SARS-CoV-2 Incidence in K-12 School Districts with Mask-Required Versus Mask-Optional Policies - Arkansas, August-October 2021.

Masks are effective at limiting transmission of SARS-CoV-2, the virus that causes COVID-19 (1), but the impact of policies requiring masks in school settings has not been widely evaluated (2-4). During fall 2021, some school districts in Arkansas implemented policies requiring masks for students in kindergarten through grade 12 (K-12). To identify any association between mask policies and COVID-19 incidence, weekly school-associated COVID-19 incidence in school districts with full or partial mask requirements was compared with incidence in districts without mask requirements during August 23-October 16, 2021. Three analyses were performed: 1) incidence rate ratios (IRRs) were calculated comparing districts with full mask requirements (universal mask requirement for all students and staff members) or partial mask requirements (e.g., masks required in certain settings, among certain populations, or if specific criteria could not be met) with school districts with no mask requirement; 2) ratios of observed-to-expected numbers of cases, by district were calculated; and 3) incidence in districts that switched from no mask requirement to any mask requirement were compared before and after implementation of the mask policy. Mean weekly district-level attack rates were 92-359 per 100,000 persons in the community* and 137-745 per 100,000 among students and staff members; mean student and staff member vaccination coverage ranged from 13.5% to 18.6%. Multivariable adjusted IRRs, which included adjustment for vaccination coverage, indicated that districts with full mask requirements had 23% lower COVID-19 incidence among students and staff members compared with school districts with no mask requirements. Observed-to-expected ratios for full and partial mask policies were lower than ratios for districts with no mask policy but were slightly higher for districts with partial policies than for those with full mask policies. Among districts that switched from no mask requirement to any mask requirement (full or partial), incidence among students and staff members decreased by 479.7 per 100,000 (p<0.01) upon implementation of the mask policy. In areas with high COVID-19 community levels, masks are an important part of a multicomponent prevention strategy in K-12 settings (5).

Adjustment to the COVID-19 pandemic: associations with global and situational meaning.

COVID-19 has created pervasive upheaval and uncertainty in communities around the world. This investigation evaluated associations between discrete dimensions of personal meaning and psychological adjustment to the pandemic among community residents in a southern US state. In this cross-sectional study, 544 respondents were assessed during a period of reopening but accelerating infection rates. Validated measures were used to evaluate theoretically distinct dimensions of perceived global meaning (Meaning-in-Life Questionnaire) and pandemic-specific meaning (Meaning in Illness Scale). Adjustment outcomes included perceived stress, pandemic-related helplessness, and acceptance of the pandemic. In multivariate models that controlled for demographic and pandemic-related factors, stronger attained global meaning (i.e., perceptions that life is generally meaningful) and attained situational meaning (i.e., perceptions that the pandemic experience was comprehensible) were related to better adjustment on all three outcomes (all p's < .001). In contrast, seeking situational meaning (i.e., ongoing efforts to find coherence in the situation) was associated with poorer adjustment on all indices (all p's < .001). Results offer novel information regarding theoretically salient dimensions of meaning, which may have direct relevance for understanding how community residents adapt to the challenges of a major public health crisis.

Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations: Toward Organization-based HIV Interventions for Young Men Who Have Sex With Men.

BACKGROUND: Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES: The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations. RESEARCH DESIGN: The study data collection method was a survey of health and social organizations from 2013-2014 in 2 cities, Chicago, IL and Houston, TX. SUBJECTS: Study participants were representatives from 138 health and social organizations. MEASURES: Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks. RESULTS: While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources. CONCLUSIONS: Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.

Project SMART: Preliminary Results From a Test of the Efficacy of a Swedish Internet-Based HIV Risk-Reduction Intervention for Men Who Have Sex With Men.

In Sweden, 57 % of HIV transmission occurs among MSM, and other sexually transmitted infections are increasing, supporting the need for innovative interventions. The Internet is a potentially useful HIV-prevention platform, but there is a lack of such programs in Sweden. The purpose of this exploratory study was to test the efficacy of the Internet-based SMART intervention to decrease HIV sexual risks in Swedish MSM. The intervention was adapted from the Wyoming Rural AIDS Prevention Project to the Swedish context, which was guided by the Information-Motivation-Behavioral (IMB) skills model and consisted of six sessions. A total of 112 men responded to a pretest questionnaire and were randomly assigned to the SMART intervention or to a waitlist group. Fifty-four men dropped out, leaving a final sample of 58 participants. Twenty-five were assigned to the SMART intervention and 33 to a waitlist group. One month post intervention, the number of casual anal sex partners significantly decreased (t = 2.19, p = .04). Compared with the waitlist group, men in the intervention group increased their HIV knowledge (ß = 0.70, p = .01), their belief of condom use as an act of responsibility (ß = 1.19, p = .04), their willingness to use a condom with every new partner all the time (ß = 1.39, p = .03), and their confidence in using condoms in challenging situations (ß = 1.65, p = .02). Condom use was not analyzed due to the small sample size. Despite the small sample, high drop-out, and short follow-up, the study provides support for the efficacy of the Internet interventions, the SMART intervention specifically, for reducing the proportion of casual anal sex partners and improving the three cognitive components of the IMB model for Swedish MSM.

