Factors and Perceptions Associated with Post-Pandemic Food Sourcing and Dietary Patterns among Urban Corner Store Customers in Baltimore, Maryland.

OBJECTIVE: Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality. DESIGN: Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti. SETTING: This study was set in Baltimore, Maryland, USA. PARTICIPANTS: The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store. RESULTS: The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting. CONCLUSIONS: This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments.

Sources of Stress and Coping Strategies Among Urban African American Adolescents: A Qualitative Study of Child and Caregiver Perspectives.

Early adolescence is a critical point for intervention to protect against negative consequences of stress on the developing brain. This study aimed to gather perspectives on stress from adolescents and their caregivers living in under-resourced Baltimore City neighborhoods. Nine African American adolescents and their caregivers (n = 18 total) participated in qualitative interviews exploring neighborhood environments, sources of stress, and coping behaviors. Neighborhood social cohesion was described as a strength of participants' communities, despite concerns about neighborhood safety. Caregivers were highly aware of their child's stressors and coping behaviors. School-related pressure was a prevalent source of stress emphasized by adolescents, along with social stress due to disrupted routines during the COVID-19 pandemic. Adolescents described frequent use of electronics to cope with stress, as well as self-care and relaxation techniques. Themes identified from these data can be used to inform future adolescent stress-reduction interventions and stress-prevention efforts in this priority population.

Dollar store policy opportunities in Baltimore City: community member and policy maker perspectives.

Introduction: There are currently over 50 dollar stores in Baltimore City, Maryland. Community perceptions of over-saturation and resulting neighborhood impacts have garnered recent attention. A Maryland State Senate Bill required further study of dollar stores in Baltimore City to inform future policy. Therefore, the over-arching goal of this study was to generate community-informed policy recommendations for the Baltimore City Council. Methods: Three methods of data collection were used: (1) in-depth interviews with community members, retail staff/owners, dollar store staff, and policy makers; (2) an online survey of Baltimore City residents; and (3) workshop with community members and one with policy makers. Triangulation across data sources, discussion amongst the research team, and member checking were used to generate the top four policy options: a conditional use ordinance, a community benefits agreements, a dispersal ordinance, and a staple foods ordinance. Results: There was strong support for policies that encourage dollar stores to better align with community priorities (e.g., improving store cleanliness and appearance, increasing availability of healthy foods), as opposed to closing or banning dollar stores entirely. There was also strong support for policies that would empower communities to participate in determining the role of dollar stores in their neighborhoods, for example through a conditional use ordinance or community benefits agreement. Key concerns included policy enforcement, given the additional funding required, and current limited capacity at the city government level. Strategies to address such challenges were generated including implementing business licenses at the city level, linking new ordinances to dollar store leases and permits, and encouraging dollar store participation in federal and local programs to more feasibly stock healthier food items (e.g., fresh produce). Dissatisfaction was expressed regarding a lack of policy options to address the existing dollar stores, not just new dollar stores entering the City. Discussion: This study is the first of its kind to assess community support for dollar store policies at the local level, and serves to inform policies that improve dollar stores. A report of these findings was provided to Baltimore City Council to inform new, community-supported dollar store policies.

Forging just ecologies: 25 years of urban long-term ecological research collaboration.

We ask how environmental justice and urban ecology have influenced one another over the past 25 years in the context of the US Long-Term Ecological Research (LTER) program and Baltimore Ecosystem Study (BES) project. BES began after environmental justice emerged through activism and scholarship in the 1980s but spans a period of increasing awareness among ecologists and environmental practitioners. The work in Baltimore provides a detailed example of how ecological research has been affected by a growing understanding of environmental justice. The shift shows how unjust environmental outcomes emerge and are reinforced over time by systemic discrimination and exclusion. We do not comprehensively review the literature on environmental justice in urban ecology but do present four brief cases from the Caribbean, Africa, and Asia, to illustrate the global relevance of the topic. The example cases demonstrate the necessity for continuous engagement with communities in addressing environmental problem solving.

Design of an innovative digital application to facilitate access to healthy foods in low-income urban settings.

