COVID-19 testing and vaccination uptake among youth and young adults: Disparities by age, race/ethnicity, sexual orientation, and gender identity.

BACKGROUND: The COVID-19 pandemic disproportionately impacts youth and young adults (YYA) and YYA with multiple marginalized identities, yet little is known about differences in uptake, testing access, and vaccine concerns among YYA by diverse demographic identities. METHODS: Between 2/2021 and 2/2022, we conducted a national, cross-sectional online survey focused on diverse YYA ages 14 to 24 (n = 983). We explored the prevalence of COVID-19 testing and vaccination among YYA by age, race/ethnicity, and sexual and gender identities. Bivariate and multivariable logistic regression models were developed to estimate associations between individual variables and COVID-19 testing and vaccination. RESULTS: The overall COVID-19 testing and vaccination rates in our sample were high (75.99% and 69.07%, respectively). No differences in testing by demographics were found. Compared to individuals aged 14 to 17 years, those aged 18 to 21 years and 22 to 24 years were over 2 times and 4 times as likely to report receiving a vaccine, respectively. All race/ethnicity groups except for Asian individuals were more likely to report being vaccinated compared to their white peers. CONCLUSIONS: Our findings showed critical disparities in COVID-19 vaccination among YYA with marginalized identities and emphasized the urgency for data collection and research on pandemic prevention for vulnerable YYA populations.

Social/Sexual Networks of People Newly Diagnosed with HIV in Ibadan, Nigeria.

Young men who have sex with men (YMSM) in Nigeria are ten times more likely to be living with HIV-1 than other young men. Due to stigma and criminalization of same-sex sexual behavior, YMSM sexual networks are likely to overlap with those of the general population, leading to a generalized HIV-1 epidemic. Due to limited research on social/sexual network dynamics related to HIV-1 in Nigeria, our study focused on YMSM and sought to assess the feasibility and acceptability of collecting social and sexual network data in Network Canvas from individuals newly diagnosed with HIV-1 in Ibadan, Nigeria. The Network Canvas software was piloted at three sites in Ibadan, Nigeria to collect social/sexual network data from 151 individuals newly diagnosed with HIV-1. Our study sample included 37.7% YMSM; participants reported a mean of 2.6 social alters and 2.6 sexual alters. From the 151 egos and 634 alters, 85 potential unique individuals (194 total) were identified; 65 egos/alters were collapsed into 25 unique individuals. Our success collecting network data from individuals newly diagnosed with HIV-1 in Ibadan demonstrates clear feasibility and acceptability of the approach and the use of Network Canvas to capture and manage these data.

Race and Sexual Identity Differences in PrEP Continuum Outcomes Among Latino Men in a Large Chicago Area Healthcare Network.

U.S. HIV incidence is threefold higher among Latino individuals than non-Latino Whites. Pre-exposure prophylaxis (PrEP) uptake remains low among Latino men. Most HIV studies view Latino communities as a monolithic group, ignoring racial and sexual diversity. This analysis examines PrEP-related outcomes including eligibility, first prescription, and second prescription across race and sexual identity in a sample of Latino cisgender men (n = 8271) who sought services from a healthcare network in Chicago in 2012-2019. Logistic regression was used to calculate adjusted odds ratios. Latino-only participants had lower odds of PrEP eligibility and first prescription compared to White-Latino participants. No other significant differences by race were detected. While bisexual participants had equivalent odds of PrEP eligibility, they had lower odds of first PrEP prescription compared to gay participants. Heterosexual participants also had lower odds of PrEP eligibility and initiation. Future research should address unique factors shaping PrEP-related outcomes among diverse Latino populations.

