Association Between Young Adult Characteristics and Blood Pressure Trajectories.

BACKGROUND: Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample. METHODS AND RESULTS: We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324). We used latent growth curve models to identify 10-year BP trajectories and to assess the associations between characteristics in young adulthood and BP trajectories. We identified the following 5 distinct systolic BP trajectories, which appeared to be determined mainly by the baseline BP with progressively higher BP at each year: group 1 (lowest BP trajectory, 7.9%), group 2 (26.5%), group 3 (33.0%), group 4 (25.4%), and group 5 (highest BP trajectory, 7.3%). Older age (adjusted odds ratio for 30-39 versus 18-29 years, 1.23 [95% CI, 1.18-1.28]), male sex (13.38 [95% CI, 12.80-13.99]), obesity (body mass index ≥30 versus 18.5-24.9 kg/m2, 14.81 [95% CI, 14.03-15.64]), overweight (body mass index 25-29.9 versus 18.5-24.9 kg/m2, 3.16 [95% CI, 3.00-3.33]), current smoking (1.58 [95% CI, 1.48-1.67]), prediabetes (1.21 [95% CI, 1.13-1.29]), diabetes (1.60 [95% CI, 1.41-1.81]) and high low-density lipoprotein cholesterol (≥160 versus <100 mg/dL, 1.52 [95% CI, 1.37-1.68]) were associated with the highest BP trajectory (group 5) compared with the reference group (group 2). CONCLUSIONS: Traditional hypertension risk factors including smoking, diabetes, and elevated lipids were associated with BP trajectories in young adults, with obesity having the strongest association with the highest BP trajectory group.

Sexual orientation in transgender adults in the United States.

BACKGROUND: Sexual orientation refers to a person's enduring emotional, romantic, or sexual attractions to other people. Sexual orientation measures do not typically consider desires for, or sexual behavior with, transgender people. We describe measures inclusive of transgender people and characterize sexual orientation identity, behavior, and attraction in a representative sample of the U.S. transgender population. METHODS: Between April 2016-December 2018, a U.S. national probability sample of transgender (n = 274) and cisgender (n = 1,162) adults were invited to complete a self-administered web or mailed paper survey. We assessed sexual identity with updated response options inclusive of recent identity terms (e.g., queer), and revised sexual behavior and attraction measures that included transgender people. Multiple response options were allowed for sexual behavior and attraction. Weighted descriptive statistics and sexual orientation differences by gender identity groups were estimated using age-adjusted comparisons. RESULTS: Compared to the cisgender population, the transgender population was more likely to identify as a sexual minority and have heterogeneity in sexual orientation, behavior, and attraction. In the transgender population, the most frequently endorsed sexual orientation identities were "bisexual" (18.9%), "queer" (18.1%), and "straight" (17.6%). Sexually active transgender respondents reported diverse partners in the prior 5 years: 52.6% cisgender women (CW), 42.7% cisgender men (CM), 16.9% transgender women (TW), and 19.5% transgender men (TM); 27.7% did not have sex in the past 5 years. Overall, 73.6% were "somewhat"/ "very" attracted to CW, 58.3% CM, 56.8% TW, 52.4% TM, 59.9% genderqueer/nonbinary-females-at-birth, 51.9% genderqueer/nonbinary-males-at-birth. Sexual orientation identity, behavior, and attraction significantly differed by gender identity for TW, TM, and nonbinary participants (all p < 0.05). CONCLUSIONS: Inclusive measures of sexual orientation captured diverse sexual identities, partner genders, and desires. Future research is needed to cognitively test and validate these measures, especially with cisgender respondents, and to assess the relation of sexual orientation and health for transgender people.

Validation of ICD-10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system.

