Community Health and Preventive Medicine Commons^™

Implementation Science Research Examining The Integration Of Evidence-Based Practices Into Hiv Prevention And Clinical Care: Protocol For A Mixed-Methods Study Using The Exploration, Preparation, Implementation, And Sustainment (Epis) Model, April Idalski Carcone, Karin Coyle, Sitaji Gurung, Demetria Cain, Rafael E. Dilones, Laura Jadwin-Cakmak, Jeffrey T. Parsons, Sylvie Naar

Publications and Research

BACKGROUND: The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the continued use of an EBP in a given clinical context (Sustainment). This is the first implementation science (IS) study of the integration of EBPs into adolescent HIV prevention and care settings.

OBJECTIVE: This protocol (ATN 153 EPIS) is part of the Scale It Up program, a research program administered by the Adolescent Medicine Trials Network for HIV/AIDS …

Intimate Partner Violence Among Expectant Adolescent Couples: Psychological And Relational Predictors And Sexual Risk, Jessica Lewis

Dissertations, Theses, and Capstone Projects

BACKGROUND/PURPOSE: Intimate partner violence (IPV) is prevalent and tends to be bilateral in adolescent relationships. Expectant adolescent couples are at even higher risk. Using the Actor-Partner Interdependence Model (APIM), this study sought to: (1) describe the patterns of physical/sexual and psychological IPV victimization of women and men in expectant adolescent couples from pregnancy through twelve months postpartum; (2) examine the associations between psychosocial and relational factors during pregnancy and postpartum IPV; and (3) investigate the relationship between IPV victimization and later sexual risk across the perinatal period.

METHODS: Data were collected from pregnant adolescents and their male partners (N=296) recruited …

Adolescent Trials Network For Hiv-Aids Scale It Up Program: Protocol For A Rational And Overview, Sylvie Naar, Jeffrey T. Parsons, Bonita F. Stanton

Publications and Research

Background: The past 30 years have witnessed such significant progress in the prevention and treatment of HIV/AIDS that an AIDS-free generation and the end to the global AIDS epidemic are ambitious, but achievable, national and global goals. Despite growing optimism, globally, youth living with HIV are markedly less likely to receive antiretroviral therapy than adults (23% vs 38%). Furthermore, marked health disparities exist regarding HIV infection risk, with young men of color who have sex with men disproportionately affected. A large body of research has identified highly impactful facilitators of and barriers to behavior change. Several efficacious interventions have been …

Model-Based Methods To Translate Adolescent Medicine Trials Network For Hiv/Aids Interventions Findings Into Policy Recommendations: Rationale And Protocol For A Modeling Core (Atn 161), Anne M. Neilan, Kunjal Patel, Allison L. Agwu, Ingrid V. Bassett, K. Rivet Amico, Catherine M. Crespi, Aditya H. Gaur, Keith J. Horvath, Kimberly A. Powers, H. Jonathon Rendina, Lisa B. Hightow-Weidman, Xiaoming Li, Sylvie Naar, Sharon Nachman, Jeffrey T. Parsons, Kit N. Simpson, Bonita F. Stanton, Kenneth A. Freedberg, Audrey C. Bangs, Michael G. Hudgens, Andrea L. Ciaranello

Publications and Research

BACKGROUND: The United States Centers for Disease Control and Prevention estimates that approximately 60,000 US youth are living with HIV. US youth living with HIV (YLWH) have poorer outcomes compared with adults, including lower rates of diagnosis, engagement, retention, and virologic suppression. With Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) support, new trials of youth-centered interventions to improve retention in care and medication adherence among YLWH are underway.

OBJECTIVE: This study aimed to use a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to evaluate selected ongoing and forthcoming ATN interventions to improve viral load suppression …

Youth Study Recruitment Using Paid Advertising On Instagram, Snapchat, And Facebook: Cross-Sectional Survey Study, Kelsey Lynett Ford, Tashuna Albritton, Tara A. Dunn, Kacy Crawford, Jessica Neuwirth, Sheana Bull

Publications and Research

Background:The use of paid social media advertising for targeted study recruitment is an effective strategy in health research and evaluation, specifically to reach diverse youth participants. Although the literature adequately describes the utility of Facebook in recruitment, limited information exists for social media platforms that are more popular with youth, specifically Instagram and Snapchat.

