Ceyenne Doroshow
- Gay and Lesbians Living in a Transgender Society, New York, New York, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kim Watson
- Community Kinship Life, New York, New York, USA
| | - Rachel Bluebond-Langner
- Hansjorg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA
| | - Nala Toussaint
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Robert Garofalo
- Department of Pediatrics & Preventive Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jae Sevelius
- Center for Excellence for Transgender Health, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Goedel WC, Regan SD, Chaix B, Radix A, Reisner SL, Janssen AC, Duncan DT. Using global positioning system methods to explore mobility patterns and exposure to high HIV prevalence neighbourhoods among transgender women in New York. Geospat Health 2019; 14:10.4081/gh.2019.752. [PMID: 31724385 PMCID: PMC9897014 DOI: 10.4081/gh.2019.752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/10/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to assess mobility patterns among a sample of transgender women (n=14) in New York City via survey and Global Positioning System (GPS) monitoring. We found varying levels of concordance between the residential neighbourhood and each of the non-residential contexts: 64.3% considered the neighbourhood that they socialised in most often to be different from their residential neighbourhood. While participants' residences represented 10 zone improvement plan code tabulation areas (ZCTAs), GPS data were recorded in 124 of 263 ZCTAs (47.1%). Overall, 58.2% (n=373,262) were recorded in ZCTAs in the highest quartile of human immunodeficiency virus (HIV) prevalence. The association between place, community HIV prevalence, mobility, and factors that increase the vulnerability of transgender women to HIV infection are worthy of future investigation in reducing the burden of the HIV epidemic in these communities.
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Affiliation(s)
- William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI.
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. Int J Environ Res Public Health 2019; 16:ijerph16111922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing ‘Neighborhoods and Networks (N2) Cohort Study’. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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10
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Duncan DT, Park SH, Goedel WC, Sheehan DM, Regan SD, Chaix B. Acceptability of smartphone applications for global positioning system (GPS) and ecological momentary assessment (EMA) research among sexual minority men. PLoS One 2019; 14:e0210240. [PMID: 30689651 PMCID: PMC6349317 DOI: 10.1371/journal.pone.0210240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/19/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Emerging research is using global positioning system (GPS) and ecological momentary assessment (EMA) methods among sexual minority men (SMM), a population that experiences multiple health disparities. However, we are not aware of any research that has combined these approaches among SMM, highlighting the need for acceptability and feasibility research. The purpose of this study was to examine the acceptability of implementing GPS and EMA research protocols using smartphone applications among SMM as well as related socio-demographic correlates. METHODS Data come from a sample of SMM on a popular geosocial-networking app in Paris, France (n = 580). We assessed the acceptability of implementing GPS and EMA research protocols on smartphone apps as well as socio-demographic characteristics (i.e., age, sexual orientation, country of origin, employment status, and relationship status). We examined the anticipated acceptability of GPS and EMA data collection methods as well as socio-demographic correlates of acceptability of GPS and EMA methods. RESULTS We found that over half (54.1%) of the sample was willing to download a smartphone app for GPS-based research and we found that almost 60% of the participants were willing to download a smartphone app for EMA-based research. In total, 44.0% reported that they were willing to download both GPS and EMA apps. In addition, we found that older participants were less willing to download a smartphone app for EMA research than younger participants aged 18-24 (40-49 years: aPR = 0.40; 95% CI = 0.20, 0.78) and students were more willing to download smartphone apps for both GPS and EMA research (aPR = 1.41; 95% CI = 1.02, 1.95). CONCLUSION Results from this study suggest that using smartphone apps to implement GPS and EMA methods among some SMM are acceptable. However, care should be taken as segments of SMM are less likely to be willing to engage in this type of research.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Su Hyun Park
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University Robert Stempel College of Public Health and Social Work, Miami, Florida, United States of America
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Basile Chaix
- Inserm, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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Tamura K, Elbel B, Athens JK, Rummo PE, Chaix B, Regan SD, Al-Ajlouni YA, Duncan DT. Assessments of residential and global positioning system activity space for food environments, body mass index and blood pressure among low-income housing residents in New York City. Geospat Health 2018; 13:10.4081/gh.2018.712. [PMID: 30451471 PMCID: PMC8546578 DOI: 10.4081/gh.2018.712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/01/2018] [Indexed: 06/09/2023]
Abstract
Research has examined how the food environment affects the risk of cardiovascular disease (CVD). Many studies have focused on residential neighbourhoods, neglecting the activity spaces of individuals. The objective of this study was to investigate whether food environments in both residential and global positioning system (GPS)-defined activity space buffers are associated with body mass index (BMI) and blood pressure (BP) among low-income adults. Data came from the New York City Low Income Housing, Neighborhoods and Health Study, including BMI and BP data (n=102, age=39.3±14.1 years), and one week of GPS data. Five food environment variables around residential and GPS buffers included: fast-food restaurants, wait-service restaurants, corner stores, grocery stores, and supermarkets. We examined associations between food environments and BMI, systolic and diastolic BP, controlling for individual- and neighbourhood-level sociodemographics and population density. Within residential buffers, a higher grocery store density was associated with lower BMI (β=- 0.20 kg/m2, P<0.05), and systolic and diastolic BP (β =-1.16 mm Hg; and β=-1.02 mm Hg, P<0.01, respectively). In contrast, a higher supermarket density was associated with higher systolic and diastolic BP (β=1.74 mm Hg, P<0.05; and β=1.68, P<0.01, respectively) within residential buffers. In GPS neighbourhoods, no associations were documented. Examining how food environments are associated with CVD risk and how differences in relationships vary by buffer types have the potential to shed light on determinants of CVD risk. Further research is needed to investigate these relationships, including refined measures of spatial accessibility/exposure, considering individual's mobility.