PURPOSE: This study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) hospital discharge diagnosis codes. METHODS: Using electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD-10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.3, and G46.4) between October 2015 and September 2020, we identified 75 patients with both incident and recurrent stroke events (total 150 cases). Two neurologists independently evaluated validity of ICD-10 codes through chart reviews. RESULTS: The positive predictive value (PPV, 95% CI) for incident stroke was 93% (95% CI: 88%, 99%) and the PPV for recurrent stroke was 72% (95% CI: 62%, 82%). The PPV for recurrent stroke improved after applying a gap of 20 days (PPV of 75%; 95% CI: 63%, 87%) or removing hospital admissions related to stroke-related procedures (PPV of 78%; 95% CI: 68%, 88%). CONCLUSION: The ICD-10 hospital discharge diagnosis codes for ischemic stroke showed a high PPV for incident cases, while the PPV for recurrent cases were less optimal. Algorithms to improve the accuracy of ICD-10 codes for recurrent ischemic stroke may be necessary.

Effectiveness of mRNA-1273 vaccination against SARS-CoV-2 omicron subvariants BA.1, BA.2, BA.2.12.1, BA.4, and BA.5.

Studies have reported reduced natural SARS-CoV-2 infection- and vaccine-induced neutralization against omicron BA.4/BA.5 compared with earlier omicron subvariants. This test-negative case-control study evaluates mRNA-1273 vaccine effectiveness (VE) against infection and hospitalization with omicron subvariants. The study includes 30,809 SARS-CoV-2 positive and 92,427 SARS-CoV-2 negative individuals aged ≥18 years tested during 1/1/2022-6/30/2022. While 3-dose VE against BA.1 infection is high and wanes slowly, VE against BA.2, BA.2.12.1, BA.4, and BA.5 infection is initially moderate to high (61.0%-90.6% 14-30 days post third dose) and wanes rapidly. The 4-dose VE against infection with BA.2, BA.2.12.1, and BA.4 ranges between 64.3%-75.7%, and is low (30.8%) against BA.5 14-30 days post fourth dose, disappearing beyond 90 days for all subvariants. The 3-dose VE against hospitalization for BA.1, BA.2, and BA.4/BA.5 is 97.5%, 82.0%, and 72.4%, respectively; 4-dose VE against hospitalization for BA.4/BA.5 is 88.5%. Evaluation of the updated bivalent booster is warranted.

Effectiveness of mRNA-1273 against SARS-CoV-2 Omicron and Delta variants.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron (B.1.1.529) variant is highly transmissible with potential immune escape. We conducted a test-negative case-control study to evaluate mRNA-1273 vaccine effectiveness (VE) against infection and hospitalization with Omicron or Delta. The large, diverse study population included 26,683 SARS-CoV-2 test-positive cases with variants determined by S gene target failure status (16% Delta and 84% Omicron). The two-dose VE against Omicron infection at 14-90 days was 44.0% (95% confidence interval, 35.1-51.6%) but declined quickly. The three-dose VE was 93.7% (92.2-94.9%) and 86.0% (78.1-91.1%) against Delta infection and 71.6% (69.7-73.4%) and 47.4% (40.5-53.5%) against Omicron infection at 14-60 days and >60 days, respectively. The three-dose VE was 29.4% (0.3-50.0%) against Omicron infection in immunocompromised individuals. The three-dose VE against hospitalization with Delta or Omicron was >99% across the entire study population. Our findings demonstrate high, durable three-dose VE against Delta infection but lower effectiveness against Omicron infection, particularly among immunocompromised people. However, three-dose VE of mRNA-1273 was high against hospitalization with Delta and Omicron variants.

Healthcare Stereotype Threat and Health Outcomes Among LGB Individuals.

BACKGROUND/PURPOSE: Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals. METHODS: LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days. RESULTS: Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort. CONCLUSIONS: Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.

Distribution of SARS-CoV-2 Variants in a Large Integrated Health Care System - California, March-July 2021.