Background: Under-resourced urban minority communities in the United States are characterized by food environments with low access to healthy foods, high food insecurity, and high rates of diet-related chronic disease. In Baltimore, Maryland, low access to healthy food largely results from a distribution gap between small food sources (retailers) and their suppliers. Digital interventions have the potential to address this gap, while keeping costs low. Methods: In this paper, we describe the technical (I) front-end design and (II) back-end development process of the Baltimore Urban food Distribution (BUD) application (app). We identify and detail four main phases of the process: (I) information architecture; (II) low and high-fidelity wireframes; (III) prototype; and (IV) back-end components, while considering formative research and a pre-pilot test of a preliminary version of the BUD app. Results: Our lessons learned provide valuable insight into developing a stable app with a user-friendly experience and interface, and accessible cloud computing services for advanced technical features. Conclusions: Next steps will involve a pilot trial of the app in Baltimore, and eventually, other urban and rural settings nationwide. Once iterative feedback is incorporated into the app, all code will be made publicly available via an open source repository to encourage adaptation for desired communities. Trial Registration: ClinicalTrials.gov NCT05010018.

Demographic and Geographic Characterization of Excess Mortality During the COVID-19 Pandemic in Baltimore City, Maryland, March 2020 to March 2021.

Estimates of excess mortality can provide insight into direct and indirect impacts of the coronavirus disease 2019 (COVID-19) pandemic beyond deaths specifically attributed to COVID-19. We analyzed death certificate data from Baltimore City, Maryland, from March 1, 2020, to March 31, 2021, and found that 1,725 individuals (95% confidence interval: 1,495, 1,954) died in excess of what was expected from all-cause mortality trends in 2016-2019; 1,050 (61%) excess deaths were attributed to COVID-19. Observed mortality was 23%-32% higher than expected among individuals aged 50 years and older. Non-White residents of Baltimore City also experienced 2 to 3 times higher rates of excess mortality than White residents (e.g., 37.4 vs. 10.7 excess deaths per 10,000 population among Black residents vs. White residents). There was little to no observed excess mortality among residents of hospice, long-term care, and nursing home facilities, despite accounting for nearly 30% (312/1,050) of recorded COVID-19 deaths. There was significant geographic variation in excess mortality within the city, largely following racial population distributions. These results demonstrate the substantial and unequal impact of the COVID-19 pandemic on Baltimore City residents and the importance of building robust, timely surveillance systems to track disparities and inform targeted strategies to remediate the impact of future epidemics.

Injection Behaviors and Use of Syringe Service Programs over Time among People Who Inject Drugs in Baltimore, Maryland.

Introduction: People who inject drugs (PWID) are at increased risk for infectious disease transmission, including hepatitis C and HIV. Understanding trends in injection risk behaviors and syringe service program (SSP) use over time can help improve infectious disease prevention and other harm reduction services. Methods: Using National HIV Behavioral Surveillance System data from Baltimore, Maryland, we examined changes in receptive sharing of (1) syringes, (2) injection equipment, (3) syringes to divide drugs; and (4) receipt of syringes from SSPs among PWID from 2009 to 2018 (n = 518 in 2009, n = 638 in 2012, n = 586 in 2015, and n = 575 in 2018) using unadjusted and adjusted logistic models calculated across time for the total sample. Results: The conditional probability of receptive sharing of syringes and receipt of syringes from SSPs remained relatively stable, while receptive sharing of injection equipment and receptive sharing of syringes to divide drugs dropped substantially after 2009. White race and daily injection frequency were positively associated with sharing syringes and injection equipment and negatively associated with SSP use over time. In 2015, there was a notable shift such that women were twice as likely as men to receive syringes from SSPs and less likely than men to report the use of shared syringes or equipment. Conclusion: Findings indicate overall steady or decreasing trends in injection risk and steady trends in SSP usage over time, with some notable improvements among women and indications of shifting drug market patterns. Injection-related risk behaviors remain high among White PWID and may require targeted outreach and interventions.

Community-driven research and capacity building to address environmental justice concerns with industrial air pollution in Curtis Bay, South Baltimore.