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Affiliation(s)
- Kosuke Tamura
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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12
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Tamura K, Elbel B, Chaix B, Regan SD, Al-Ajlouni YA, Athens JK, Meline J, Duncan DT. Residential and GPS-Defined Activity Space Neighborhood Noise Complaints, Body Mass Index and Blood Pressure Among Low-Income Housing Residents in New York City. J Community Health 2018; 42:974-982. [PMID: 28386706 DOI: 10.1007/s10900-017-0344-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/22/2023]
Abstract
Little is known about how neighborhood noise influences cardiovascular disease (CVD) risk among low-income populations. The aim of this study was to investigate associations between neighborhood noise complaints and body mass index (BMI) and blood pressure (BP) among low-income housing residents in New York City (NYC), including the use of global positioning system (GPS) data. Data came from the NYC Low-Income Housing, Neighborhoods and Health Study in 2014, including objectively measured BMI and BP data (N = 102, Black = 69%), and 1 week of GPS data. Noise reports from "NYC 311" were used to create a noise complaints density (unit: 1000 reports/km2) around participants' home and GPS-defined activity space neighborhoods. In fully-adjusted models, we examined associations of noise complaints density with BMI (kg/m2), and systolic and diastolic BP (mmHg), controlling for individual- and neighborhood-level socio-demographics. We found inverse relationships between home noise density and BMI (B = -2.7 [kg/m2], p = 0.009), and systolic BP (B = -5.3 mmHg, p = 0.008) in the fully-adjusted models, and diastolic BP (B = -3.9 mmHg, p = 0.013) in age-adjusted models. Using GPS-defined activity space neighborhoods, we observed inverse associations between noise density and systolic BP (B = -10.3 mmHg, p = 0.019) in fully-adjusted models and diastolic BP (B = -7.5 mmHg, p = 0.016) in age-adjusted model, but not with BMI. The inverse associations between neighborhood noise and CVD risk factors were unexpected. Further investigation is needed to determine if these results are affected by unobserved confounding (e.g., variations in walkability). Examining how noise could be related to CVD risk could inform effective neighborhood intervention programs for CVD risk reduction.
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Affiliation(s)
- Kosuke Tamura
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA.
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA.,Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Basile Chaix
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.,Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Seann D Regan
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA
| | - Yazan A Al-Ajlouni
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA
| | - Jessica K Athens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA
| | - Julie Meline
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.,Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Dustin T Duncan
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA
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Duncan DT, Chaix B, Regan SD, Park SH, Draper C, Goedel WC, Gipson JA, Guilamo-Ramos V, Halkitis PN, Brewer R, Hickson DA. Collecting Mobility Data with GPS Methods to Understand the HIV Environmental Riskscape Among Young Black Men Who Have Sex with Men: A Multi-city Feasibility Study in the Deep South. AIDS Behav 2018; 22:3057-3070. [PMID: 29797163 DOI: 10.1007/s10461-018-2163-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
While research increasingly studies how neighborhood contexts influence HIV among gay, bisexual and other men who have sex with men (MSM) populations, to date, no research has used global positioning system (GPS) devices, an innovative method to study spatial mobility through neighborhood contexts, i.e., the environmental riskscape, among a sample of Black MSM. The purpose of this study was to examine the feasibility of collecting two-week GPS data (as measured by a pre- and post-surveys as well as objectively measured adherence to GPS protocol) among a geographically-diverse sample of Black MSM in the Deep South: Gulfport, MS, Jackson, MS, and New Orleans LA (n = 75). GPS feasibility was demonstrated including from survey items, e.g. Black MSM reported high ratings of pre-protocol acceptability, ease of use, and low levels of wear-related concerns. Findings from this study demonstrate that using GPS methods is acceptable and feasible among Black MSM in the Deep South.
