Health disparities in mortality among individuals with HIV-associated dementia in South Carolina.

HIV disproportionately affects the South compared to other regions of the US. Some people living with HIV (PLWH) may acquire HIV-associated neurocognitive disorders (HAND), of which HIV-associated dementia (HAD) is the most severe form. This study aimed to examine the disparities in mortality among individuals with HAD. Data were obtained from the South Carolina Alzheimer's Disease and Related Dementias Registry from 2010 to 2016 (HAD: n = 505; N = 164,982). Logistic regression and Cox proportional hazards models were used to determine mortality related to HIV-associated dementia and potential sociodemographic differences. Adjusted models controlled for age, gender, race, rurality, and place of diagnosis. Individuals diagnosed in a nursing facility were three times more likely to die with HAD compared to those diagnosed in the community (OR: 3.25; 95% CI: 2.08-5.08). Black populations were more likely to die with HAD compared to White populations (OR: 1.52; 95% CI: 0.953-2.42). Disparities in mortality among patients with HAD were found in place of diagnosis and by race. Future research should determine if mortality among individuals with HAD were as a result of HAD or non-HIV related decline.

A dual approach to addressing gaps in scholar diversity in aging research.

The number of people with Alzheimer's disease and related dementias (ADRD) in the United States is steadily increasing, with minoritized populations having a disproportionate burden of disease. One strategy to address the racial and ethnic disparities in aging is to diversify scholars in the field of aging, to increase dynamic solution development and create cultural congruence among researchers and participants. The National Institute on Aging has a committed effort to increase and diversify the number of scientists who conduct aging and ADRD research, placing a call for Centers to focus on this effort. In response to the National Institute on Aging call, the Carolina Center for Alzheimer's Disease and Minority Research, housed at the University of South Carolina, proposed a dual approach to addressing these gaps through a joint national conference and mentorship program for underrepresented minoritized faculty. After one year of the program, the participating scholars were surveyed, and successes and growth points of the program were identified to help guide the improvement of this dual approach to addressing gaps in scholar diversity in aging research.

Sociodemographic Characteristics of HIV-Associated Dementia in the South Carolina Alzheimer's Disease Registry.

OBJECTIVES: Studies examining the sociodemographic characteristics associated with human immunodeficiency virus (HIV)-associated dementia (HAD) are lacking, especially in the southern United States. The aim of this study was to describe the characteristics of HAD using South Carolina Alzheimer's Disease Registry data, and examine these characteristics across two time periods. METHODS: Data were obtained from the population-based, South Carolina Alzheimer's Disease Registry from 2000-2006 and 2010-2016 (N = 165,487). Crude and multivariable logistic regression models were applied to determine sociodemographic characteristics associated with HAD by time period. RESULTS: Younger, Black, Other, men, and urban populations had greater odds of being diagnosed as having HAD in both time periods. For example, compared with individuals aged 85 years and older, individuals aged 18 to 34 had 97 times the odds (adjusted odds ratio 97.0; 95% confidence interval 31.6-297.8) of being diagnosed as having HAD. In 2010-2016, however, nursing facility populations had a greater odds of being diagnosed as having HAD. CONCLUSIONS: We found that younger populations (younger than 74 years), communities of color, men, urban populations, and nursing facility populations were more likely to have HAD. Future research should focus on the association between HAD and risk for Alzheimer's disease.

Understanding the Social Environmental Influences on Pregnancy and Planning for Pregnancy for Young Women in Harare, Zimbabwe.

OBJECTIVES: Social environmental influences on pregnancy-related practices and outcomes have been studied, yet few studies explore these influences qualitatively from the perspectives of women's personal social networks and the larger social networks that exist within their communities. This study sought to understand and describe the social environment related to pregnancy and planning for pregnancy in Harare, Zimbabwe from the perspectives of women's social networks, and its influence on pregnancy-related decisions and practices. METHODS: Semi-structured, in-depth, qualitative interviews were conducted in both Shona and English with 24 key community stakeholders (6 healthcare workers, 6 school teachers, 6 family members of females aged 14-24 years, and 6 community leaders) who lived or worked in 2 low-income, high-density communities in Harare. Data were analyzed thematically using NVivo 10 software. RESULTS: The social environment related to pregnancy and planning for pregnancy described by participants was deeply rooted in culture and cultural practices and centered on four themes: (1) pregnancy importance to the role of a woman in the community and the fulfillment of marriage, (2) pregnancy silence to prevent adverse pregnancy outcomes and adolescent and out of wedlock pregnancies, (3) patriarchal pregnancy culture, and (4) community support during pregnancy. CONCLUSIONS FOR PRACTICE: Maternal health efforts in Zimbabwe should acknowledge cultural influences on pregnancy and address pregnancy silence to improve reproductive health communication, empower women to be partners in the pregnancy decision-making process, and include women's social networks.