Introduction: Curtis Bay (CB) is an environmental justice (EJ) community in South Baltimore. With a high concentration of industrial polluters and compounding non-chemical stressors, CB has experienced socioeconomic, quality of life, and health burdens for over 100 years. Today, these polluters include the open-air CSX Coal Terminal, waste-to-energy incinerators, and heavy diesel traffic through residential areas. The Community of Curtis Bay Association, Free Your Voice, and South Baltimore Community Land Trust are local organizations enacting a vision for equitable, healthy, and community-led development without industrial encroachment. In response to community-identified EJ concerns and an explosion at the CSX Coal Terminal, CB community groups partnered with academic researchers to develop a community-driven hyperlocal air monitoring and capacity building approach. This paper describes this approach to characterizing hyperlocal air quality in CB, building bridges between community residents and regulatory agencies, and nurturing a cohesive and effective community-academic partnership toward EJ. Methods: Using hyperlocal air monitoring, we are collecting real-time air pollution (particulate matter, black carbon, and ground-level gas species) and meteorological data from 15 low-cost sensors in residential and industrial areas of CB. We also use trail cameras to record activities at the CSX Coal Terminal. We merge air pollution and industrial activity data to evaluate the following: overall air quality in CB, multi-air pollutant profiles of elevated events, spatiotemporal changes in air quality in the community, patterns of industrial activity, and potential correlations between air quality and observed industrial activity. Members of our partnership also lead a high school course educating students about the history and ongoing efforts of the EJ movement in their community. Students in this course learn how to employ qualitative and quantitative data collection and analysis methods to bring scientific support to community EJ concerns. Results and Discussion: Our hyperlocal air monitoring network and community-academic partnership are continuing to evolve and have already demonstrated the ability to respond to community-identified EJ issues with real-time data while developing future EJ leaders. Our reflections can assist other community and academic groups in developing strong and fruitful partnerships to address similar EJ issues.

Complimentary Addictions: Pharmaceutical Experimentalism and the Problem of Recovery in Baltimore.

In Baltimore, clients in methadone maintenance treatment (MMT) experiment with prescription medicine and in doing so face new risks of noncompliance as they tread this blurry line between medical and illegal. This can potentially lead to suspension from drug treatment programs, resulting in clients finding the next most suitable treatment center to enroll into. I argue that the close interaction between drug treatment centers and illegal markets results in new pharmaceutical dependencies, forms of self-care as well as suspicions toward, but also among clients, about their intentions to recover.

Vacant Building Removals Associated with Relative Reductions in Violent and Property Crimes in Baltimore, MD 2014-2019.

Vacant and abandoned buildings are common features in many post-industrial US cities, and are consistent predictors of violence. Demolition programs are regularly employed as an urban land use policy to stabilize housing markets and mitigate public health problems including violence. The objective of this research was to examine the effect of vacant building removals on violent and property crimes in Baltimore, MD from 2014 to 2019. We conducted a difference-in-differences analysis using spatio-temporal Bayesian mixed models on six crime types on block faces with and without building removals, before compared with after removal. There were significant reductions in total, violent crimes (with and without assaults), thefts, and burglaries on block faces with building removals relative to their controls. Total crimes decreased 1.4% per mi2 (CrI: 0.5 - 2.3%), which translates to a relative reduction ~ 2.6 total crimes per mi2 per year. The largest relative decreases in crime were found among assaults (4.9%; CrI: 3.4 - 6.3%) and violent crimes (3.0%; CrI: 1.9 - 4.1%). Building removals were associated with relative reductions in crime in Baltimore City. The relative reductions in crime, at building removals compared to at control vacant lots, were found among assaults and violent crimes, the crimes of greatest public health concern. Building removals provide co-benefits to their communities, and may be considered part of a crime reduction strategy compatible with other approaches. A systematic effort to understand the role of care for remaining vacant lots could further inform our findings, and efforts to further decrease violence and improve community health.

Geographic variation in HCV treatment penetration among people who inject drugs in Baltimore, MD.