Multiplex crack smoking and sexual networks: associations between network members' incarceration and HIV risks among high-risk MSM.

This study examined HIV risks in the multiplex crack-smoking and sexual networks of incarcerated drug-using men who have sex with men (MSM) and their associates. We estimated the associations between the network members' incarceration, self-reported HIV infection, and trading sex for money. Our analytic sample consisted of 508 crack-smoking or sexual partnerships of 273 high-risk MSM. Network members were specified by (1) crack smoking and sexual behavior or (2) crack smoking only. Longer incarceration of the crack-smoking and sexual network members was associated with self-reported HIV infection (AOR = 1.61, p < 0.05), which extended up to one's partners' partners' partners (AOR = 1.63, p < 0.05). Similar results were found for trading sex (AOR = 2.77, p < 0.05). The findings of the study call for the development of a system-level HIV intervention among former incarcerated MSM and their associates.

A network analysis of relationship dynamics in sexual dyads as correlates of HIV risk misperceptions among high-risk MSM.

OBJECTIVES: Relationship dynamics influence the perception of HIV risk in sexual dyads. The objective of this study was to examine the effect of relational dynamics on knowledge or perception of a partner's HIV status in a sample of most at-risk men who have sex with men (MSM): drug-using male sex workers. The study identified relationship dimensions and examined their association with misperceptions about a particular partner's HIV status. METHODS: The analytical sample for the study consisted of 168 sexual partnerships of 116 male sex workers and their associates. Exploratory factor analysis was conducted to identify dimensions of the interpersonal relationships in sexual partnerships that were then regressed on 'risky misperceptions' (misperceiving HIV negative when partner's self-report was positive or unknown). RESULTS: Six relationship dimensions of intimate, commitment, socialising, financial, trust and honesty were extracted. Commitment was found to be protective against misperception (adjusted OR (AOR)=0.45), while trust was not (AOR=2.78). Other factors also were found to be associated with misperception. HIV-negative MSM (AOR=7.69) and partners who were both self-identified as gay (AOR=3.57) were associated with misperception, while encounters identified as sex work (AOR=0.29), in which both partners were Caucasian (AOR=0.16), and involved with an older partner (AOR=0.90) were protective. CONCLUSIONS: Couple-based HIV intervention efforts among MSM should consider that less trust and more commitment are protective factors in sexual partnerships.

Venue-Mediated Weak Ties in Multiplex HIV Transmission Risk Networks Among Drug-Using Male Sex Workers and Associates.

OBJECTIVES: We investigated the structural characteristics of a multiplex HIV transmission risk network of drug-using male sex workers and their associates. METHODS: Using a sample of 387 drug-using male sex workers and their male and female associates in Houston, Texas, we estimated an exponential random graph model to examine the venue-mediated relationships between individuals, the structural characteristics of relationships not linked to social venues, and homophily. We collected data in 2003 to 2004. The network comprised social, sexual, and drug-using relationships and affiliations with social venues. RESULTS: Individuals affiliated with the same social venues, bars, or street intersections were more likely to have nonreciprocated (weak) ties with others. Sex workers were less likely than were other associates to have reciprocated (strong) ties to other sex workers with the same venues. Individuals tended to have reciprocated ties not linked to venues. Partner choice tended to be predicated on homophily. CONCLUSIONS: Social venues may provide a milieu for forming weak ties in HIV transmission risk networks centered on male sex workers, which may foster the efficient diffusion of prevention messages as diverse information is obtained and information redundancy is avoided.

Racial/Ethnic Differences in Sexual Network Mixing: A Log-Linear Analysis of HIV Status by Partnership and Sexual Behavior Among Most at-Risk MSM.

