The Association Between Cardiovascular Health with Internet and Mobile Technology Use Among Jackson Heart Study Participants.

Background: Although studies have examined if the internet and mobile technology (IMT) can support cardiovascular health (CVH) self-management and health information-seeking efforts, limited studies have targeted African American communities. This study analyzes a possible association between CVH and IMT use and if socioeconomic status is linked to this relationship among older, African Americans in the Jackson Heart Study (JHS). Methods: This analysis uses JHS data from three time points: Examination 1 (2000-2004), Examination 3 (2009-2013), and the Digital Connectedness Survey (2017-2019). Participants completed measures of CVH (the American Heart Association's Life Simple 7 [LS7]), IMT use, and demographic characteristics via telephone interview. Both multivariable logistic and linear regression analyses were conducted to analyze the relationship between the LS7 composite and component scores (representing CVH) and IMT use. Results: Fifty eight percent of participants were 60 or older; 64% were women. Overall, 2,255 (88%) of participants were IMT users. Generally, no association was found when analyzing LS7 composite scores and IMT use except for the association between LS7 composite scores and use of other smart devices (p = 0.01). However, having ideal blood pressure, body mass index, and cholesterol had positive associations with using technology to track health (p = 0.003, p = 0.004, p = 0.052, respectively), and having ideal physical activity was positively associated with using smart devices (p = 0.012). Conclusions: No association was found between LS7 composite scores and IMT use. However, there were associations between individual LS7 metrics, IMT use, and IMT use characteristics. More research should be done to continue assessing the feasibility of using IMT for CVH self-management among older African Americans.

Inequities in Physical Activity Environments and Leisure-Time Physical Activity in Rural Communities.

INTRODUCTION: Differential access to environments supportive of physical activity (PA) may help explain racial and socioeconomic disparities in leisure-time physical activity (LTPA) in rural communities. METHODS: We used baseline data from a mailed survey (N = 728) conducted in 2019 as part of an evaluation of The Two Georgias Initiative to examine the relationships among LTPA, sociodemographic characteristics, and perceived access to supportive PA environments (eg, areas around the home/neighborhood, indoor and outdoor exercise areas, town center connectivity) in 3 rural Georgia counties. RESULTS: More than half of respondents (53.5%) engaged in LTPA in the previous month. Perceptions of PA environments were generally neutral to somewhat negative. In multivariable models, overall PA environment was associated with LTPA (OR, 1.58; 95% CI, 1.06-2.35), as was annual household income >$50,000 relative to ≤$20,000 (OR, 2.72; 95% CI, 1.53-4.83) and race, with Black respondents less likely to engage in LTPA than White respondents (OR, 0.49; 95% CI, 0.29-0.85). Of the 5 PA environment domains examined, town center connectivity was significantly associated with LTPA (OR, 1.68, 95% CI, 1.20-2.36). Both the overall PA score (ß = -0.014; 95% CI, -0.029 to -0.002) and town center connectivity (ß = -0.020; 95% CI, -0.038 to -0.005) partially mediated associations between annual household income and LTPA. Areas supportive of PA around the home/neighborhood partially mediated the association by race (ß = 0.016; 95% CI, 0.001-0.034). CONCLUSION: Findings lend support for investing in town centers and racially diverse neighborhoods to increase walkability and PA infrastructure as potential strategies to reduce inequities in LTPA.

A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation.

Georgia has the lowest kidney transplant rates in the United States and substantial racial disparities in transplantation. We determined the effectiveness of a multicomponent intervention to increase referral of patients on dialysis for transplant evaluation in the Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT), a randomized, dialysis facility-based, controlled trial involving >9000 patients receiving dialysis from 134 dialysis facilities in Georgia. In December of 2013, we selected dialysis facilities with either low transplant referral or racial disparity in referral. The intervention consisted of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients conducted from January to December of 2014. We examined the proportion of patients with prevalent ESRD in each facility referred for transplant within 1 year as the primary outcome, and disparity in the referral of black and white patients as a secondary outcome. Compared with control facilities, intervention facilities referred a higher proportion of patients for transplant at 12 months (adjusted mean difference [aMD], 7.3%; 95% confidence interval [95% CI], 5.5% to 9.2%; odds ratio, 1.75; 95% CI, 1.36 to 2.26). The difference between intervention and control facilities in the proportion of patients referred for transplant was higher among black patients (aMD, 6.4%; 95% CI, 4.3% to 8.6%) than white patients (aMD, 3.7%; 95% CI, 1.6% to 5.9%; P<0.05). In conclusion, this intervention increased referral and improved equity in kidney transplant referral for patients on dialysis in Georgia; long-term follow-up is needed to determine whether these effects led to more transplants.