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Affiliation(s)
- Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Basile Chaix
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Seann D Regan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Cordarian Draper
- Center for Research, Evaluation and Environmental & Policy Change, My Brother's Keeper, Inc, Jackson, MS, USA
| | - William C Goedel
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - June A Gipson
- Center for Community-Based Programs, My Brother's Keeper, Inc, Jackson, MS, USA
| | - Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health (CLAFH), Silver School of Social Work, New York University, New York, NY, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University School of Public Health, New Brunswick, NJ, USA
| | - Russell Brewer
- Louisiana Public Health Institute (LPHI), New Orleans, LA, USA
| | - DeMarc A Hickson
- Center for Research, Evaluation and Environmental & Policy Change, My Brother's Keeper, Inc, Jackson, MS, USA
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Duncan DT, Park SH, Hambrick HR, Dangerfield Ii DT, Goedel WC, Brewer R, Mgbako O, Lindsey J, Regan SD, Hickson DA. Characterizing Geosocial-Networking App Use Among Young Black Men Who Have Sex With Men: A Multi-City Cross-Sectional Survey in the Southern United States. JMIR Mhealth Uhealth 2018; 6:e10316. [PMID: 29903702 PMCID: PMC6024099 DOI: 10.2196/10316] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background Understanding where and how young black men who have sex with men (YBMSM) in the southern United States meet their sexual partners is germane to understanding the underlying factors contributing to the ongoing HIV transmission in this community. Men who have sex with men (MSM) commonly use geosocial networking apps to meet sexual partners. However, there is a lack of literature exploring geosocial networking app use in this particular population. Objective Our aim was to examine the characteristics, preferences, and behaviors of a geographically diverse sample of geosocial networking app-using YBMSM in the southern United States. Methods Data were collected from a sample of 75 YBMSM across three cities (Gulfport, Mississippi; Jackson, Mississippi; and New Orleans, Louisiana). Multiple aspects of geosocial networking app use were assessed, including overall app use, age of participant at first app use, specific apps used, reasons for app use, photos presented on apps, logon times and duration, number of messages sent and received, and characteristics of and behaviors with partners met on apps. Survey measures of app-met partner and sexual behavior characteristics assessed at midpoint (Day 7) and completion visits (Day 14) were compared using McNemar’s test or Wilcoxon signed-rank test. In addition, we assessed activity spaces derived from GPS devices that participants wore for 2 weeks. Results Of the 70 participants who responded to the overall app-use item, almost three-quarters (53/70, 76%) had ever used geosocial networking apps. Jack’d was the most commonly used geosocial networking app (37/53, 70%), followed by Adam4Adam (22/53, 42%), and Grindr (19/53, 36%). The mean and median number of apps used were 4.3 (SD 2.7) and 4.0 (range 0-13), respectively. Most app-using participants displayed their face on the profile picture (35/52, 67%), whereas fewer displayed their bare legs (2/52, 4%) or bare buttocks (or ass; 2/52, 4%). The mean age at the initiation of app use was 20.1 years (SD 2.78) ranging from 13-26 years. Two-thirds (35/53, 66%) of the sample reported using the apps to “kill time” when bored. A minority (9/53, 17%) reported using the apps to meet people to have sex/hook up with. The vast majority of participants reported meeting black partners for sex. Over two-thirds (36/53, 68%) reported that the HIV status of their app-met partners was negative, and 26% (14/53) reported that they did not know their partner’s HIV status. There was a significant difference in GPS activity spaces between app using YBMSM compared to nonapp using YBMSM (2719.54 km2 vs 1855.68 km2, P=.011). Conclusions Use of geosocial networking apps to meet sexual partners among our sample of YBMSM in the southern United States was common, with a diverse range of app use behaviors being reported. Further research should characterize the association between geosocial networking app use and engagement in sexual behaviors that increase risk for HIV acquisition and transmission. In addition, geosocial networking apps present a promising platform for HIV prevention interventions targeting YBMSM who use these apps.