Mixing patterns within sexual networks have been shown to have an effect on HIV transmission, both within and across groups. This study examined sexual mixing patterns involving HIV-unknown status and risky sexual behavior conditioned on assortative/dissortative mixing by race/ethnicity. The sample used for this study consisted of drug-using male sex workers and their male sex partners. A log-linear analysis of 257 most at-risk MSM and 3,072 sex partners was conducted. The analysis found two significant patterns. HIV-positive most at-risk Black MSM had a strong tendency to have HIV-unknown Black partners (relative risk, RR = 2.91, p < 0.001) and to engage in risky sexual behavior (RR = 2.22, p < 0.001). White most at-risk MSM with unknown HIV status also had a tendency to engage in risky sexual behavior with Whites (RR = 1.72, p < 0.001). The results suggest that interventions that target the most at-risk MSM and their sex partners should account for specific sexual network mixing patterns by HIV status.

Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved.

Leadership Qualities Emerging in an Online Social Support Group Intervention.

Technology-delivered interventions addressing a broad range of problems for which clients present for therapy are proliferating. However, little is known of leadership dynamics that emerge in online group interventions. The purpose of this study was to assess the types of leadership qualities that would emerge in an online social support group intervention to improve medication adherence for men with HIV, and to characterize the demographic and psychosocial profiles of leaders. Written posts (n=616) from 66 men were coded using an adapted version of the Full Range Model of Leadership. Results showed that 10% (n=64) of posts reflected one of five leadership types, the most common of which was mentoring/providing feedback (40% of leadership posts). The next most common leadership style were instances in which encouragement was offered (30% of leadership posts). Leaders appeared to have lived with HIV longer and have higher Internet knowledge scores than non-leaders. Results indicate that online group interventions potentially may be useful to supplement traditional face-to-face treatment by providing an additional venue for group members to mentor and provide emotional support to each other. However, additional research is needed to more fully understand leadership qualities and group dynamics in other online group intervention settings.

Venue-based affiliation networks and HIV risk-taking behavior among male sex workers.

BACKGROUND: This study examined venue-based networks constituted by affiliation with gay bars and street intersections where male sex workers (MSWs) congregate to find their sexual/drug-sharing partners and network influence on risky sexual behavior (e.g., unprotected anal intercourse [UAI]) and HIV infection. METHODS: Data collected in 2003 to 2004 in Houston, Texas, consists of 208 MSWs affiliated with 15 gay bars and 51 street intersections. Two-mode network analysis was conducted to examine structural characteristics in affiliation networks, as well as venue-based network influence on UAI and HIV infection. RESULTS: Centralized affiliation patterns were found where only a few venues were popular among MSWs, and these were highly interdependent. Distinctive structural patterns of venue-based clustering were associated with UAI and infection. Individuals who shared venue affiliation with MSWs who engage in UAI were less likely to have UAI themselves. This suggests a downhill effect; that is, individuals compensate for their risk of infection by adjusting their own risk-taking behavior, based on their perceptions of their venue affiliates. CONCLUSIONS: Venue-based HIV/AIDs interventions could be tailored to specific venues so as to target specific clusters that are more likely to engage in risky sexual behavior.

Feasibility, acceptability and preliminary efficacy of an online peer-to-peer social support ART adherence intervention.

This study describes the results of an online social support intervention, called "Thrive with Me" (TWM), to improve antiretroviral therapy (ART) adherence. HIV-positive gay or bisexually-identified men self-reporting imperfect ART adherence in the past month were randomized to receive usual care (n = 57) or the eight-week TWM intervention (n = 67). Self-reported ART outcome measures (0-100 % in the past month) were collected at baseline, post-intervention, and 1-month follow-up. Follow-up assessment completion rate was 90%. Participants rated (1-7 scale) the intervention high in information and system quality and overall satisfaction (Means ≥ 5.0). The intervention showed modest effects for the overall sample. However, among current drug-using participants, the TWM (vs. Control) group reported significantly higher overall ART adherence (90.1 vs. 57.5% at follow-up; difference = 31.1, p = 0.02) and ART taken correctly with food (81.6 vs. 55.7% at follow-up; difference = 47.9, p = 0.01). The TWM intervention appeared feasible to implement, acceptable to users, and demonstrated greatest benefits for current drug users.

A longitudinal study of SARS-CoV-2 antibody seroprevalence and mitigation behaviors among college students at an Arkansas University.