Population-Attributable Risk Percentages for Racialized Risk Environments.

Research about relationships between place characteristics and racial/ethnic inequities in health has largely ignored conceptual advances about race and place within the discipline of geography. Research has also almost exclusively quantified these relationships using effect estimates (e.g., odds ratios), statistics that fail to adequately capture the full impact of place characteristics on inequities and thus undermine our ability to translate research into action. We draw on geography to further develop the concept of "racialized risk environments," and we argue for the routine calculation of race/ethnicity-specific population-attributable risk percentages.

Male Incarceration Rates and Rates of Sexually Transmitted Infections: Results From a Longitudinal Analysis in a Southeastern US City.

BACKGROUND: In the United States, rates of certain sexually transmitted infections (STIs) are increasing. Contextual factors seem to play an important role in shaping STI transmission dynamics. This longitudinal study explores the relationship between one contextual determinant of health (the male incarceration rate) and rates of newly diagnosed STIs in census tracts in Atlanta, GA. METHODS: The sample consisted of all census tracts in Atlanta (n = 946). Annual data on STI diagnoses were drawn from the Georgia surveillance system for 2005 to 2010; annual male incarceration data were drawn from the Georgia Department of Corrections for 2005 to 2010; and data on potential confounders were drawn from the US Census. Multivariable growth models were used to examine the association between the male incarceration rate and rates of newly diagnosed STIs, controlling for covariates. RESULTS: Census tracts with higher baseline male incarceration rates had a higher baseline rate of newly diagnosed STIs. Census tracts with increasing male incarceration rates experienced a more rapid increase in their rate of newly diagnosed STIs. Census tracts with medium and high baseline male incarceration rates experienced a decrease in their rate of newly diagnosed STIs over time. CONCLUSIONS: The present study strengthens the evidence that male incarceration rates have negative consequences on sexual health outcomes, although the relationship may be more nuanced than originally thought. Future multilevel research should explore individual sexual risk behaviors and networks in the context of high male incarceration rates to better understand how male incarceration shapes rates of STIs.

Collateral consequences: implications of male incarceration rates, imbalanced sex ratios and partner availability for heterosexual Black women.

While studies have found correlations between rates of incarceration and sexually transmitted infections (STIs), few studies have explored the mechanisms linking these phenomena. This qualitative study examines how male incarceration rates and sex ratios influence perceived partner availability and sexual partnerships for heterosexual Black women. Semi-structured interviews were conducted with 33 Black women living in two US neighbourhoods, one with a high male incarceration rate and an imbalanced sex ratio (referred to as 'Allentown') and one with a low male incarceration rate and an equitable sex ratio (referred to as 'Blackrock'). Data were analysed using grounded theory. In Allentown, male incarceration reduced the number of available men, and participants largely viewed men available for partnerships as being of an undesirable quality. The number and desirability of men impacted on the nature of partnerships such that they were shorter, focused on sexual activity and may be with higher-risk sexual partners (e.g. transactional sex partners). In Blackrock, marriage rates contributed to the shortage of desirable male partners. By highlighting the role that the quantity and quality of male partners has on shaping sexual partnerships, this study advances current understandings of how incarceration and sex ratios shape HIV- and STI-related risk.

Understanding the relationship between social capital, health, and well-being in a southern rural population.

PURPOSE: Social capital is thought to contribute to health and well-being, but its application to a rural context is poorly understood. This study seeks to examine how different forms of social capital relate to health and well-being among rural residents and the extent to which race and degree of rurality moderates these relationships. METHODS: Data from a population-based survey of 6 counties in rural Georgia (n = 1,385) are used. We examined 3 forms of social capital (diversity of interaction, civic engagement, and voting behavior) in relation to 3 health and well-being measures (overall life satisfaction, general health status, and 30-day physical health). FINDINGS: Interacting with more diverse social networks was associated with higher overall life satisfaction for White but not Black participants (P ≤ .001). For those living in more rural communities, interacting with a more diverse social network was more strongly associated with greater general health as compared to those who lived "in town" (P ≤ .01). Greater civic engagement and voting behavior were associated with greater general health for White but not Black participants (Ps < .05). Likewise, voting in all 3 elections was associated with greater overall life satisfaction and fewer days of poor physical health for White but not Black participants (Ps ≤ .05). CONCLUSION: Social capital may be associated with positive health and well-being among those living in rural areas, but it may vary by race and degree of community rurality, suggesting the need to further understand how social capital operates in a rural context.

Reducing barriers to breast cancer care through Avon patient navigation programs.

CONTEXT: Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women. OBJECTIVE: To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms. PARTICIPANTS: Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted. DESIGN: An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed. RESULTS: Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30 000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum. CONCLUSIONS: Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care.