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Affiliation(s)
- Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - H Rhodes Hambrick
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Derek T Dangerfield Ii
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - William C Goedel
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Russell Brewer
- Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Ofole Mgbako
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Joseph Lindsey
- MBK Gulf Coast, My Brother's Keeper, Inc, Gulfport, MS, United States
| | - Seann D Regan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - DeMarc A Hickson
- Us Helping Us, People Into Living, Inc, Washington, DC, United States
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15
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Goedel WC, Reisner SL, Janssen AC, Poteat TC, Regan SD, Kreski NT, Confident G, Duncan DT. Acceptability and Feasibility of Using a Novel Geospatial Method to Measure Neighborhood Contexts and Mobility Among Transgender Women in New York City. Transgend Health 2017; 2:96-106. [PMID: 29082330 PMCID: PMC5627666 DOI: 10.1089/trgh.2017.0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/13/2022] Open
Abstract
Purpose: To date, no studies utilizing global positioning system (GPS) technologies to measure mobility and environmental exposures have been conducted among a sample of transgender women despite the potential salient role neighborhood contexts may play in the health of this population. As such, the purpose of this study was to assess the acceptability and feasibility of a weeklong GPS protocol among a sample of transgender women in New York City. Methods: A sample of 14 transgender women residing in the New York City metropolitan area were recruited through community based methods to wear and charge a GPS device for 7 days to measure daily mobility. The acceptability of these methods was assessed using a pre- and postprotocol survey and their feasibility was measured using objective data derived from the GPS device. Pre- and postprotocol survey measures were compared using McNemar's test. Results: Participants reported high ratings of preprotocol acceptability, as well as few concerns regarding safety, appearance, and losing the device, all of which were maintained after completing the protocol. All 14 devices that were distributed were returned. In addition, all 14 participants had GPS data for at least 1 h on 1 day, and nine participants (64.3%) had at least 8 h of GPS data on all days. Conclusion: The findings of this pilot study demonstrate that the GPS methods are both acceptable and feasible among this sample of transgender women. GPS devices may be used in research among transgender women to understand neighborhood determinants of HIV and other STIs.
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Affiliation(s)
- William C Goedel
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Fenway Health, The Fenway Institute, Boston, Massachusetts
| | - Aron C Janssen
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
| | - Tonia C Poteat
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Seann D Regan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Noah T Kreski
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Gladyne Confident
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
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Duncan DT, Tamura K, Regan SD, Athens J, Elbel B, Meline J, Al-Ajlouni YA, Chaix B. Quantifying spatial misclassification in exposure to noise complaints among low-income housing residents across New York City neighborhoods: a Global Positioning System (GPS) study. Ann Epidemiol 2016; 27:67-75. [PMID: 28063754 DOI: 10.1016/j.annepidem.2016.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/11/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine if there was spatial misclassification in exposure to neighborhood noise complaints among a sample of low-income housing residents in New York City, comparing home-based spatial buffers and Global Positioning System (GPS) daily path buffers. METHODS Data came from the community-based NYC Low-Income Housing, Neighborhoods and Health Study, where GPS tracking of the sample was conducted for a week (analytic n = 102). We created a GPS daily path buffer (a buffering zone drawn around GPS tracks) of 200 m and 400 m. We also used home-based buffers of 200 m and 400 m. Using these "neighborhoods" (or exposure areas), we calculated neighborhood exposure to noisy events from 311 complaints data (analytic n = 143,967). Friedman tests (to compare overall differences in neighborhood definitions) were applied. RESULTS There were differences in neighborhood noise complaints according to the selected neighborhood definitions (P < .05). For example, the mean neighborhood noise complaint count was 1196 per square kilometer for the 400-m home-based and 812 per square kilometer for the 400-m activity space buffer, illustrating how neighborhood definition influences the estimates of exposure to neighborhood noise complaints. CONCLUSIONS These analyses suggest that, whenever appropriate, GPS neighborhood definitions can be used in spatial epidemiology research in spatially mobile populations to understand people's lived experience.
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Affiliation(s)
- Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York.
| | - Kosuke Tamura
- Department of Population Health, New York University School of Medicine, New York
| | - Seann D Regan
- Department of Population Health, New York University School of Medicine, New York
| | - Jessica Athens
- Department of Population Health, New York University School of Medicine, New York
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York; Wagner Graduate School of Public Service, New York University, New York
| | - Julie Meline
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Yazan A Al-Ajlouni
- Department of Population Health, New York University School of Medicine, New York
| | - Basile Chaix
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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Duncan DT, Ruff RR, Chaix B, Regan SD, Williams JH, Ravenell J, Bragg MA, Ogedegbe G, Elbel B. Perceived spatial stigma, body mass index and blood pressure: a global positioning system study among low-income housing residents in New York City. Geospat Health 2016; 11:399. [PMID: 27245795 DOI: 10.4081/gh.2016.399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
Previous research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI), and blood pressure among a sample of low-income housing residents in New York City (NYC). Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample). Global positioning systems (GPS) tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income) we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051), as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01) and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004). In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR)=1.32, 95%CI: 1.1, 1.4, P=0.02) and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007). However, we found no differences in spatial mobility (based GPS data) among participants who reported living in neighborhoods with and without spatial stigma (P>0.05). Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals in stigmatised neighborhoods to inform effective cardiovascular risk reduction interventions.