We evaluated geographic heterogeneity in hepatitis C virus (HCV) treatment penetration among people who inject drug (PWID) across Baltimore, MD since the advent of direct-acting antivirals (DAAs) using space-time clusters of HCV viraemia. Using data from a community-based cohort of PWID, the AIDS Linked to the IntraVenous Experience (ALIVE) study, we identified space-time clusters with higher-than-expected rates of HCV viraemia between 2015 and 2019 using scan statistics. We used Poisson regression to identify covariates associated with HCV viraemia and used the regression-fitted values to detect adjusted space-time clusters of HCV viraemia in Baltimore city. Overall, in the cohort, HCV viraemia fell from 77% in 2015 to 64%, 49%, 39% and 36% from 2016 to 2019. In Baltimore city, the percentage of census tracts where prevalence of HCV viraemia was ≥85% dropped from 57% to 34%, 25%, 22% and 10% from 2015 to 2019. We identified two clusters of higher-than-expected HCV viraemia in the unadjusted analysis that lasted from 2015 to 2017 in East and West Baltimore and one adjusted cluster of HCV viraemia in West Baltimore from 2015 to 2016. Neither differences in age, sex, race, HIV status, nor neighbourhood deprivation were able to explain the significant space-time clusters. However, residing in a cluster with higher-than-expected viraemia was associated with age, sex, educational attainment and higher levels of neighbourhood deprivation. Nearly 4 years after DAAs became available, HCV treatment has penetrated all PWID communities across Baltimore city. While nearly all census tracts experienced improvements, change was more gradual in areas with higher levels of poverty.

Assessing behavioral economic biases among young adults who have increased likelihood of acquiring HIV: a mixed methods study in Baltimore, Maryland.

BACKGROUND: Behavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases-present bias, information salience, overoptimism, and loss aversion-relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants' perceptions of these biases. METHODS: 43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. RESULTS: 56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one's plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one's own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan. CONCLUSION: Mixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.

A Novel Approach to Locating Community Clinics to Promote Health Care Accessibility and Reduce Health Disparities in Baltimore, Maryland.

Baltimore, Maryland's entrenched racial residential segregation renders the city's world-class medical facilities and services inaccessible to many Black residents living in its most divested neighborhoods. Arguing the need for post-pandemic health care facilities to address health inequities as a practice of care-giving, this article describes a project funded by the National Institutes of Health (NIH) to define a novel, transdisciplinary methodology for identifying ideal vacant sites for conversion into community clinics in Baltimore's most vulnerable neighborhoods. Positioning architecture as a social determinant of health, this paper suggests ethical and methodological reorientations toward a compassionate approach to clinic design and placement.

Treatment Failure in Patient with Severe Mpox and Untreated HIV, Maryland, USA.

A 33-year-old man in Baltimore, Maryland, USA, with untreated HIV infection had a 74-day course of mpox with multiorgan system involvement and unique clinical findings. In this clinical experience combining 3 novel therapeutic regimens, this patient died from severe mpox in the context of untreated HIV and advanced immunodeficiency.

Lessons learned to improve COVID-19 response in communities with greatest socio-economic vulnerabilities.

BACKGROUND: Vulnerable communities are susceptible to and disproportionately affected by the impacts of the COVID-19 pandemic. Understanding the challenges faced, perceptions, lessons learned, and recommendations of the organizations that provide services in response to COVID-19 to vulnerable communities is critical to improving emergency response and preparedness in these communities. METHODS: This study employed GIS mapping to identify the needs and assets that exist in communities in Baltimore City, where vulnerabilities related to social determinants of health and the burden of the COVID-19 pandemic were greatest. We also conducted an online survey between September 1, 2021, and May 30, 2022, to assess the COVID-19-related services provided by local organizations, challenges faced, perceptions, lessons learned, and recommendations to inform policies, programs, and funding related to improving the COVID-19 response in underserved communities. The survey was disseminated through the online Kobo Toolbox platform to leaders and representatives of organizations in Baltimore City. RESULTS: Based on GIS mapping analysis, we identified three communities as the most vulnerable and 522 organizations involved in the COVID-19 response across Baltimore City. 247 surveys were disseminated, and 50 survey responses were received (20.24% response rate). Out of these organizations, nearly 80% provided services in response to COVID-19 to the identified vulnerable communities. Challenges experienced ranged from funding (29%), and outreach/recruitment (26%), to not having access to updated and accurate information from local officials (32%). CONCLUSIONS: This research highlights critical insights gained related to the experiences of vulnerable populations and suggests ways forward to address challenges faced during the emergency response by providing recommendations for policy and program changes. Furthermore, the findings will help better prepare vulnerable communities for public health emergencies and build more community resilience.

