Oncologists' perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American cancer patients.

BACKGROUND: Tumor genomic profiling (TGP) identifies targets for precision cancer treatments, but also secondary hereditary risks. Oncologists are poorly trained to communicate the results of TGP, especially among patients with lower health literacy, poorer genetics knowledge, and higher mistrust. African American (AA) patients are especially vulnerable to poor understanding due to significant cancer disparities and lower uptake of TGP. The goal of this research is to inform the development of an internet-based brief educational support for oncologists to prepare them to provide better decisional support related to TGP for their AA cancer patients. METHODS: This mixed-methods study used semi-structured interviews of oncologists to inform development of an online survey with a convenience sample of US-based oncologists (n = 50) to assess perceptions of the challenges of TGP and communicating results to AA patients. RESULTS: Most interviewed oncologists felt it was important to consider racial/cultural differences when communicating about hereditary risks. Cost, family dynamics, discrimination concerns, and medical mistrust were identified as particularly salient. Survey respondents' views related to AAs and perceptions of TGP were strongly associated with years since completing training, with recent graduates expressing stronger agreement with statements identifying barriers/disadvantages to TGP for AA patients. CONCLUSIONS: Oncologists who had more recently completed training expressed more negative perceptions of TGP and more perceived challenges in communicating about TGP with their AA patients. Focused training for oncologists that addresses barriers specific to AAs may be helpful in supporting improved communication about TGP and improved decisional support for AA patients with cancer considering TGP to evaluate their tumors.

Acceptability and Feasibility of Providing Adherence Feedback Based on Tenofovir Diphosphate in Dried Blood Spots: Results from a Pilot Study Among Patients and Providers in Cape Town, South Africa.

Tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS) predict viral breakthrough, but their use remains understudied in real-world clinic settings. This pilot study examined acceptability, feasibility, and initial adherence outcomes of providing adherence feedback using TFV-DP concentrations on patient- and provider-levels in Cape Town, South Africa. We enrolled 60 persons with HIV (PWH) receiving tenofovir-containing ART attending a primary health clinic. They were randomized 1:1 to an intervention receiving TFV-DP concentration feedback by research staff vs. no feedback at monthly visits for 4 months. Acceptability among medical providers and level of clinical follow-up of TFV-DP results was examined. Patient acceptability was assessed descriptively. Mean electronic adherence (EA), as measured by WisePill device, and TFV-DP in DBS were compared between the two arms. All participants in the intervention group (100%) reported finding TFV-DP feedback helpful and 86% reported changing adherence behaviors. Medical providers indicated high acceptability of incorporating TFV-DP concentration feedback into the clinic, yet among 29 results < 1000 fmol/punch, only 2 were reviewed with no follow-up actions performed. In the intervention arm, mean TFV-DP concentrations were significantly higher (t = 2.5, p < .01) during follow-up and EA in upper quartile (96-100%) was greater compared to controls (x2 = 7.8, p ≤ .05). This study found high acceptability among patients for receiving adherence feedback based on TFV-DP concentrations. TFV-DP and EA data demonstrated greater adherence in the intervention group. Providers indicated high acceptability of incorporating TFV-DP feedback into the clinic, but few providers reviewed results, which could impact clinic-level feasibility.

The relationship of PrEP beliefs to perceived personal, interpersonal and structural benefits and barriers to PrEP use in women who inject drugs.