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Affiliation(s)
- Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, NY; College of Global Public Health, New York University, New York, NY; Population Center, New York University, New York, NY; Center for Data Science, New York University, New York, NY.
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Duncan DT, Kapadia F, Regan SD, Goedel WC, Levy MD, Barton SC, Friedman SR, Halkitis PN. Feasibility and Acceptability of Global Positioning System (GPS) Methods to Study the Spatial Contexts of Substance Use and Sexual Risk Behaviors among Young Men Who Have Sex with Men in New York City: A P18 Cohort Sub-Study. PLoS One 2016; 11:e0147520. [PMID: 26918766 PMCID: PMC4769145 DOI: 10.1371/journal.pone.0147520] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/05/2016] [Indexed: 01/26/2023] Open
Abstract
Background No global positioning system (GPS) technology study has been conducted among a sample of young gay, bisexual, and other men who have sex with men (YMSM). As such, the purpose of this study was to evaluate the feasibility and acceptability of using GPS methods to understand the spatial context of substance use and sexual risk behaviors among a sample of YMSM in New York City, a high-risk population. Methods Data came from a subsample of the ongoing P18 Cohort Study (n = 75). GPS feasibility and acceptability among participants was measured with: 1) a pre- and post-survey and 2) adherence to the GPS protocol which included returning the GPS device, self-report of charging and carrying the GPS device as well as objective data analyzed from the GPS devices. Analyses of the feasibility surveys were treated as repeated measures as each participant had a pre- and post-feasibility survey. When comparing the similar GPS survey items asked at baseline and at follow-up, we present percentages and associated p-values based on chi-square statistics. Results Participants reported high ratings of pre-GPS acceptability, ease of use, and low levels of wear-related concerns in addition to few concerns related to safety, loss, or appearance, which were maintained after baseline GPS feasibility data collection. The GPS return rate was 100%. Most participants charged and carried the GPS device on most days. Of the total of 75 participants with GPS data, 75 (100%) have at least one hour of GPS data for one day and 63 (84%) had at least one hour on all 7 days. Conclusions Results from this pilot study demonstrate that utilizing GPS methods among YMSM is feasible and acceptable. GPS devices may be used in spatial epidemiology research in YMSM populations to understand place-based determinants of health such as substance use and sexual risk behaviors.
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Affiliation(s)
- Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
- Center for Data Science, New York University, New York, NY, United States of America
- * E-mail:
| | - Farzana Kapadia
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
| | - Seann D. Regan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - William C. Goedel
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
| | - Michael D. Levy
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
| | - Staci C. Barton
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
| | - Samuel R. Friedman
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY, United States of America
| | - Perry N. Halkitis
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
- Population Center, New York University, New York, NY, United States of America
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America
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Abstract
Multi-day GPS data is increasingly being used in research-including in the field of spatial epidemiology. We present several maps as ways to present multi-day GPS data. Data come from the NYC Low-Income Housing, Neighborhoods and Health Study (n=120). Participants wore a QStarz BT-Q1000XT GPS device for about a week (mean: 7.44, SD= 2.15). Our maps show various ways to visualize multi-day GPS data; these data are presented by overall GPS data, by weekday/weekend and by day of the week. We discuss implications for each of the maps.
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Affiliation(s)
- Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, NY USA
| | - Seann D Regan
- Department of Population Health, New York University School of Medicine, New York, NY USA
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Reitzel LR, Okamoto H, Hernandez DC, Regan SD, McNeill LH, Obasi EM. The Built Food Environment and Dietary Intake among African-American Adults. Am J Health Behav 2016; 40:3-11. [PMID: 26685808 DOI: 10.5993/ajhb.40.1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The built food environment surrounding people's homes may influence their dietary intake. This exploratory study examined how the density of different sources of food in the residential environment was associated with dietary consumption among 77 African-American adults in Houston, Texas. METHODS The number of fast-food-type restaurants, large grocery stores, and convenience-type stores within 2- and 5-mile residential buffers were divided by the respective areas to obtain food environment density variables. Intake of fruit and vegetables [FV], fiber [FI], and percent energy from fat [PEF] was assessed using National Health Interview Survey items. Covariate-adjusted regressions were used to assess relations of interest. RESULTS Greater density of fast-food-type restaurants within 2 miles was associated with greater FV, FI, and PEF (ps ≤ .012); and for FV and FI within 5 miles (ps ≤ .004). Density of large grocery stores was unrelated to intake. Greater density of convenience-type stores within 2 miles was negatively associated with FV and FI (ps ≤ .03); results became marginal at 5 miles for FV (p = .10) but not FI (p = .03). CONCLUSION Maximizing healthy offerings in venue-rich metropolitan areas might provide direction for policies to reduce obesity.