Objective:This paper outlines a paid advertising approach using Instagram, Snapchat, and Facebook to evaluate a statewide youth marijuana prevention campaign. The objective of this study was to compare recruitment metrics across Instagram, Snapchat, and Facebook for two surveys documenting youth knowledge, attitudes, and behaviors related to …

Assessing Participants’ Feedback To Dental Screening Provided By New York City College Of Technology’S Dental Hygiene Students, Dirien Santos, Roseanna M. Torres, Nazrin Akbarova, Susan Davide

Publications and Research

The purpose of this research is to determine if CUNY students, faculty and staff are aware of the Dental Hygiene Program and services located at New York City College of Technology (NYCCT). Dental Hygiene students at NYCCT provide educational, clinical and therapeutic services to the public in accordance with individual state Dental Hygiene practice acts. Prevention and treatment of oral disease are recognized as important factors in a patient's overall health and well-being. Dental hygienists are important members of the dental health care team providing these services. The first phase of the project consisted of a free dental screening event …

Increasing Access To Pre-Exposure Prophylaxis (Prep) Among Transgender Women And Trans Feminine Non-Binary Individuals In New York City, Augustus Klein

Dissertations, Theses, and Capstone Projects

In the United States transgender women (i.e., individuals born male whose gender identity is on the feminine spectrum) are a highly vulnerable and marginalized population at high risk for HIV. Substance use, survival sex work, depression, unstable housing, and high levels of victimization and violence are commonly reported by transgender women and trans feminine individuals, indicating the potential for multiple concurrent HIV risks and underlying vulnerabilities. Structural forms of discrimination may contribute to these risk factors, possibly leading to poor outcomes such as unemployment or underemployment, homelessness, and lack of access to gender-affirming health care. Given this context, a biomedical …

Casualties Of Racism: Racial And Ethnic Discrimination And Suicidal Thoughts And Behaviors Among Racial And Ethnic Minority Emerging Adults, Lillian Anais Polanco

Dissertations, Theses, and Capstone Projects

The evidence demonstrating that experiences of racial/ethnic discrimination is detrimental to the mental health of racial/ethnic minority youth is unequivocal. What remains unclear, however, is whether racial/ethnic discrimination increases vulnerability for suicidal thoughts and behaviors in particular, and if so, what are the underlying mechanisms to explain this relation. Drawing upon the Race-based Traumatic Stress Theory (Carter, 2007), which suggests that some individuals may experience racial/ethnic discrimination as a traumatic stressor, and thus, eliciting a traumatic stress response, the present study examined posttraumatic stress reactions (i.e., posttraumatic stress, depression, dissociation, stress sensitivity) as mediators in the relation between racial/ethnic discrimination …

Empowering With Prep (E-Prep), A Peer-Led Social Media–Based Intervention To Facilitate Hiv Preexposure Prophylaxis Adoption Among Young Black And Latinx Gay And Bisexual Men: Protocol For A Cluster Randomized Controlled Trial, Viraj V. Patel, Zoë Ginsburg, Sarit A. Golub, Keith J. Horvath, Nataly Rios, Kenneth H. Mayer, Ryunh S. Kim, Julia H. Arnsten

Publications and Research

Background: Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption.

Objective: …

Supermarket Retailers’ Perspectives On Healthy Food Retail Strategies: In-Depth Interviews, Olivia Martinez, Noemi Rodriguez, Allison Mercurio, Marie Bragg, Brian Elbel

Publications and Research

Background

Excess calorie consumption and poor diet are major contributors to the obesity epidemic. Food retailers, in particular at supermarkets, are key shapers of the food environment which influences consumers’ diets. This study seeks to understand the decision-making processes of supermarket retailers—including motivators for and barriers to promoting more healthy products—and to catalogue elements of the complex relationships between customers, suppliers, and, supermarket retailers.