Data from observational studies demonstrate that variants of SARS-CoV-2, the virus that causes COVID-19, have evolved rapidly across many countries (1,2). The SARS-CoV-2 B.1.617.2 (Delta) variant of concern is more transmissible than previously identified variants,* and as of September 2021, is the predominant variant in the United States.† Studies characterizing the distribution and severity of illness caused by SARS-CoV-2 variants, particularly the Delta variant, are limited in the United States (3), and are subject to limitations related to study setting, specimen collection, study population, or study period (4-7). This study used whole genome sequencing (WGS) data on SARS-CoV-2-positive specimens collected across Kaiser Permanente Southern California (KPSC), a large integrated health care system, to describe the distribution and risk of hospitalization associated with SARS-CoV-2 variants during March 4-July 21, 2021, by patient vaccination status. Among 13,039 SARS-CoV-2-positive specimens identified from KPSC patients during this period, 6,798 (52%) were sequenced and included in this report. Of these, 5,994 (88%) were collected from unvaccinated persons, 648 (10%) from fully vaccinated persons, and 156 (2%) from partially vaccinated persons. Among all sequenced specimens, the weekly percentage of B.1.1.7 (Alpha) variant infections increased from 20% to 67% during March 4-May 19, 2021. During April 15-July 21, 2021, the weekly percentage of Delta variant infections increased from 0% to 95%. During March 4-July 21, 2021, the weekly percentage of variants was similar among fully vaccinated and unvaccinated persons, but the Delta variant was more commonly identified among vaccinated persons then unvaccinated persons overall, relative to other variants. The Delta variant was more prevalent among younger persons, with the highest percentage (55%) identified among persons aged 18-44 years. Infections attributed to the Delta variant were also more commonly identified among non-Hispanic Black persons, relative to other variants. These findings reinforce the importance of continued monitoring of SARS-CoV-2 variants and implementing multiple COVID-19 prevention strategies, particularly during the current period in which Delta is the predominant variant circulating in the United States.

Mental Health Among Black and Latinx Sexual Minority Adults Leading Up to and Following the 2016 U.S. Presidential Election: Results from a Natural Experiment.

Purpose: Multi-level hostility toward sexual minority (SM; includes, but is not limited to those identifying as gay, lesbian, bisexual, queer, or same-gender loving) and other minority populations (e.g., racial/ethnic) increased after the 2016 U.S. presidential election. This may generate stress and mental health problems among those groups, and particularly among SM people of color. This study assessed whether the mental health of Black and Latinx SM adults declined after the 2016 U.S. presidential election. Methods: Data were from a daily national probability survey (thus, mean changes in mental health outcomes over time may reflect population shifts in mental health) of Black and Latinx SM adults (N = 537), recruited 7 months before and 17 months after the November 8, 2016 election. Using a between-subjects design, spline-based regressions (spline set at election date), adjusted for sociodemographic characteristics, estimated four mental health outcomes (past-month number of "poor mental health" days and psychological distress, past-year suicidal ideation, and social wellbeing) as a function of survey completion date. Results: There was marked worsening in each of the mental health outcomes over the postelection period (past-month poor mental health days, B = 0.05, standard error [SE] = 0.02, p < 0.05; psychological distress, B = 0.28, SE = 0.14, p < 0.05; suicidal ideation, odds ratio = 1.13, 95% confidence interval >1.00-1.26, p < 0.05; and social wellbeing, B = -0.05, SE = 0.02, p < 0.05). None of the outcomes varied over the pre-election period. Conclusions: This study provides evidence of worsening mental health among Black and Latinx SM adults in the United States during the 1.5 years after the 2016 U.S. presidential election.

Suicidal Behavior and Coming Out Milestones in Three Cohorts of Sexual Minority Adults.

Purpose: We describe the timing of suicidality across the life span in three cohorts of sexual minority adults. We hypothesized that suicide attempts coincide with the coming out period and that younger sexual minority people, who grew up in more accepting social environments, will have lower prevalence of suicide attempts than older generations. Methods: A U.S. national probability sample of 1518 sexual minority adults in three age cohorts of 18-25, 34-41, and 52-59 years (collected 2016-2018) completed a self-administered survey. Results: Sexual minority adults had high prevalence of lifetime suicidal thoughts, plans, and attempts, with the highest attempted suicides in the younger cohort (30.8%, 95% confidence interval [CI] = 26.8-35.1) compared with the middle (23.7%, 95% CI = 19.0-29.1) and older (20.3%, 95% CI = 16.3-25.1) cohorts. There were no differences in suicidal behavior by race and ethnicity or between men and women, but gender nonbinary people had higher prevalence of suicidal thoughts. The mean age at suicidal thoughts, plans, and attempts tracked closely with age of first realization of sexual minority identity. Most suicide attempts (60.9%) occurred within 5 years of realizing one's sexual minority identity, but a significant proportion of attempts (39.1%) occurred outside this range. Conclusion: Our findings are contrary to the hypothesis that younger cohorts of sexual minority people are at lower risk of suicidality.