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Affiliation(s)
- Lorraine R Reitzel
- The University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA
| | - Hiroe Okamoto
- The University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA
| | - Daphne C Hernandez
- The University of Houston, Department of Health and Human Performance, Houston, TX, USA
| | | | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX, USA
| | - Ezemenari M Obasi
- The University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA
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21
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Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B. Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study. Geospat Health 2014; 9:57-70. [PMID: 25545926 PMCID: PMC4767499 DOI: 10.4081/gh.2014.6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.
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Affiliation(s)
- Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, New York, USA
- Global Institute of Public Health, New York University, New York, USA
- Population Center, New York University, New York, USA
| | - Seann D. Regan
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, USA
- Global Institute of Public Health, New York University, New York, USA
| | - Kristen Day
- Department of Technology, Culture and Society, New York University Polytechnic School of Engineering, New York, USA
- Wagner Graduate School of Public Service, New York University, New York, USA
| | - Ryan R. Ruff
- Global Institute of Public Health, New York University, New York, USA
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, USA
| | - Maliyhah Al-Bayan
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, USA
- Global Institute of Public Health, New York University, New York, USA
- Population Center, New York University, New York, USA
- Wagner Graduate School of Public Service, New York University, New York, USA
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Reitzel LR, Kendzor DE, Nguyen N, Regan SD, Okuyemi KS, Castro Y, Wetter DW, Businelle MS. Shelter proximity and affect among homeless smokers making a quit attempt. Am J Health Behav 2014; 38:161-9. [PMID: 24629545 DOI: 10.5993/ajhb.38.2.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore the associations between shelter proximity and real-time affect during a specific smoking quit attempt among 22 homeless adults. METHODS Affect was measured via 485 smartphone-based Ecological Momentary Assessments randomly administered during the weeks immediately before and after the quit day, and proximity to the shelter was measured via GPS. Adjusted linear mixed model regressions examined associations between shelter proximity and affect. RESULTS Closer proximity to the shelter was associated with greater negative affect only during the post-quit attempt week (p = .008). All participants relapsed to smoking by one week post-quit attempt. CONCLUSIONS Among homeless smokers trying to quit, the shelter may be associated with unexpected negative affect/stress. Potential intervention applications are suggested.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Educational Psychology, College of Education, University of Houston, Houston, Health Disparities Research at The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Darla E Kendzor
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health and The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer, Dallas, TX, USA
| | - Nga Nguyen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seann D Regan
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yessenia Castro
- School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - David W Wetter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael S Businelle
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health and The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer, Dallas, TX, USA.
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Abstract
BACKGROUND Thyroid cancer incidence is increasing, potentially due to enhanced diagnostic practices. However, access to healthcare may be dependent on socioeconomic status (SES) and race/ethnicity. Consequently, certain segments of the population may experience thyroid cancer overdiagnosis as a result of greater access to and use of enhanced diagnostic technology. The current study examined trends by SES in thyroid cancer incidence at the census tract level from 1995 to 2008 for the population of Texas, as well as by racial/ethnic subgroup. METHODS Joinpoint regressions were used to examine incidence trends over time by SES for the study population, and for the non-Hispanic white, non-Hispanic black, and Hispanic subgroups separately. Other race/ethnicities were not adequately represented for subgroup analyses. RESULTS There were 22,390 incident thyroid cancer cases (65.0% white, 6.7% black, 24.3% Hispanic, 4.1% Asian/other races; 85.9% papillary histology). The low SES group experienced a steady increase in incidence since 1995 (6.7% per year, p<0.05), whereas incidence among the high SES group has increased at a rate of 8.6% per year since 1999 (p<0.05). The joinpoint projected incidence trends for the low and high SES groups were significantly different (p=0.047). Whites experienced a steady increase in incidence over time among both high and low SES groups (7.6% per year p<0.05), whereas blacks and Hispanics of higher SES had a much more pronounced increase in incidence over time relative to their lower SES counterparts (blacks=12.8% vs. 4.1%; Hispanics=11.2% vs. 8.3%, p<0.05). For blacks and Hispanics, joinpoint projected incidence trends for the low and high SES groups were significantly different from one another (p<0.001-0.004). CONCLUSIONS These results identify groups experiencing the greatest problem of increasing thyroid cancer incidence, and raise concern that greater access to healthcare may be accompanied by thyroid cancer overdiagnosis. A dual focus on delineating and preventing disease-related causal factors and focusing clinical attention on avoiding overdiagnosis among certain populations (e.g., high SES) may be advisable to address thyroid cancer in Texas. Clinicians are encouraged to adhere to ATA/NCCN guidelines when choosing patients for thyroid ultrasound, selecting which nodules to examine, and deciding which patients should proceed to biopsy.