Evaluation Design for The Two Georgias Initiative: Assessing Progress Toward Health Equity in the Rural South.

As persistent inequities in health gained increased attention nationally due to COVID-19 and racial justice protests in 2020, it has become increasingly important to evaluate both the process and outcomes associated with coalition-based efforts to address health inequities. The Two Georgias Initiative supports coalitions in 11 rural counties to (1) achieve greater health equity, (2) improve health and health care, (3) build healthier rural communities and improve social conditions that impact the health of rural populations, and (4) build community, organizational, and individual leadership capacity for health equity. Rural communities suffer significant health disparities relative to urban areas, and also experience internal inequities by race and poverty level. The evaluation framework for The Two Georgias Initiative provides a comprehensive mixed methods approach to evaluating both processes and outcomes. Early results related to community readiness and capacity to address health inequities, measured through a coalition member survey (n = 236) conducted at the end of the planning phase, suggest coalitions were in the preparation stage, with higher levels of readiness among coalition members and organizations/groups similar to the coalition members' own, lower levels among public officials and other leaders, and the lowest levels among county residents. In addition, coalition members reported more experience with downstream drivers (e.g., access to care) of health than upstream drivers (e.g., affordable housing, environmental or racial justice). By providing a logic model, evaluation questions and associated indicators, as well as a range of data collection methods, this evaluation approach may prove practical to others aiming to evaluate their efforts to address health equity.

Strategies to enhance linkages between care for HIV/AIDS in jail and community settings.

The policies of mass incarceration and the expansion of the criminal justice system in the USA over the last 40 years have weighed heavily on individuals and communities impacted by drug use and HIV disease. Though less than ideal, jails provide a unique opportunity to diagnose, treat and implement effective interventions. The role of jails in HIV detection, treatment, and continuity of care, however, has yet to be systematically examined. This paper reviews the service strategies and contexts for 10 demonstration sites funded to develop innovative methods for providing care and treatment to HIV-infected individuals in jail settings who are returning to their communities. The sites have implemented varied intervention strategies; each set in unique policy and service system contexts. Collaboration among agencies and between systems to implement these interventions is viewed as particularly challenging undertakings. We anticipate the sites will collectively serve 700-1000 individuals across the duration of the initiative. In this paper, we review the service contexts and strategies developed by the 10 sites. The individual and multi-site evaluations aim to provide new data on testing, treatment, and community linkages from jails that will further develop our knowledge base on effective intervention strategies in these settings.

A randomized trial of race-related stress among African Americans with chronic kidney disease.

OBJECTIVE: African Americans progress from early to late-stage chronic kidney disease (CKD) at a rate that is three times that of Whites. Given research that implicates social stress in poor kidney outcomes, there is a need to examine whether race-related stress contributes to these disparities. Through experimental manipulation, this study sought to determine whether acute race-related stress was associated with autonomic arousal and an inflammatory marker, which are well-established pathways to poor kidney outcomes. Further we tested the hypothesis that expectations of racism may moderate this relationship. METHOD: Fifty-two African American patients along the CKD continuum were randomized to recall a general or race-related stressful experience. Before, during, and after the recall, patients' blood pressure and Interleukin-6 (IL-6) were monitored. Prior to the experimental manipulation, participants completed self-reported measures of expectations of racism. RESULTS: Across both study conditions, change in self-reported distress from baseline to stress was associated with both systolic and diastolic reactivity (both ps <.01), but not change in IL-6 responses (all ps > 0.05). A significant interaction revealed that those who were randomized to recall a race-related stressor demonstrated less diastolic blood pressure reactivity (F=4.80, p<.05) if they scored lower in expectations of racism as compared to those who scored high. Moreover, those who were randomized to the race-related stressor demonstrated greater increase in IL-6 from 45 to 90 min post-recall than those who recalled a general stressor (F=6.35, p<.05). CONCLUSIONS: Acute race-related stress may be associated with autonomic arousal and inflammatory response among African American patients along the CKD continuum, suggesting the need to further understand its role in racial disparities in CKD progression.

Exploring the "bisexual bridge": a qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men.

OBJECTIVES: We explored factors influencing sexual behavior, disclosure of same-sex behavior, and condom-use practices among Black bisexual men. METHODS: We conducted semistructured interviews with 38 Black men in Atlanta, Georgia, who reported having had oral, vaginal, or anal sex with both men and women in the prior 6 months. RESULTS: Participants described approaches to disclosure of same-sex behavior as part of a complex decisional balance influenced by both situational and individual factors and ranging from full disclosure to total secrecy. Influences on sexual behavior and condom-use practices included: (1) type of relationship, (2) gender-specific considerations, (3) perceptions of comfort or trust, and (4) fear of disease or pregnancy. CONCLUSIONS: Disclosure of same-sex behavior was not a major influence on the sexual behavior and condom-use practices of the Black bisexual men in our study, who demonstrated heterogeneity in approaches to sexual behavior, disclosure of same-sex behavior, and condom-use practices. Additional research is needed to assess the social determinants of sexual risk for this population. Future HIV-prevention efforts should include initiatives to encourage accuracy in risk assessment and in taking sexual histories in clinical settings.