Methods

We recruited 20 supermarket retailers from a convenience sample of full service supermarkets and national supermarket chain headquarters serving low- and high-income consumers in urban and non-urban areas of New York. Individuals responsible for making …

Obesity Inequalities According To Place Of Birth: The Role Of Education, Elena Rodriguez-Alvarez, Nerea Lanborena, Luisa N. Borrell

Publications and Research

This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18–64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22–1.64) and …

To Switch Or Not To Switch: Intentions To Switch To Injectable Prep Among Gay And Bisexual Men With At Least Twelve Months Oral Prep Experience, Kathrine Meyers, Yumeng Wu, Atrina Brill, Theodorus Sandfort, Sarit A. Golub

Publications and Research

Background: Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method.

Methods: Participants (n = 105; ages 19–63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for 12 months. Participants were given information about LAI PrEP and asked whether they would …

The Impact Of Comorbidities, Depression, And Substance Use Problems On Quality Of Life Among Older Adults Living With Hiv, Brett M. Millar, Tyrel Starks, Sitaji Gurung, Jeffrey T. Parsons

Publications and Research

Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people’s lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual …

Thrive With Me: Protocol For A Randomized Controlled Trial To Test A Peer Support Intervention To Improve Antiretroviral Therapy Adherence Among Men Who Have Sex With Men, Keith J. Horvath, K. Rivet Amico, Darin Erickson, Alexandra M. Ecklund, Aldona Martinka, James Dewitt, Jeffrey Mclaughlin, Jeffrey T. Parsons

Publications and Research

Background: The suboptimal rate of viral suppression among persons aged 13 years and older and residing in 37 states and the District of Columbia leaves considerable opportunities for onward transmission and contributes to poor health outcomes. Men who have sex with men (MSM) represent one of the most at-risk groups in the United States. There is a clear and continued need for innovative adherence support programs to optimize viral suppression. To address this gap, we designed and are implementing a randomized controlled trial (RCT) to test the efficacy of the Thrive with Me intervention for MSM living with HIV. Critical …

Factors Associated With Household Contacts' Tuberculosis Testing And Evaluation, Elvy G. Barroso

Dissertations, Theses, and Capstone Projects

Contact investigation (CI) is one of the core elements of tuberculosis (TB) control. It is intended to achieve early identification of contacts who may have been exposed to a patient with infectious active TB and contacts who may benefit from treatment for latent tuberculosis infection (LTBI). LTBI is an infection in which the Mycobacterium tuberculosis organisms cause no signs and symptoms but the infection can be reactivated and develop into full-blown active TB disease. Failure to be identified as a contact is the primary reason for disease development in more than half of TB patients, thus a complete and timely …

Understanding The New Blood Pressure Guidelines, Susan H. Davide, Anty Lam

Publications and Research

Oral health professionals who are well versed in the new guidelines will be best prepared to handle the implications on patient care.

Whether, When, And How: Fertility Intentions And Age In The U.S., Andrea Melnikas

Dissertations and Theses

Thinking about, planning for, and having children is a deeply personal experience influenced by myriad factors at individual, intrapersonal, community and larger social levels. Examining fertility intentions is of interest to researchers from numerous social science disciplines in part because these intentions are potentially tied to larger demographic and economic shifts. In recent years in the U.S. the mean age at first birth has been increasing, with more women of older ages (age 35 and older) giving birth, due to both delays in childbearing that accompanied larger social trends such as increased educational and career opportunities and a decrease in …

Adolescent Medicine Trials Network For Hiv/Aids Interventions Data Harmonization: Rationale And Development Of Guidelines, Micah Mccumber, Demetria Cain, Sara Legrand, Kenneth H. Mayer, Debra A. Murphy, Matthew A. Psioda, Arlene C. Seña, Tyrel J. Starks, Michael Hudgens

Publications and Research

Background: The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program aims to defeat the rising HIV epidemic among adolescents and young adults in the United States.