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Affiliation(s)
- Lorraine R. Reitzel
- Department of Educational Psychology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Educational Psychology, University of Houston, Houston, Texas
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nan Li
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Li Xu
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seann D. Regan
- Department of Educational Psychology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M. Sturgis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Cuevas AG, Reitzel LR, Adams CE, Cao Y, Nguyen N, Wetter DW, Watkins KL, Regan SD, McNeill LH. Discrimination, affect, and cancer risk factors among African Americans. Am J Health Behav 2014; 38:31-41. [PMID: 24034678 DOI: 10.5993/ajhb.38.1.4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults. METHODS Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation. RESULTS Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05). CONCLUSIONS Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.
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Affiliation(s)
- Adolfo G Cuevas
- University of Texas MD Anderson Cancer Center, Houston, TX, USA; Portland State University, Portland, OR, USA
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Cuevas AG, Reitzel LR, Cao Y, Nguyen N, Wetter DW, Adams CE, Watkins KL, Regan SD, McNeill LH. Mediators of discrimination and self-rated health among African Americans. Am J Health Behav 2013; 37:745-54. [PMID: 24001623 DOI: 10.5993/ajhb.37.6.3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans. METHODS A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male). RESULTS Greater discrimination was associated with poorer self-rated health (β =-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05). CONCLUSIONS Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Watkins KL, Regan SD, Nguyen N, Businelle MS, Kendzor DE, Lam C, Balis D, Cuevas AG, Cao Y, Reitzel LR. Advancing cessation research by integrating EMA and geospatial methodologies: associations between tobacco retail outlets and real-time smoking urges during a quit attempt. Nicotine Tob Res 2013; 16 Suppl 2:S93-101. [PMID: 24057995 DOI: 10.1093/ntr/ntt135] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Residential tobacco retail outlet (TRO) density and proximity have been associated with smoking behaviors. More research is needed to understand the mechanisms underlying these relations and their potential relevance outside of the residential setting. This study integrates ecological momentary assessment (EMA) and geo-location tracking to explore real-time associations between exposure to TROs and smoking urges among 47 economically disadvantaged smokers in a cessation trial (59.6% female; 36.2% White). METHODS EMA data were collected for 1 week postquit via smartphone, which recorded smoking urge strength ≤ 4 random times daily along with real-time participant location data. For each assessment, the participants' proximity to the closest TRO and the density of TROs surrounding the participant were calculated. Linear mixed model regressions examined associations between TRO variables and smoking urges and whether relations varied based on participants' distance from their home. Covariates included sociodemographics, prequit tobacco dependence, treatment group, and daily smoking status. RESULTS Main effects were nonsignificant; however, the interaction between TRO proximity and distance from home was considered significant (p = .056). Specifically, closer proximity to TROs was associated with stronger smoking urges ≤ 1 mile of home (p = .001) but not >1 mile from home (p = .307). Significant associations were attributable to assessments completed at participants' home addresses. All density analyses were nonsignificant. CONCLUSIONS Technological challenges encountered in this study resulted in a significant amount of missing data, highlighting the preliminary nature of these findings and limiting the inferences that can be drawn. However, results suggest that closer residential proximity to tobacco outlets may trigger stronger urges to smoke among economically disadvantaged smokers trying to quit, perhaps due to enhanced cigarette availability and accessibility. Therefore, limiting tobacco sales in close proximity to residential areas may complement existing tobacco control efforts and facilitate cessation.