Black US college women's strategies of sexual self-protection.

While previous scholarship on the sexual practices of college students in the USA has explored how the co-constitution of whiteness, economic privilege and gender inequality are central to 'hooking up', less attention has been paid to how the sexual culture of predominantly white universities shape Black college women's sexual practices. In this article, we use an intersectional theoretical framework informed by Black feminism to analyse interviews with Black, cisgender, heterosexual women, aged 18-22, attending a university in the south-eastern USA. We explore how they interpret the university's sexual culture and in turn how that informs their sexual decision-making. We find that the intersection of racism and sexism limits Black college women's sexual partner options and leads them to pursue sexual relationships outside the university setting. While most do not engage in committed romantic relationships with off-campus partners, they do engage in a range of strategies to protect their social, emotional and sexual well-being. The study findings expand the scholarship on hook-up culture by centring the narratives of a group often excluded from the literature.

Understanding Conceptualizations of Pregnancy and Planning for Pregnancy Among Adolescent Girls and Young Women in Harare, Zimbabwe.

Zimbabwe has one of the highest rates of maternal mortality, yet little is understood about adolescent girls' and young women's perspectives on pregnancy or planning for pregnancy. The research study took an emic approach to understand and describe how adolescent girls and young women (14-24 years) in Harare, Zimbabwe, conceptualize pregnancy and planning for pregnancy and how these conceptualizations inform pregnancy decisions. Semi-structured, in-depth, qualitative interviews were conducted with adolescent girls and young women ( N = 48) and data were analyzed thematically using NVivo 10. Pregnancy was conceptualized across nine themes: carrying a child and oneself, growing a family, motherhood, the best time for pregnancy, pregnancy decision makers, who is responsible for the pregnancy, pregnancy burden, pregnancy dangers, and increase in social status with pregnancy. Planning for pregnancy was conceptualized during the prepregnancy, pregnancy, and postpregnancy phases. Findings emphasize considering sociocultural views concerning pregnancy and including social networks in maternal health efforts.

Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study.

BACKGROUND: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. METHODS: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 and 16 weeks of pregnancy and were asked to take two BP readings twice daily three times a week through their pregnancy. Primary outcomes were recruitment, retention and persistence of self-monitoring. Study recruitment and retention were analysed with descriptive statistics. Survival analysis was used to evaluate the persistence of self-monitoring and the performance of self-monitoring in the early detection of gestational hypertension, compared to clinic BP monitoring. Secondary outcomes were the mean clinic and self-monitored BP readings and the performance of self-monitoring in the detection of gestational hypertension and pre-eclampsia compared to clinic BP. RESULTS: Of 201 women recruited, 161 (80%) remained in the study at 36 weeks or to the end of their pregnancy, 162 (81%) provided any home readings suitable for analysis, 148 (74%) continued to self-monitor at 20 weeks and 107 (66%) at 36 weeks. Self-monitored readings were similar in value to contemporaneous matched clinic readings for both systolic and diastolic BP. Of the 23 who developed gestational hypertension or pre-eclampsia and self-monitored, 9 (39%) had a raised home BP prior to a raised clinic BP. CONCLUSIONS: Self-monitoring of BP in pregnancy is feasible and has potential to be useful in the early detection of gestational hypertensive disorders but maintaining self-monitoring throughout pregnancy requires support and probably enhanced training.

Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe.

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to a lack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Care established a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant women receiving daily iron and folic acid (IFA) at their first antenatal care visit and throughout pregnancy. Despite these efforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand the experiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare, Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured in-depth interviews were conducted in Shona and English, with pregnant women (n = 24) and healthcare workers (n = 14) providing direct antenatal care services to pregnant women in two high-density community clinics. Data were analysed thematically using NVivo 10. Influences on utilization were at the individual and structural environmental levels. Reasons for low utilization of IFA supplementation included forgetting to take IFA, side effects, misconceptions about IFA, limited access to nutrition information, delayed entry or non-uptake of antenatal care and social norms of pregnant women for IFA supplementation. Utilization was enhanced by knowledge of risks and benefits of supplementation, fear of negative health complications with non-utilization, family support and healthcare worker recommendation for supplementation. Study findings can inform approaches to strengthen micronutrient supplementation utilization to improve the micronutrient status of pregnant women to decrease maternal mortality and improve overall maternal and child health in Zimbabwe. © 2016 John Wiley & Sons Ltd.

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster.