RESUMEN: La incidencia del VIH en los EEUU és 3 veces mayor entre las personas latinos que entre los blancos no latinos. La iniciación de la profilaxis previa a la exposición (PrEP) sigue siendo baja entre los hombres latinos. La mayoría de los estudios sobre el VIH ven a las comunidades latinos como un grupo monolítico, ignorando la diversidad racial y sexual. Este análisis examina los resultados relacionados con la PrEP, incluida la elegibilidad, la primera prescripción y la segunda prescripción según la raza y la identidad sexual en una muestra de hombres latinos cisgénero (n = 8.271) que buscaron servicios de una gran red de servicios de salud en Chicago 2012­2019. Se utilizó la regresión logística para calcular las razones de momios ajustadas. Los participantes que solo eran latinos tenían menores probabilidades de ser elegibles para PrEP y de recibir la primera prescripción en comparación con los participantes de blancos-latinos. No se detectaron otras diferencias significativas por raza. Si bien los participantes bisexuales tenían probabilidades equivalentes de ser elegibles para PrEP, tenían probabilidades más bajas de recibir la primera prescripción de PrEP en comparación con los participantes homosexuales. Los participantes heterosexuales también tenían menores probabilidades de ser elegibles y de iniciarse en la PrEP. Las investigaciones futuras deben abordar los factores únicos que dan forma a los resultados relacionados con la PrEP entre las diversas poblaciones latinos.

Student characteristics and substance use as predictors of self-reported HIV testing: the youth risk behavior survey (YRBS) 2013-2015.

Many adolescents and young adults (AYAs; ages 13-24) are unaware of their HIV status despite participating in behavior that places them at risk for contracting HIV. This study examined possible predictors of self-reported HIV testing for high school students (grades 9-12) who completed the Youth Risk Behavior Survey (YRBS). Three sex-stratified, stepwise multivariable logistic models were used to estimate odds of having received a HIV test being associated with student characteristics and substance use. The likelihood of being tested for HIV was associated with students who were a racial/ethnic minority and age 18 and older. HIV testing was also associated with male students who reported same sex partners (males) or same sex partners (males) and different sex partners (females). Female students who reported same sex partners (females) and different sex partners (males) were more likely to have been tested for HIV. Male and female students were more likely to have been tested for HIV if they reported illicit drug and/or marijuana use, while prescription drug use was also associated with HIV testing for female students. Knowledge of the predictors of HIV testing for adolescents can guide efforts for the effective scale up of testing for this vulnerable population.

Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis.

BACKGROUND: Characteristics of an individual's social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. OBJECTIVE: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. METHODS: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. RESULTS: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as "easy to use," with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. CONCLUSIONS: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals' social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors.

Associations with COVID-19 Symptoms, Prevention Interest, and Testing Among Sexual and Gender Minority Adults in a Diverse National Sample.

Purpose: Sexual and gender minority (SGM) and racial/ethnic minority populations may differ in coronavirus disease 2019 (COVID-19) prevention, testing, and vaccine interest, although little research has explored these disparities. It is critical to understand the differential experiences within minoritized communities to ensure effective intervention and vaccine rollout. Methods: In a national online survey of U.S. adult SGM individuals, conducted between April and August 2020, 932 participants responded about COVID-19 testing, symptoms, interest in vaccination, and interest in at-home testing. Bivariate associations between these outcomes and demographic factors, including sexual orientation, gender identity, endorsing intersex traits, gender modality, race/ethnicity, and HIV status were calculated. Results: Despite 24% of the sample reporting COVID-19 symptoms, testing was relatively low at 13.3%. Transgender and bisexual/pansexual individuals were more likely to be interested in a COVID-19 vaccine and an at-home test compared with cisgender and gay/lesbian respondents, respectively. Compared with cisgender individuals, transgender individuals were nearly twice as likely to report COVID-19 symptoms. Latinx individuals were less likely to be interested in a future COVID-19 vaccination and Black individuals were less likely to be interested in an at-home COVID-19 test compared with White participants. Both respondents who endorsed intersex traits and people with HIV were less likely to be interested in an at-home test compared with those who did not endorse having intersex traits and people without HIV, respectively. Conclusions: These results show critical disparities in COVID-19 symptomology and prevention interest within SGM populations that must be taken into account when designing or tailoring effective COVID-19 interventions.