Objective: Assess university students' SARS-CoV-2 antibody seroprevalence and mitigation behaviors over time. Participants: Randomly selected college students (N = 344) in a predominantly rural Southern state. Methods: Participants provided blood samples and completed self-administered questionnaires at three timepoints over the academic year. Adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. Results: SARS-CoV-2 antibody seroprevalence was 18.2% in September 2020, 13.1% in December, and 45.5% in March 2021 (21% for those with no vaccination history). SARS-CoV-2 antibody seroprevalence was associated with large social gatherings, staying local during the summer break, symptoms of fatigue or rhinitis, Greek affiliation, attending Greek events, employment, and using social media as the primary COVID-19 information source. In March 2021, seroprevalence was associated with receiving at least one dose of a COVID-19 vaccination. Conclusion: SARS-CoV-2 seroprevalence was higher in this population of college students than previous studies. Results can assist leaders in making informed decisions as new variants threaten college campuses.

Technology use and reasons to participate in social networking health websites among people living with HIV in the US.

Online social media and mobile technologies hold potential to enhance adherence to antiretroviral therapy (ART), although little is known about the current use of these technologies among people living with HIV (PLWH). To address this gap in understanding, 312 PLWH (84% male, 69% White) US adults completed an online survey in 2009, from which 22 persons accepted an invitation to participate in one of two online focus groups. Results showed that 76% of participants with lower ART adherence used social networking websites/features at least once a week. Their ideal online social networking health websites included one that facilitated socializing with others (45% of participants) and ones with relevant HIV informational content (22%), although privacy was a barrier to use (26%). Texting (81%), and to a lesser extent mobile web-access (51%), was widely used among participants. Results support the potential reach of online social networking and text messaging intervention approaches.

Dimensions of gender relations and reproductive health inequity perceived by female undergraduate students in the Mekong Delta of Vietnam: a qualitative exploration.

INTRODUCTION: Increasing evidence indicates that gender equity has a significant influence on women's health; yet few culturally specific indicators of gender relations exist which are applicable to health. This study explores dimensions of gender relations perceived by female undergraduate students in southern Vietnamese culture, and qualitatively examines how this perceived gender inequity may influence females' sexual or reproductive health. METHODS: Sixty-two female undergraduate students from two universities participated in eight focus group discussions to talk about their perspectives regarding national and local gender equity issues. RESULTS: Although overall gender gaps in the Mekong Delta were perceived to have decreased in comparison to previous times, several specific dimensions of gender relations were emergent in students' discussions. Perceived dimensions of gender relations were comparable to theoretical structures of the Theory of Gender and Power, and to findings from several reports describing the actual inferiority of women. Allocation of housework and social paid work represented salient dimensions of labor. The most salient dimension of power related to women in positions of authority. Salient dimensions of cathexis related to son preference, women's vulnerability to blame or criticism, and double standards or expectations. Findings also suggested that gender inequity potentially influenced women's sexual and reproductive health as regards to health information seeking, gynecological care access, contraceptive use responsibility, and child bearing. CONCLUSION: Further investigations of the associations between gender relations and different women's sexual and reproductive health outcomes in this region are needed. It may be important to address gender relations as a distal determinant in health interventions in order to promote gender-based equity in sexual and reproductive health.

Hopelessness and HIV infection: an exploratory study with a gender-specific perspective.

BACKGROUND: An understudied psychological response to HIV-related stressors among people living with HIV is hopelessness. Hopelessness is the expectation that things will not improve and feeling helpless to change one's current situation. The aim of this study was to assess prevalence and levels of hopelessness and its direct and indirect contributors in people living with HIV in Sweden. METHODS: Participants included 967 women and men from the "Living with HIV in Sweden" cross-sectional study with available data regarding hopelessness measured by the Beck Hopelessness Scale. Binary and multiple logistic regression analyses were used to determine direct and indirect factors that may contribute to feelings of hopelessness. Path analyses were used to assess the underlying structure of hopelessness. All analyses were conducted by gender. RESULTS: Almost half the participants reported moderate to severe hopelessness. There were no differences in frequency of feeling hopeless or level of hopelessness by gender or sexual orientation. Dissatisfaction with finances, dissatisfaction with physical health, and low HIV-related emotional support were found to be directly associated with hopelessness for both women and men. Although having some indirect factors in common, unemployment and HIV stigmatization, women and men had different underlying structures of hopelessness. CONCLUSIONS: Our findings are important to HIV clinicians in identifying those at risk of hopelessness from a gender perspective in order to reduce preventable psychological distress among people living with HIV.

National vaccine coverage trends and funding in Latin America and the Caribbean.