INTRODUCTION: In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US. HISTORY: Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing. METHODS: Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data. RESULTS: Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing. CONCLUSIONS: Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.

Exploring perceptions of cancer risk, neighborhood environmental risks, and health behaviors of blacks.

Cancer risk perceptions and cancer worry are shaped by race/ethnicity, and social, economic, and environmental factors, which in turn shape health decision-making. A paucity of studies has explored risk perceptions and worry in metropolitan areas with disparate environmental conditions and cancer outcomes. This study examined perceptions of cancer risk, neighborhood environmental health risks, and risk-reducing health behaviors among Blacks. A 59-item survey was administered to respondents in Metropolitan Charleston, South Carolina from March to September 2013. A convenience sample of males and females was recruited at local venues and community events. Descriptive statistics, bivariate analyses (Chi square tests), and logistic regression models were estimated using SAS 9.3 software. Respondents (N = 405) were 100% Black, 81% female (n = 323), and ranged from 18 to 87 years of age (M = 49.55, SD = 15.27). Most respondents reported lower perceptions of cancer risk (37%) and equated their cancer beliefs to direct or indirect (i.e. personal or family) experiences. Low perceived cancer risk (absolute risk) was significantly associated (p < .05) with non-alcohol consumption, having a colon cancer screening test, being female, and being age 25-44 or 45-64. Cancer worry was significantly associated (p < .05) with being a current smoker, having a "fair" diet, non-alcohol consumption, and having any colon cancer screening test. Perceived cancer risk is an important indicator of health behaviors among Blacks. Direct or indirect experiences with cancer and/or the environment and awareness of family history of cancer may explain cancer risk perceptions.

An exploratory study of indicators of recent nonmedical prescription stimulant use among college students.

Objective: To explore the relationship between past 30-day nonmedical prescription stimulant use (NPSU) and past 30-day marijuana and/or alcohol use, past 30-day risky marijuana and/or alcohol use, student demographics, and student activity involvement among college students. Participants: Sample of 604 college-aged students at two large universities in the southeastern U.S. Methods: A cross-sectional survey was completed electronically. Logistic regression was used to identify and test covariates of past 30-day NPSU. Results: Over 20% of participants self-reported past NPSU. Using both marijuana and alcohol in the past 30 days (B = 3.293, p = .002, OR= 26.91, 95% CI OR= 3.42, 211.92) and engaging in both risky marijuana and alcohol use (B = 2.095, p < .001, OR = 8.13, 95% CI OR = 2.52, 25.17) were significantly related to past 30-day NPSU. Conclusions: NPSU may be indicative of broader polysubstance use problems among college-aged students.

Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP.

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.

Sanitary sewage overflows, boil water advisories, and emergency room and urgent care visits for gastrointestinal illness: a case-crossover study in South Carolina, USA, 2013-2017.

BACKGROUND: Sanitary sewage overflows (SSOs) release raw sewage, which may contaminate the drinking water supply. Boil water advisories (BWAs) are issued during low or negative pressure events, alerting customers to potential contamination in the drinking water distribution system. OBJECTIVE: We evaluated the associations between SSOs and BWAs and diagnoses of gastrointestinal (GI) illness in Columbia, South Carolina, and neighboring communities, 2013-2017. METHODS: A symmetric bi-directional case-crossover study design was used to assess the role of SSOs and BWAs on Emergency Room and Urgent Care visits with a primary diagnosis of GI illness. Cases were considered exposed if an SSO or BWA occurred 0-4 days, 5-9 days, or 10-14 days prior to the diagnosis, within the same residential zip code. Effect modification was explored via stratification on participant-level factors (e.g., sex, race, age) and season (January-March versus April-December). RESULTS: There were 830 SSOs, 423 BWAs, and 25,969 cases of GI illness. Highest numbers of SSOs, BWAs and GI cases were observed in a zip code where >80% of residents identified as Black or African-American. SSOs were associated with a 13% increase in the odds of a diagnosis for GI illness during the 0-4 day hazard period, compared to control periods (Odds Ratio: 1.13, 95% Confidence Interval: 1.09, 1.18), while no associations were observed during the other hazard periods. BWAs were not associated with increased or decreased odds of GI illness during all three hazard periods. However, in stratified analyses BWAs issued between January-March were associated with higher odds of GI illness, compared to advisories issued between April-December, in all three hazard periods. SIGNIFICANCE: SSOs (all months) and BWAs (January-March) were associated with increased odds of a diagnosis of GI illness. Future research should examine sewage contamination of the drinking water distribution system, and mechanisms of sewage intrusion from SSOs. IMPACT: Sewage contains pathogens, which cause gastrointestinal (GI) illness. In Columbia, South Carolina, USA, between 2013-2017, there were 830 sanitary sewage overflows (SSOs). There were also 423 boil water advisories, which were issued during negative pressure events. Using case-crossover design, SSOs (all months) and boil water advisories (January-March) were associated with increased odds of Emergency Room and Urgent Care diagnoses of GI illness, potentially due to contamination of the drinking water distribution system. Lastly, we identified a community where >80% of residents identified as Black or African-American, which experienced a disproportionate burden of sewage exposure, compared to the rest of Columbia.