Evidence of Social and Structural COVID-19 Disparities by Sexual Orientation, Gender Identity, and Race/Ethnicity in an Urban Environment.

The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago's initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations.

Differential Alcohol Use Disparities by Sexual Identity and Behavior Among High School Students.

AIMS: Sexual minority youth (SMY) use alcohol at disproportionate rates compared to their heterosexual peers. However, sexual orientation is multidimensional. Analyzing alcohol use disparities only by one dimension of sexual orientation may result in critical disparities being obscured. METHODS: Data from state and local versions of the Youth Risk Behavior Survey were pooled (2009-2017), resulting in a large, diverse sample (n = 201,671). Multivariable logistic regression models were used to analyze associations between sexual identity/sexual behavior and three alcohol use outcomes among sexually active youth: age at first drink, binge drinking and current drinking. RESULTS: SMY, when categorized by sexual identity and sexual behavior, reported greater alcohol use than their heterosexual peers, though the magnitude of these disparities varied by subgroup. Both those who identified as bisexual and those who reported sexual behavior with both males and females reported the greatest levels of alcohol use. Decomposition analysis revealed that youth whose reported sexual behavior was not aligned with stereotypical behavioral expectations based on their sexual identity had higher odds of current drinking and drinking before 13 years as compared to other youth. CONCLUSIONS: Results highlight the need to incorporate multiple methods of sexual orientation measurement into substance use research. Interventions based solely on identity, rather than both identity and behavior, may not be sufficient; targeted research into the causes of alcohol use disparities is needed, especially for bisexual youth, youth whose sexual behavior and sexual identity are not stereotypically aligned, and youth who report a sexual identity of 'not sure.'

Geospatial perspectives on health: The PrEP4Love campaign and the role of local context in health promotion messaging.

Pre-exposure prophylaxis (PrEP) remains one of the most effective biomedical interventions for the prevention of HIV transmission. However, uptake among populations most impacted by the HIV epidemic remains low. La rge-scale awareness and mobilization campaigns have sought to address gaps in knowledge and motivation in order to improve PrEP diffusion. Such campaigns must be cognizant of the historical, physical, and structural contexts in which they exist. In urban contexts, neighborhood segregation has the potential to impact health outcomes and amplify disparities. Therefore, we present novel geospatial approaches to the evaluation of a Chicago-based PrEP messaging campaign (PrEP4Love) in a 2018 cohort of men who have sex with men and transgender women, contextualizing results within the localized infrastructure and public health landscape, and examining associations between geographic location and campaign efficacy. Results revealed notable variance in rates of PrEP uptake associated with campaign exposure by Chicago planning area, which are likely explained by the historical and contemporary impacts of racist structures on physical environment and city infrastructure. Findings have important implications for the evaluation and implementation of future messaging campaigns, which should take the unique historical, structural, and geospatial factors of their particular settings into account in order to achieve maximum impact.

Differential Decline in Illicit Drug Use by Sexual Identity Among United States High School Students, 2005-2017.

Purpose: Adolescent drug use remains a significant public health concern. Sexual minority youth (SMY) are at elevated risk for illicit drug use compared with their heterosexual peers. We investigated this pattern at the national level, exploring whether trends and disparities in drug use vary over time and by sexual identity. Methods: This study used Youth Risk Behavior Survey (YRBS) data, which were collected at seven time points from 2005 to 2017. Trends and disparities over time in the use of five drugs, as well as any drug use, were analyzed by self-reported sexual identity. Results: The results demonstrated a general decrease in drug use behaviors from 2005 to 2017. The greatest number of significant decreases was among heterosexual and bisexual students; the fewest were among gay and lesbian students. Disparities between heterosexual youth and SMY persisted across years, and were greater for gay and lesbian students in 2017 than for bisexual and not-sure youth. Conclusions: Our results represent the most comprehensive analysis of recent trends in drug use by sexual identity to date. Disparities in drug use remained significant despite overall downward trends within our sample. The significant decreases among bisexual students are not readily explained. We emphasize the need for ongoing research in this area, particularly given the currently volatile social position of sexual minority populations in the United States, and for culturally responsive and trauma-informed responses to SMY drug use.