A qualitative evaluation of the Avon Foundation Community Education and Outreach Initiative Patient Navigation Program.

This study presents a qualitative evaluation of the Avon Foundation Community Education and Outreach Initiative (CEOI) Patient Navigation Program. Qualitative in-depth interviews were conducted with breast cancer patients (N = 18) of the CEOI Patient Navigation Program. Primary strengths of the program include the nature of the relationship between the patient and navigator, the availability of navigators to attend appointments, and the fact that navigators were breast cancer survivors. The process of enrolling patients into the program was a weakness. Participants described positive experiences with this program. They also identified areas of improvement that are relevant to other patient navigation programs in the US.

Understanding the pros and cons of organ donation decision-making: Decisional balance and expressing donation intentions among African Americans.

Increasing public commitment to organ donation is critical to improving donor kidney availability for end-stage renal disease patients desiring transplant. This study surveyed (N = 1339) African Americans, measuring perceived pros relative to cons of organ donation, to evaluate an existing Transtheoretical Model decisional balance scale and associations between decisional balance and expressing donation intentions. Findings supported the existing scale structure. More positive decisional balance ratios were associated with 1.76 times the odds of expressing intentions (95% confidence interval = 1.52-2.04). Pros were more strongly linked to donation intentions than cons. Greater understanding of organ donation decision-making is valuable for informing interventions that encourage donation.

Development and validation of the Retrospective Alcohol Context Scale.

BACKGROUND: Few validated measures exist to capture the context and consequences of specific drinking events among college students. OBJECTIVES: This study sought to describe the development and validation of the Retrospective Alcohol Context Scale (RACS), a 30-day measure of drinking context among college students. METHODS: A sample of 169 college students completed daily alcohol assessments for 30 days and completed the RACS at follow-up. RESULTS: The RACS captured fewer negative consequences than daily assessments; however, high agreement was observed on context variables. CONCLUSION: Results support the validity of the RACS as a measure of drinking context among college students. The RACS may be most useful when information about drinking needs to be collected under limited time and resources. SCIENTIFIC SIGNIFICANCE: Further research is needed to examine the RACS among more diverse, probability samples and over longer time periods.

A Culturally Sensitive Web-based Intervention to Improve Living Donor Kidney Transplant Among African Americans.

INTRODUCTION: There are pervasive racial disparities in access to living donor kidney transplantation, which for most patients with end-stage renal disease (ESRD) represents the optimal treatment. We previously developed a theory-driven, culturally sensitive intervention for African American (AA) patients with kidney disease called Living ACTS (About Choices in Transplantation and Sharing) as a DVD and booklet, and found this intervention was effective in increasing living donor transplant knowledge. However, it is unknown whether modifying this intervention for a Web-based environment is effective at increasing access to living donor transplantation. METHODS: We describe the Web-based Living ACTS study, a multicenter, randomized controlled study designed to test the effectiveness of a revised Living ACTS intervention in 4 transplant centers in the southeastern United States. The intervention consists of a Web site with 5 modules: Introduction, Benefits and Risks, The Kidney Transplant Process, Identifying a Potential Kidney Donor, and ACT Now (which encourages communication with friends and family about transplantation). RESULTS: This study will enroll approximately 800 patients from the 4 transplant centers. The primary outcome is the percentage of patients with at least 1 inquiry from a potential living donor among patients who receive Living ACTS as compared with those who receive a control Web site. CONCLUSION: The results from this study are expected to demonstrate the effectiveness of an intervention designed to increase access to living donor transplantation among AA individuals. If successful, the Web-based intervention could be disseminated across the >250 transplant centers in the United States to improve equity in living donor kidney transplantation.

Alcohol assessment using wireless handheld computers: a pilot study.

The present study sought to test the feasibility of measuring quantity and frequency of self-reported alcohol consumption among college students using the Handheld Assisted Network Diary (HAND) by comparing results to a retrospective Timeline Followback (TLFB). A total of 40 undergraduate college students completed a HAND assessment during the two-week study period and completed a TLFB at follow-up. The HAND recorded similar levels of alcohol consumption compared to the TLFB. There were no significant differences in overall alcohol consumption, drinks per drinking day, or heavy drinking days between the two methods of assessment. Handheld computers may represent a useful tool for assessing daily alcohol use among college students.