Revisiting the Baltimore-Bullock's Oriole hybrid zone reveals changing plumage colour in Bullock's Orioles.

Hybrid zones are dynamic areas where populations of two or more interbreeding species may change through an influx of novel genetic material resulting from hybridization or selection on standing genetic variation. Documenting changes in populations through time, however, is challenging because repeated samples are often missing or because long-term storage can affect trait morphologies, especially colour traits that may fade through time. We document a change in carotenoid-based orange breast feathers of Bullock's Orioles (Icterus bullockii) from the Great Plains hybrid zone, USA. Contemporary Bullock's Orioles are more orange than historic individuals from the same location sampled approximately 60 years ago. Spectrophotometry revealed that contemporary Bullock's Orioles resemble orange colour profiles of Baltimore Orioles (I. galbula), the species with which they hybridize. Fading or changes in diet hypotheses do not appear to explain the shift in colour we report for Bullock's Orioles. We propose that these changes in colour are facilitated through introgression with Baltimore Orioles, and favoured by females that choose brighter, more orange males. Our study highlights the long memory of natural history collections and how they offer new insights to the dynamic roll of hybrid zones in trait evolution between interacting species.

Anterior Scalene Muscle Block Response Predicts Outcomes Following Thoracic Outlet Decompression.

BACKGROUND: There is no definitive objective measure for diagnosis of thoracic outlet syndrome (TOS), and functional capacity testing on standardized rehabilitation exercises before and after an anterior scalene muscle block (ASMB) has the potential to serve as a predictor of response to surgery and to improve diagnostic accuracy in these cases. METHODS: Patients evaluated for TOS underwent ASMB as a diagnostic test and were retrospectively reviewed. Functional capacity scores were recorded for patients performing repetitive motion exercises immediately before ASMB, 15 minutes after ASMB, and at a minimum of 6 weeks after thoracic outlet decompression (TOD). The primary outcome of interest was correlation between the pre- to post-ASMB difference and the pre-ASMB to postoperative difference with respect to 3 functional work capacity scores. RESULTS: The average change in time-to-fatigue and work product between pre- and post-ASMB of all exercises was an increase of 39.5% and 53.8%, respectively. The greatest pre-ASMB to post-TOD difference was seen for the Extremity Abduction Stress Test with an average improvement of 109.7% and 150.4% for time-to-fatigue and work product, respectively. The degree of percent improvement post-ASMB correlated positively with the degree of percent improvement post-TOD for all exercises with respect to work product and time-to-fatigue. CONCLUSIONS: Patient response to ASMB as measured by functional capacity on rehabilitation exercises predicted objective functional outcomes following TOD. Post-ASMB outcomes correlated with post-TOD outcomes. The ASMB can be used to assist in diagnosing TOS and provide a surrogate for expectation in patients considering undergoing neurogenic TOD.

A discussion of RNA virus taxonomy based on the 2020 International Committee on Taxonomy of Viruses report.

RNA viruses have a higher mutation rate than DNA viruses; however, RNA viruses are insufficiently studied outside disease settings. The International Committee on Taxonomy of Viruses (ICTV) is an organization set up by virologists to standardize virus classification. To better understand ICTV taxonomy and the characteristics and rules of different RNA virus families, we analyzed the 3,529 RNA viruses included in the 2020 ICTV report using five widely used metrics: length, host, GC content, number of predicted ORFs, and sequence similarity. The results show that host type has a significant influence on viral genome length and GC content. The genome lengths of virus members within the same genus are quite similar: 98.28% of the genome length differences within any particular genus are less than 20%. The species within those genera containing segmented viruses also have a similar length and number of segments. The number of predicted ORFs in the RNA viral genomes also shows a strong, statistically significant correlation with genome length. We suggest that due to the high mutation rate of RNA virus genomes, current RNA virus classification should mainly rely on protein similarities rather than nucleic acid similarities.