Addressing the Disproportionate Impacts of the COVID-19 Pandemic on Sexual and Gender Minority Populations in the United States: Actions Toward Equity.

Sexual and gender minority (SGM) populations may be affected disproportionately by health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. Health professionals must take immediate steps to ensure equitable treatment of SGM populations. These steps are to (1) maintain and increase cultural responsiveness training and preparedness for SGM populations, (2) increase use of sexual orientation and gender identity measures in surveillance, (3) conduct research on the impacts of COVID-19 on SGM populations, and (4) include equity-focused initiatives in disaster preparedness plans. These actions toward equity would begin to allow for our current health system to care more appropriately for SGM populations.

Engagement with LGBTQ community moderates the association between victimization and substance use among a cohort of sexual and gender minority individuals assigned female at birth.

BACKGROUND: Research has documented higher levels of substance use among sexual and gender minority (SGM) individuals - particularly sexual minority women (SMW) and transgender people - than among their heterosexual and cisgender peers. Because SGM substance use is linked to stigma-based victimization, it is crucial to identify social contexts that may buffer the association between victimization and substance use among SGM. METHODS: We explored how engagement with LGBTQ-specific community influences victimization experiences and substance use among 488 SGM individuals assigned female at birth (FAB-SGM; ages 16-32; 26% White) in a large Midwestern city. We tested whether participants who used LGBTQ community spaces differed from those who do not in levels of victimization and substance use, and whether use of LGBTQ spaces buffered SGM from the negative effects of victimization on substance use. RESULTS: Results demonstrated significant associations between victimization and alcohol and use of specific drugs. Contrary to expectations, participants who used LGBTQ spaces reported more victimization and more use of certain substances; however, when controlling for being out about non-heterosexual identity, this association remained only for LGBTQ community centers and school groups. Evidence was mixed for community engagement as a moderator of the association between victimization and substance use. CONCLUSIONS: Overall, results indicated that LGBTQ spaces may be associated with adaptive and maladaptive coping functions and should be considered a potential target for health interventions. Findings emphasize the need for increased research on FAB-SGM, including SMW and transgender individuals, and provide actionable recommendations to reduce incidence of victimization and substance use.

Trends in Alcohol Use Behaviors by Sexual Identity and Behavior Among High School Students, 2007-2017.

PURPOSE: Certain groups, particularly sexual minority youth, demonstrate notable disparities in alcohol use risk. Assessing trends in alcohol use behaviors by sexual orientation over time is therefore important to the epidemiologic study of adolescent health equity. METHODS: We analyzed age at first drink, lifetime drinking behavior, current drinking, and binge drinking in a large, national sample of high school youth across six time points, beginning in 2007 and biennially through 2017. We assessed trends by sex, sexual identity, and sexual behavior, controlling for race/ethnicity and age. RESULTS: Our results demonstrated that, although overall alcohol use is decreasing among youth, disparities between heterosexual and sexual minority youth remain significant. The largest decreases were seen in current alcohol use among lesbian youth, which fell from a prevalence of 56.1% in 2007 to 38.9% in 2017, and among bisexual females (64.3% in 2007 to 41.1% in 2017). Despite this, alcohol use behaviors were still elevated among lesbian and bisexual female youth compared with heterosexual sex-matched counterparts. Heterosexual-identified male students saw significant decreases in alcohol use, whereas most alcohol use behaviors among sexual minority males decreased but not to a statistically significant degree, with the exception of binge drinking among those who identified as gay (2007: 36.0% to 2017: 12.6%) and bisexual (2007: 24.7% to 2017: 11.6%). Results by sexual behavior are presented within. CONCLUSIONS: Sexual minority youth continued to demonstrate markedly high prevalence of alcohol use behaviors compared with heterosexual peers across all time points. Downward trends in alcohol use may thus mask serious population health risks if not adequately explored. Research and health promotion efforts must consider sexual minority orientation to avoid incomplete or inaccurate representation of findings.