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Affiliation(s)
- Kellie L Watkins
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
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Reitzel LR, Regan SD, Nguyen N, Cromley EK, Strong LL, Wetter DW, McNeill LH. Density and proximity of fast food restaurants and body mass index among African Americans. Am J Public Health 2013; 104:110-6. [PMID: 23678913 DOI: 10.2105/ajph.2012.301140] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to address current gaps in the literature by examining the associations of fast food restaurant (FFR) density around the home and FFR proximity to the home, respectively, with body mass index (BMI) among a large sample of African American adults from Houston, Texas. METHODS We used generalized linear models with generalized estimating equations to examine associations of FFR density at 0.5-, 1-, 2-, and 5-mile road network buffers around the home with BMI and associations of the closest FFR to the home with BMI. All models were adjusted for a range of individual-level covariates and neighborhood socioeconomic status. We additionally investigated the moderating effects of household income on these relations. Data were collected from December 2008 to July 2009. RESULTS FFR density was not associated with BMI in the main analyses. However, FFR density at 0.5, 1, and 2 miles was positively associated with BMI among participants with lower incomes (P ≤ .025). Closer FFR proximity was associated with higher BMI among all participants (P < .001), with stronger associations emerging among those of lower income (P < .013) relative to higher income (P < .014). CONCLUSIONS Additional research with more diverse African American samples is needed, but results supported the potential for the fast food environment to affect BMI among African Americans, particularly among those of lower economic means.
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Affiliation(s)
- Lorraine R Reitzel
- At the time of the study, Lorraine R. Reitzel was with and Seann D. Regan, Larkin L. Strong, David W. Wetter, and Lorna H. McNeill are with the Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston. Nga Nguyen is with the Department of Biostatistics, The University of Texas MD Anderson Cancer Center. Ellen K. Cromley is with the Department of Community Medicine and Health Care, The University of Connecticut School of Medicine, Farmington
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Cuevas AG, Reitzel LR, Claire ACE, Cao Y, Nguyen NNT, Wetter DW, Watkins KL, Regan SD. Abstract B40: The mediating role of perceived stress and depression in relations between perceived discrimination and cancer risk behaviors and outcomes among African American adults. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-b40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Several modifiable risk behaviors (smoking, heavy alcohol use, inadequate physical activity, poor diet) and associated outcomes (overweight/obesity) have been causally linked to cancer incidence and related mortality. Research indicates that African Americans suffer disproportionately from the adverse consequences of these risk factors relative to other ethnic groups, even after accounting for differences in risk behavior prevalence. In addition, some studies suggest that African Americans may be more likely than other ethnic groups to engage in multiple risk behaviors.
Purpose: A better understanding of factors associated with cancer risk behaviors/outcomes is needed to inform interventions to reduce cancer risk among African Americans. Discrimination has been linked to risk behaviors in the literature, but the mechanisms underlying these associations are not well understood. Because perceived discrimination has been associated with elevated stress and depression, and because stress and depression have been implicated in cancer risk behavior engagement, these psychosocial factors may help to explain relations between discrimination and cancer risk behaviors/outcomes. The current study examined the mediating role of stress and depression in the association between perceived discrimination and smoking status, alcohol use, physical activity, fruit and vegetable consumption, and body mass index, as well as the total number of behavioral risk factors among 1363 African American adults (age=45+13, 75% female).
Methods: A nonparametric bootstrapping procedure was used to assess whether stress and/or depression mediated relations of discrimination and behavioral risk factors in single mediator models. All analyses controlled for age, sex, marital status, income, education, and employment status. Analyses involving body mass index were additionally adjusted for physical activity and fruit and vegetable consumption.
Results: Associations between discrimination and cancer risk factors were non-significant; however, there were several significant indirect effects. Specifically, discrimination had an indirect effect on smoking (CIs.95= .0012, .0109; .0003, .0096), physical activity (CIs.95= .0007, .0073; .0003, .0065), and number of risk factors (CIs.95= .0008, .0029; .0005, .0024) through stress and depressive symptoms. Greater discrimination was associated with greater stress and depression, which were each associated with a higher likelihood of current smoking, higher odds of low physical activity, and a greater number of behavioral risk factors. Additionally, discrimination had an indirect effect on body mass index (CIs.95= .0015, .0115) through depressive symptoms. Greater discrimination was associated with greater depressive symptoms, which were associated with higher odds of overweight/obesity. No indirect effects emerged for at-risk drinking or fruit and vegetable consumption.
Conclusions: Results suggest that perceived discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depression. Interventions to reduce cancer risk among African Americans may need to address experiences of discrimination, as well as the stress and depression that these may engender.
Citation Format: Adolfo G. Cuevas, Lorraine R. Reitzel, Adams CE Claire, Yumei Cao, Nga NT Nguyen, David W. Wetter, Kellie L. Watkins, Seann D. Regan. The mediating role of perceived stress and depression in relations between perceived discrimination and cancer risk behaviors and outcomes among African American adults. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B40.
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Affiliation(s)
| | | | - Adams CE Claire
- 2University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Yumei Cao
- 2University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Nga NT Nguyen
- 2University of Texas, MD Anderson Cancer Center, Houston, TX
| | - David W. Wetter
- 2University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | - Seann D. Regan
- 2University of Texas, MD Anderson Cancer Center, Houston, TX
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