Highlighting the value of Alzheimer's disease-focused registries: lessons learned from cancer surveillance.

Like cancer, Alzheimer's disease and related dementias (ADRD) comprise a global health burden that can benefit tremendously from the power of disease registry data. With an aging population, the incidence, treatment, and mortality from ADRD is increasing and changing rapidly. In the same way that current cancer registries work toward prevention and control, so do ADRD registries. ADRD registries maintain a comprehensive and accurate registry of ADRD within their state, provide disease prevalence estimates to enable better planning for social and medical services, identify differences in disease prevalence among demographic groups, help those who care for individuals with ADRD, and foster research into risk factors for ADRD. ADRD registries offer a unique opportunity to conduct high-impact, scientifically rigorous research efficiently. As research on and development of ADRD treatments continue to be a priority, such registries can be powerful tools for conducting observational studies of the disease. This perspectives piece examines how established cancer registries can inform ADRD registries' impact on public health surveillance, research, and intervention, and inform and engage policymakers.

Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial.

BACKGROUND: Maternal, neonatal and child health outcomes are worse in families from black and ethnic minority groups and disadvantaged backgrounds. There is little evidence on whether lay support improves maternal and infant outcomes among women with complex social needs within a disadvantaged multi-ethnic population in the United Kingdom (UK). METHOD/DESIGN: The aim of this study is to evaluate a lay Pregnancy Outreach Worker (POW) service for nulliparous women identified as having social risk within a maternity service that is systematically assessing social risks alongside the usual obstetric and medical risks. The study design is a randomised controlled trial (RCT) in nulliparous women assessed as having social risk comparing standard maternity care with the addition of referral to the POW support service. The POWs work alongside community midwifery teams and offer individualised support to women to encourage engagement with services (health and social care) from randomisation (before 28 weeks gestation) until 6 weeks after birth. The primary outcomes have been chosen on the basis that they are linked to maternal and infant health. The two primary outcomes are engagement with antenatal care, assessed by the number of antenatal visits; and maternal depression, assessed using the Edinburgh Postnatal Depression Scale at 8-12 weeks after birth. Secondary outcomes include maternal and neonatal morbidity and mortality, routine child health assessments, including immunisation uptake and breastfeeding at 6 weeks. Other psychological outcomes (self efficacy) and mother-to-infant bonding will also be collected using validated tools.A sample size of 1316 will provide 90% power (at the 5% significance level) to detect increased engagement with antenatal services of 1.5 visits and a reduction of 1.5 in the average EPDS score for women with two or more social risk factors, with power in excess of this for women with any social risk factor. Analysis will be by intention to treat. Qualitative research will explore the POWs' daily work in context. This will complement the findings of the RCT through a triangulation of quantitative and qualitative data on the process of the intervention, and identify other contextual factors that affect the implementation of the intervention. DISCUSSION: The trial will provide high quality evidence as to whether or not lay support (POW) offered to women identified with social risk factors improves engagement with maternity services and reduces numbers of women with depression. MREC NUMBER: 10/H1207/23 TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN35027323.

Examination of maternal near-miss experiences in the hospital setting among Black women in the United States.

INTRODUCTION: The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. METHODS: Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. RESULTS: We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient-provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. CONCLUSION: Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems.

A qualitative study of health care access among African American older adults in a socio-demographically under-resourced region during the COVID-19 pandemic.

Background: In the U.S., health inequities experienced by the African American community, specifically among those ages 65 and older, have been well-documented in research literature. Alongside the findings regarding disparities in disease prevalence and management, researchers have also highlighted disparities in health care access. Despite recent evidence of health inequities experienced by African Americans during the COVID pandemic, there is little research on the lived experience of this group in this critical time, health care access challenges that may be exacerbated by the pandemic, and the community's outlook for the future in addressing health disparities. Methods: We conducted a qualitative study of African Americans to gather their perspectives about access to health care, particularly during the COVID-19 pandemic. Study participants consisted of African Americans, ages 50-85 years, who spoke English as their primary language, who resided in one of 17 counties in South Carolina that represent a region of the State known as the corridor of economic disadvantage. Results: Forty-seven telephone interviews were conducted. While research has shown that certain populations experienced health care access disparities during the early COVID pandemic, these disparities did not appear to be exacerbated in our sample. However, participants noted an increase in the use of telehealth, and identified challenges to using this technology. Participants made recommendations about how to address disparities in health care access in their communities. Conclusion: Our qualitative approach was useful in obtaining perspectives about access to health care during the COVID-19 pandemic from African American older adults. Continued research with older African Americans, particularly those in under-resourced communities are warranted to further elucidate these findings.