BACKGROUND: From 2006 to 2011 nearly 174,000 deaths were prevented in Latin America and the Caribbean through vaccination of children under five, which is widely attributed to the Expanded Program on Immunization (EPI). Despite near global adoption of EPI recommendations, vaccination coverage shows substantial variation across world regions. Causes for low immunizations within regions are multifaceted and include vaccination program costs. To date, publications regarding vaccine coverage across Latin America and the Caribbean are not readily available. This study aimed to: (1) compare vaccine coverage trends across nations within the region; and (2) assess whether national immunization program expenditures are correlated with vaccine coverage. METHODS: Coverage for nine vaccines were collected by nation using publicly available data from WHO. National immunization program expenditures for each country were collected from the World Bank Index. The proportion of countries achieving 90% coverage in the years 2013 and 2017 for each vaccine were compared. Pearson correlation coefficients were calculated to measure the relationship between financing variables and DTP3 coverage for 2017. RESULTS: In 2017, fewer Latin American and Caribbean nations were able to achieve 90% vaccine coverage for five vaccines compared to 2013. Mostly weak to moderate positive relationships were found between national immunization program expenditures and DTP3 coverage for 2017. Excluding Haiti, a weak negative relationship was found between total government expenditure on vaccines per infant and DTP3 coverage for 2017. Countries across Latin America and the Caribbean were largely self-reliant in funding vaccine expenditures. CONCLUSIONS: Fewer countries across Latin America and the Caribbean are currently achieving optimum national vaccine coverage and weak to moderate relationships between routine immunization and vaccine expenditures and coverage were observed. Additional factors contributing to national vaccine coverage should be concomitantly examined to implement strategies which optimize delivery of childhood immunizations.

A Social Network Analysis of Cooperation and Support in an HIV Service Delivery Network for Young Latino MSM in Miami.

Purpose: The study aimed to identify HIV prevention, testing, and care services prioritizing young Latino men who have sex with men (MSM) in an HIV service delivery network in Miami-Dade County, Florida, by visually describing structural features and processes of collaboration within and between health and social venues.Methods: The study used cross-sectional data from 40 social and healthcare venues providing goods and services to young Latino MSM. Each venue provided information surrounding HIV-related services provided and collaborations with other venues. Network visualization analyses were performed using UCINET6 and NetDraw2.160.Results: The most commonly used services offered by health and social venues were free condoms and HIV education materials. Collaborations both within and between health and social venues components of the network existed. Not all health and social venues provided services to young Latino MSM.Conclusion: Health venues can reach and incorporate hard to reach populations, such as non-English speaking and undocumented young Latino MSM, to provide HIV-related services using service delivery venue social networks.

Anxiety, depressive, and trauma symptoms during the COVID-19 pandemic: Evaluating the role of disappointment with God.

BACKGROUND: The COVID-19 pandemic has led to pervasive social and economic disruptions. This cross-sectional investigation aimed to evaluate associations between religious/spiritual factors and mental health symptoms among community residents in a southern US state. In particular, we focused on perceptions of God's distance, a salient aspect of religious/spiritual struggle that has received little scrutiny in health research. METHODS: Participants included 551 respondents assessed during a period of gradual reopening but rising infection rates. Mental health outcomes were assessed using standardized measures of generalized anxiety, depression, and trauma symptoms. Perceptions of an affirming relationship with God, anger at God, and disappointment at God's distance were evaluated using an adapted version of the Attitudes-Toward-God Scale-9. RESULTS: In multivariate analyses that accounted for pandemic-related and demographic factors, positive relationships with God were related to diminished symptoms on all three mental heatlh indices (all p's ≤.003), whereas disappointment with God's distance was associated with more pronounced difficulties (all p's ≤.014). LIMTATIONS: The cross-sectional design precludes causal conclusions. CONCLUSIONS: Findings suggest that perceived relationships with God are tied to clinically relevant mental health outcomes during periods of major upheaval. Disappointment with God's distance may be an important, understudied dimension of religious/spiritual struggle meriting further investigation.

Multiple sexual partnerships in a sample of African-American crack smokers.

The sample for this study consisted of 692 sexually active African-American crack cocaine users living in Houston, TX who reported more than one sexual partner in the previous 30 days. Participants were asked to describe each of their two most recent partners from a list of eight choices: spouse/like a spouse/lover; close friend/friend/acquaintance/customer you like/customer. Analyses were conducted on the 1,384 partners and 692 partnership combinations reported. Partnerships and partnership patterns were examined with respect to three risk behaviors-unprotected sex, alcohol use to accompany sex, and drug use to accompany sex-and with respect to three affective measures-partner intimacy, condom use responsibility, and condom use self-efficacy. Results indicate that while many partnerships were based on trading sex for money or drugs, many participants reported partners they considered a spouse or friend. Risk behaviors and affective measures were found to differ by partner type.