Objective: This study aims to optimize cross-study analyses and comparisons of standardized measures (variables) collected in the ATN. Methods: Guidelines were developed for harmonizing measures to be collected across ATN studies.

Results: Eight domains were identified for harmonization—Demographics and Socioeconomic Characteristics, Sexual Behavior and Risk, Substance Use and Abuse, HIV-Positive Cascade, HIV-Negative Cascade, Mental Health, Social Support and Isolation, and Pre-exposure Prophylaxis Cascade.

Conclusions: The collection of selected key measures in a …

Mental Hell, Jesenia De Moya, Hanaa' Tameez, Maritza Villela

Capstones

Mental Hell explores how difficult it is for low-income Latinos in New York City to access mental health care. Through explanations from experts and the personal stories of three Latinas New Yorkers who have gone through the process of trying to get the care they need, the story guides the reader through the many roadblocks this demographic encounters specifically under the insurance of Medicaid.

This is an extremely important topic that affects many New Yorkers, and we believe something needs to be done to make this type of healthcare more accessible for Latinos. New York City has a very high …

Patients’ Willingness To Participate In Rapid Hiv Testing: A Pilot Study In Three New York City Dental Hygiene Clinics, Susan H. Davide, Anthony J. Santella, Winnie Furnari, Petal Leuwaisee, Marilyn Cortell, Bhuma Krishnamachari

Publications and Research

Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics.

Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months. The survey questionnaire was based …

Exploring The Health Effects Of Precarious Employment By Sex/Gender Using Mixed Methods, Kathleen Flandrick

Dissertations and Theses

Employment in the United States has changed dramatically since the mid-1970s. Labor market forces like globalization and diversification of the American workforce have led to a heavily segmented labor market where new types of flexible employment such as temporary, contingent, and nonstandard work arrangements are increasingly common. These newer types of work are often on the lower end of the precarious employment continuum, categorizing jobs by their degree of: 1) temporariness, 2) disempowerment, 3) vulnerability, 4) compensation (wages), 5) rights, and 6) ability to exercise worker rights. The increase in precarious employment likely disproportionately affects women when compared to men, …

Incorporating Place And Space: A Hierarchical Spatial Approach To Exploring Preventable Congestive Heart Failure Hospitalizations In New York City, Rachael Weiss Riley

Dissertations and Theses

Background: Faced with rising medical care costs, increasing prevalence, and widening health disparities, preventing congestive heart failure (CHF) hospitalizations is a central public health concern. Despite evidence of geographical clustering in preventable CHF admissions, there is a lack of research designed to examine spatial patterning of CHF and the local area neighborhood determinants that contribute to this variability. This study sought to assess and evaluate the importance of both space and place in analyzing preventable CHF hospitalizations and readmissions by applying appropriate statistical techniques, clarifying the assumption inherent in each method, and interpreting the findings within the context of existing …

From Food To Food Justice: Pathways And Narratives Of Young Food Activists In New York City, Amy Kwan

Dissertations and Theses

With a rise in obesity and other non-communicable, diet-related health problems and the persistence of food insecurity among many vulnerable populations, the involvement of young people in the current, burgeoning food-justice movement has the potential to bring forth transformative changes to our food system and thus improve population health. While much is known about the outcomes of providing opportunities for young people to be actively and civically engaged in their communities, there is a lack of research on the pathways, narratives, and experiences that bring young people into food justice activism.