BACKGROUND: Women who inject drugs (WWID) have significant biological, behavioral, and gender-based barriers to accessing HIV prevention services, including Pre-Exposure Prophylaxis (PrEP) medication. Little is known about how beliefs about PrEP impact both perceived barriers and benefits of PrEP use and how they may be related to the decision-making process. METHODS: Surveys were conducted with 100 female clients of a large syringe services program in Philadelphia, Pennsylvania. The sample was categorized into three groups based on mean PrEP beliefs scores using terciles: accurate beliefs, moderately accurate beliefs, and inaccurate beliefs. Oneway ANOVA tests were used to compare groups by perceived benefits and barriers to PrEP, drug use stigma, healthcare beliefs, patient self-advocacy, and intention to use PrEP. RESULTS: Participants had a mean age of 39 years (SD 9.00), 66% reported being White, 74% finished high school, and 80% reported having been homeless within the past 6 months. Those with the most accurate PrEP beliefs reported highest intent to use PrEP and were more likely to agree that benefits of PrEP included it preventing HIV and helping them "feel in charge". Those with inaccurate beliefs were more likely to strongly agree that barriers, such as fear of reprisal from a partner, potential theft, or feeling they "might get HIV anyway", were reasons not to use PrEP. CONCLUSIONS: Results indicate perceived personal, interpersonal and structural barriers to PrEP use are associated with accuracy of beliefs is, pointing to important intervention targets to increase uptake among WWID.

Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication.

BACKGROUND: Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use. METHODS: This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues. RESULTS: Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP's effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication. CONCLUSIONS: Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.

Changing Behavior, Attitudes, and Beliefs About Food Safety: A Scoping Review of Interventions Across the World and Implications for Empowering Consumers.

Foodborne illnesses are a global public health issue. Responsibility to prevent foodborne disease is shared by many actors along the food supply chain, including consumers. However, consumers often lack knowledge about food safety and behaviors that can reduce risk. Consumers are often targeted for interventions to address these gaps, but a current comprehensive analysis of such interventions globally by type, geography, and outcome is lacking in the literature. In addition, there is a need to understand how individual interventions could be broadened to include the relationships between consumers and other actors in the food system, and how targeted communication strategies can affect behavior. We conducted a rigorous scoping review to assess consumer-facing food safety interventions carried out globally over the past 20 years, and categorized and analyzed them by type of intervention, methods, and outcomes to understand which interventions might be effective in changing consumer behavior, knowledge, attitudes, beliefs, and perceptions on food safety. Ninety-two interventions were reviewed, the majority of which were published in the last 10 years in North America. Most target adults, and 25% are directed at women and mothers. Health or risk communication interventions are becoming increasingly common to move beyond skill-based education and address risk perceptions of food safety that might motivate consumers. Only two studies addressed risk perception in consumers to potentially change food handlers' behavior outside of the home. This review suggests that focusing on risk perception combined with strategies that leverage emotion and trusted sources, such as respected peers or family members, might be useful strategies for interventions.

Community Belonging and Attitudes Towards HIV Pre-Exposure Prophylaxis (PrEP) Among Transgender Women.

For transgender (trans) women, community belonging may play an important role in shaping perceptions of HIV Pre-exposure Prophylaxis (PrEP). A cluster analysis was performed using data obtained from a survey administered to 128 trans women residing in Philadelphia, PA and the San Francisco Bay area, CA. Six items assessing feelings of community belongingness among trans women produced three distinct clusters. Associations were examined between cluster membership and perceptual items including beliefs about PrEP, experiences with healthcare, patient self-advocacy, and perceived trusted sources for PrEP information. Clusters were demographically comparable apart from age. There were significant differences noted between trust in various communication channels and perceptions of PrEP; the least community-connected cluster had less trust and more negative perceptions of PrEP. Analyses suggest that psychographic differences exist based on perceived community belongingness in this population, and this in turn may be consequential in determining how information about PrEP is communicated and diffused to trans women for whom PrEP may be indicated.

Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis.

Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.

Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort Study.

Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.

Personality and its Relation to Mental and Psychosocial Health in Emerging Adult Sexual Minority Men: The P18 Cohort Study.

Personality disorder and personality pathology encompass a dimension of psychological dysfunction known to severely impact multiple domains of functioning. However, there is a notable dearth of research regarding both the pervasiveness and correlates of personality pathology among young sexual minority males who themselves experience heightened mental health burdens. Using the self-report version of the Standardized Assessment of Personality-Abbreviated Scale we tested associations between distinct personality characteristics with sociodemographic and psychosocial factors as well as mental health states in a sample of 528 young (aged 21-25 years) sexual minority men. In multivariate analysis, personality traits varied significantly by race/ethnicity. Personality traits were also positively associated with psychosocial states, specifically, internalized anti-homosexual bias, level of connection with the gay community, and male body dissatisfaction, as well as mental health in the form of recent depressive and anxious symptomatology. These findings support the complex synergy which exists between personality characteristics, psychosocial conditions, and mental health burdens present among sexual minority men and support the need for an all-encompassing approach to both the study and care of this population that addresses the influences of both internal and external factors on well-being.