Not getting high with a little help from your friends: Social versus drug network correlates of marijuana use among YMSM.

Substantial evidence has documented the importance of social connections in shaping health and drug use behaviors among adolescents and young adults. The current study extends previous research into the associations between network characteristics and drug use behavior among young men who have sex with men (YMSM) by 1) examining multiple network characteristics, 2) simultaneously assessing multiple network types (i.e., social and drug use), and 3) examining change in network characteristics and drug use behavior over time. Data for the current study comes from RADAR, a longitudinal cohort study of YMSM. Latent growth curve models examined the change in frequency of marijuana use across four observations and individual and network correlates of this change including: demographics, drug network size, drug network density, social network size, and social network density. Baseline frequency of marijuana use was positively associated with drug network size and density, while it was inversely related to social network size and density. In addition, increasing frequency of marijuana use was associated with increases in drug network size and density, while it was associated with decreases in social network size. These findings highlight the complexity of multiple network types (e.g., drug and social) and network structures (e.g., size and density) in understanding drug use behavior among YMSM. Furthermore, as changes in drug and social networks may be indicative of changes in marijuana use, peer relationships may be especially important in understanding an individual's trajectories of marijuana use.

Reaching Adolescent Gay, Bisexual, and Queer Men Online: Development and Refinement of a National Recruitment Strategy.

BACKGROUND: Using social networking websites to recruit research participants is increasingly documented in the literature, although few studies have leveraged these sites to reach those younger than 18 years. OBJECTIVE: To discuss the development and refinement of a recruitment protocol to reach and engage adolescent gay, bisexual, and other teenaged men who have sex with men (AGBM). Participants were recruited for development and evaluation activities related to Guy2Guy, a text messaging-based human immunodeficiency virus infection prevention program. METHODS: Eligibility criteria included being between 14 to 18 years old; being a cisgender male; self-identifying as gay, bisexual, and/or queer; being literate in English, exclusively owning a cell phone, enrolled in an unlimited text messaging plan, intending to keep their current phone number over the next 6 months, and having used text messaging for at least the past 6 months. Recruitment experiences and subsequent steps to refine the Internet-based recruitment strategy are discussed for 4 research activities: online focus groups, content advisory team, beta test, and randomized controlled trial (RCT). Recruitment relied primarily on Facebook advertising. To a lesser extent, Google AdWords and promotion through partner organizations working with AGBM youth were also utilized. RESULTS: Facebook advertising strategies were regularly adjusted based on preidentified recruitment targets for race, ethnicity, urban-rural residence, and sexual experience. The result was a diverse sample of participants, of whom 30% belonged to a racial minority and 20% were Hispanic. Facebook advertising was the most cost-effective method, and it was also able to reach diverse recruitment goals: recruitment for the first focus group cost an average of US $2.50 per enrolled participant, and it took 9 days to enroll 40 participants; the second focus group cost an average of US $6.96 per enrolled participant, and it took 11 days to enroll 40 participants. Recruitment for the first content advisory team cost an average of US $32.52 per enrolled participant; the second cost US $29.52 per participant. Both recruitment drives required 10 days to enroll 24 participants. For the beta test, recruitment cost an average of US $17.19 per enrolled participant, and it took 16 days to complete enrollment of 20 participants. For the RCT, recruitment cost an average of US $12.54 per enrolled participant, and it took 148 days to enroll 302 participants. Google AdWords campaigns did not result in any enrolled participants of whom the research staff members were aware. CONCLUSIONS: Internet-based strategies can be a cost-efficient means to recruit and retain hard-to-reach populations from across the country. With real-time monitoring of participant demographic characteristics, diverse samples can be achieved. Although Facebook advertising was particularly successful in this study, alternative social media strategies can be explored in future research as these media are ever-changing.