Reflections on Mentorship From Scientists and Mentors in an Alzheimer's Disease Focused Research Training Program.

This paper presents reflections on mentorship from scientists and mentors of the National Institute on Aging (NIA)-funded Carolina Center on Alzheimer's Disease and Minority Research (CCADMR). Using a network approach to mentoring, this program aims to increase the pipeline of underrepresented minority (URM) scientists studying Alzheimer's disease (AD) disparities. Six mentors and five scientists participated in interviews. Thematic analysis identified recurring themes; transcripts of mentors and scientists were compared. Most common thematic categories identified by mentors included experience interacting with scientists, goals as a mentor, recruitment of underrepresented minorities, scientists' challenges, and programmatic qualities. The most mentioned categories by scientists were challenges, seminars, working with mentors, career development, and project experience. The CCADMR will use findings to enhance the experience and training methods for future grant years. Results can benefit other training programs focused on aging and AD.

African American Women's Current Knowledge, Perceptions, and Willingness of PrEP Use for HIV Prevention in the South.

African American women accounted for approximately 60% of new HIV diagnoses among women in the United States, with the greatest burden occurring in the South. Past efforts to prevent HIV focused on behavioral interventions aimed at reducing sexual risk behavior. More recent HIV prevention methods have included oral pre-exposure prophylaxis (PrEP) with antiretroviral drugs. Although PrEP has been designated as an effective HIV prevention method since 2012, awareness and uptake of PrEP remains low among African American women. Our study explored African American women's knowledge, perceptions, and willingness of PrEP use. Four focus groups were held in April 2019, consisting of 27 women, who identified as African American and resided in South Carolina. Focus group topics focused on participants' awareness, perceptions, and potential use of PrEP. The majority of women had heard of PrEP; however, over half of the participants were in the HIV or health field. Overall, participants believed that the "lay woman" would be unaware of PrEP. Participants' perceptions of PrEP included stigma of PrEP use, benefits to non-monogamous couples, and experiences with PrEP clients. The majority of women were willing to use PrEP, but major concerns around short and long-term side effects were expressed. Participants provided recommendations to improve PrEP uptake among African American women that included targeted campaigns and spokespersons. African American women are interested and supportive of PrEP use for HIV prevention in the South, where HIV rates remain highest. Past PrEP implementation efforts have not been relatable to African American women; therefore, awareness and uptake rates remain low. Future efforts to increase PrEP awareness and uptake among African American women should be relevant, and should provide comprehensive information on potential side effects, purpose of use, and eligibility criteria.

Racial/ethnic differences in positive childhood experiences across a national sample.

BACKGROUND: Examination of racial/ethnic differences in positive childhood experiences (PCEs) is needed, as the absence of supportive factors may hinder children from healthy processing and mitigation of adversity. OBJECTIVE: The purpose of this study was to examine the prevalence of PCEs in a nationally representative sample of children and determine whether PCE exposure differed across race and ethnic groups. PARTICIPANTS AND SETTING: Data were drawn from the nationally representative 2017-2018 National Survey of Children's Health (NSCH) (n = 33,747). METHODS: Descriptive statistics and bivariate analyses were used in order to calculate frequencies, proportions, and unadjusted associations for each variable. Multivariable regression models were used to examine the association between race/ethnicity and PCEs. RESULTS: All racial-ethnic minority groups of children had a lower likelihood of mentorship, living in a safe neighborhood, or living in a supportive neighborhood, than their Non-Hispanic White counterparts. Non-Hispanic Black children had a lower likelihood of having a mentor for advice or guidance (aOR 0.50; 95 % CI 0.38-0.62), living in a safe neighborhood (aOR 0.62; 95 % CI 0.52-0.73), and living in a supportive neighborhood (aOR 0.75; 95 % CI 0.64-0.87) than Non-Hispanic white children. CONCLUSIONS: The information from this study highlights the negative disparities borne by racial/ethnic minority populations. Findings can be used to inform policymakers, program developers, and stakeholders on where to target interventions and how to bring together families and communities to not only confront adversity in childhood, but also to leverage community and family-level assets to create PCEs for all children.