Through semi-structured, in-depth interviews with 25 young food activists …

The Role Of Socioeconomic Context In The Association Between Educational Attainment And Morbidity And Mortality, Jennifer Brite

Dissertations and Theses

Although the association between educational attainment and health is one of the most studied in the social science, little is known about the role of social and economic context. Fundamental Cause Theory suggests that the education-health gradient will be weakest in contexts where the better educated are unable to leverage their resources to achieve better health. This dissertation tests several different factors that may moderate the association between educational attainment and morbidity and mortality: 1. Demographic characteristics, including race, immigration status, and gender, 2. Status consistency (defined as education equivalent to that required for current occupation), 3. Unemployment rates at …

Hepatitis C Serosorting Among People Who Inject Drugs In Rural Puerto Rico, Ian Duncan, Ric Curtis, Juan Carlos Reyes, Roberto Abadie, Bilal Khan, Kirk Dombrowski

Publications and Research

Due to the high cost of treatment, preventative measures to limit Hepatitis C (HCV) transmission among people who inject drugs (PWID) are encouraged by many public health officials. A key one of these is serosorting, where PWID select risk partners based on concordant HCV status. Research on the general U.S. population bySmith et al. (2013) found that knowledge of one's own HCV status facilitated serosorting behaviors among PWID, such that respondents with knowledge of their own status were more likely to ask potential partners about their status prior to sharing risk. Our objective was to see if this held true …

Characteristics Of Hiv-Infected Children At Enrollment Into Care And At Antiretroviral Therapy Initiation In Central Africa, Adebola Adedimeji, Andrew Edmonds, Donald Hoover, Qiuhu Shi, Jean D'Amour Sinayobye, Martin Nduwinmana, Patricia Lelo, Denis Nash, Kathryn Anastos, Marcel Yotebieng

Publications and Research

Background Despite the World Health Organization (WHO) regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART) in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described.

Materials and Methods Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) pediatric cohort of 3,426 children (0±15 years) entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and …

Creating Integrated Strategies For Increasing Access To Healthy Affordable Food In Urban Communities: A Case Study Of Intersecting Food Initiatives, Michele Silver, Afia Bediako, Tracey Capers, Aysu Kirac, Nicholas Freudenberg

Publications and Research

In New York and other cities, substantial evidence documents that community food environments interact with inequitable allocation of power, wealth and services to shape the distribution of diet-related diseases and food insecurity. This case study shows how one Central Brooklyn community organization, Bedford Stuyvesant Restoration Corporation, has launched multiple coordinated food initiatives in order to reduce the burden of food-related health problems and boost community development. The report used standard case study methods to document the implementation of the New York City Food and Fitness Partnership in Central Brooklyn. The case study shows how two distinct strands of activities, a …

Burnout Or Depression: Both Individual And Social Issue, Bianchi Renzo, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

In view of the profound problems attached to the construct of burnout, we recommended that occupational health specialists focus on (job-related) depression rather than burnout to help workers more effectively. Epstein and Privitera (April 8, 1398) rejected our recommendation on the grounds that burnout is not a “purely individual syndrome”. Problematically, Epstein and Privitera attributed to us an idea that is not ours. In these authors’ view, equating burnout with depression is synonymous with mistakenly individualising a social problem. For two reasons, the argument that depression cannot replace burnout because burnout is a social problem whereas depression is an individual …

A Green Oasis: What Makes Community Gardens Worth Saving? While Researchers Amass Evidence Of Benefits, Advocates Develop New Strategy To Prove Their Value., Joel Wolfram

Capstones

Green Valley Community Garden in Brownsville, Brooklyn, is one of about a dozen gardens on land owned by the New York City Department of Housing Preservation and Development that are being uprooted by plans to build affordable housing. The gardeners are fighting back to prevent the garden’s destruction, saying that the food-producing green space is a source of healthy eating in a community with high rates of health problems, like diabetes and obesity. Researchers are attempting to tease out the public health benefits of community gardens as one metric of their value, but the science is still catching up with …

Cause For Question: Risk And Postmodern Panic In The Vaccine Safety Debate, Marygrace Trifilio

Theses and Dissertations

This thesis analyzes the thoughts and feelings of non-vaccinating parents in America and argues that contemporary vaccine refusal results from overwhelming information saturation in the Internet age. Non-vaccinating parents express distrust of competing scientific research and call for a return to a more natural, toxin-free lifestyle.