Health Disparities of Older Adults in California: The Role of Sexual Identity and Latinx Ethnicity.

BACKGROUND AND OBJECTIVES: We examined the health disparities of older adults (age 50 and older) in California at the intersection of sexual identity and Latinx ethnicity, by comparing the prevalence of health outcomes of 4 groups: LGB (lesbian, gay, and bisexual) Latinx, straight Latinx, LGB non-Latinx, and straight non-Latinx older adults. RESEARCH DESIGN AND METHODS: Data were from the 2015-2016 California Health Interview Survey. Multivariable logistic regressions tested differences among the 4 groups and the effect of covariates on prevalence of mental and physical health outcomes. We compared LGB and straight people within the same ethnic groups and Latinx and non-Latinx people within the same sexual identity groups to understand the intersectional effect of Latinx ethnicity and LGB identity. RESULTS: Tests by sexual identity showed that among Latinx older adults, more LGB than non-LGB people experienced serious psychological distress. Among non-Latinx older adults, there were no health disparities due to sexual identity. Tests by Latinx ethnicity showed that among LGB older adults, more Latinx than non-Latinx people were obese. Among straight people, more Latinx than non-Latinx older people had poor health, diabetes, and obesity. DISCUSSION AND IMPLICATIONS: The compounded effect of Latinx and LGB identity on psychological distress is notable. However, most health disparities were among straight older adults, between Latinx and non-Latinx people, indicating that Latinx, not sexual identity, nor their intersection, was most influential. Given the importance of sociodemographic factors on health outcomes, programs targeting LGB older adults should take a comprehensive approach to understand their experiences as ethnic minorities.

A randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception.

OBJECTIVES: mHealth, or the use of mobile phones for health, is a promising but largely untested method for increasing family planning knowledge in developing countries. This study estimates the effect of m4RH, an mHealth service in Kenya that provides family planning information via text message, on consumers' knowledge and use of contraception. STUDY DESIGN: We randomly assigned new consumers of the m4RH service to receive either full access or limited access to m4RH. We collected data on outcomes by sending questions directly to consumers via text message. RESULTS: Response rates to the text message surveys ranged from 51.8% to 13.5%. Despite relatively low response rates, response rates were very similar across the full-access and limited-access groups. We find that full access to m4RH increased consumers' scores on a test of contraceptive knowledge by 14% (95% confidence interval: 9.9%-18.2%) compared to a control group with limited access to m4RH. m4RH did not increase consumers' use of contraception, likelihood of discussing family planning with their partners, or likelihood of visiting a clinic to discuss family planning. CONCLUSION: Text messages may increase family planning knowledge but do not, by themselves, lead to behavior change. IMPLICATIONS: Text messages can be an effective method of increasing family planning knowledge but may be insufficient on their own to cause behavior change.

Effectiveness of evidence-based medicine on knowledge, attitudes, and practices of family planning providers: a randomized experiment in Jordan.

BACKGROUND: Provider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan. Evidence-Based Medicine (EBM) programs aim to reduce biases and misconceptions by providing doctors with the most up-to-date scientific evidence on contraceptive methods. METHODS: We evaluate the effects of an EBM program conducted in Jordan on private providers' knowledge, attitudes, and practices. Family planning providers randomly assigned to a treatment group were invited to attend a roundtable seminar on the injectable contraceptive Depot Medroxy Progesterone Acetate (DMPA), and to receive two 15 min one-on-one educational visits that reinforce the messages from the seminar. RESULTS: There was low compliance with the EBM program. The study fails to detect an impact on providers' knowledge of DMPA's side effects or on reported clinical practices. There is suggestive evidence of a positive impact on providers' attitudes toward and confidence in prescribing the contraceptive to their patients. There is also evidence of positive selection into program participation. CONCLUSIONS: We conclude that EBM may not be effective as a stand-alone program targeting a family planning method with a high level of provider and consumer bias. Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions. TRIAL REGISTRATION: AEA RCT Registry, AEARCTR0000539 , 11/3/2014.