Early Life Psychosocial Stressors and Housing Instability among Young Sexual Minority Men: the P18 Cohort Study.

Homelessness and housing instability is a significant public health problem among young sexual minority men. While there is a growing body of literature on correlates of homelessness among sexual minority men, there is a lack of literature parsing the different facets of housing instability. The present study examines factors associated with both living and sleeping in unstable housing among n = 600 sexual minority men (ages 18-19). Multivariate models were constructed to examine the extent to which sociodemographic, interpersonal, and behavioral factors as well as adverse childhood experiences explain housing instability. Overall, 13 % of participants reported sleeping in unstable housing and 18 % had lived in unstable housing at some point in the 6 months preceding the assessment. The odds of currently sleeping in unstable housing were greater among those who experienced more frequent lack of basic needs (food, proper hygiene, clothing) during their childhoods. More frequent experiences of childhood physical abuse and a history of arrest were associated with currently living in unstable housing. Current enrollment in school was a protective factor with both living and sleeping in unstable housing. These findings indicate that being unstably housed can be rooted in early life experiences and suggest a point of intervention that may prevent unstable housing among sexual minority men.

Vaccination uptake in LGBTQ adults in two US states: Findings from the QVax study.

OBJECTIVES: Lesbian, gay, bisexual, transgender, queer and other (LGBTQ+) individuals face numerous health disparities, including higher rates of chronic diseases and sexually transmitted infections, partly due to marginalization, discrimination, and a healthcare system often unprepared to meet their specific needs. Despite the importance of vaccination in preventing these health issues, vaccination patterns in LGBTQ+ populations remain under-researched, with limited data available due to the absence of sexual orientation and gender identity information on most healthcare forms. As such, we sought to understand vaccine uptake among LGBTQ+ individuals living in New Jersey and New York for 7 primary adult vaccines. METHODS: Participants were 768 LGBTQ+ adults living in New Jersey and New York, US. We recruited this convenience sample through community centers and events, social media, and listservs of local professional organizations. The online survey examined uptake for 7 adult vaccines. RESULTS: Of the 7 adult vaccines, human papilloma virus (HPV) had the lowest proportion of participants who were fully/partially vaccinated (54.4 %), followed by hepatitis A (59.8 %), hepatitis B (63.0 %), meningitis B (63.7 %), seasonal influenza during the COVID-19 pandemic (70.2 %), seasonal influenza before the COVID-19 pandemic (70.3 %), and nearly all participants (99.2 %) received at least one dose of the COVID-19 vaccine. For Shingles virus, among participants age 50+, 63.8 % were fully/partially vaccinated. In adjusted models, age was the strongest predictor of vaccination uptake in HPV, hepatitis A, hepatitis B, meningitis B, and seasonal influenza before and during the COVID-19 pandemic. Younger participants were more likely to be vaccinated for 4 of the 6 vaccines, excluding Shingles (<0.001), whereas older adults were more likely to be vaccinated for seasonal influenza before and during the COVID-19 pandemic (<0.010). CONCLUSIONS: This study highlights the differences in uptake across different vaccines. It also draws attention to differences within LGBTQ+ populations which is important to consider when ensuring more equitable vaccine access.

Identifying Key Factors to PrEP Initiation and Persistence Among YMSM Through Focus Groups and Surveys in Two High-Priority Settings.

Cisgender men are diagnosed with HIV at a rate four times greater than cisgender women, with 71% of infections attributed to male-male sexual contact. Despite expanding accessibility, pre-exposure prophylaxis (PrEP) for HIV prevention is initiated by only 30% of people with PrEP indications. Five focus groups with 42 young men who have sex with men from New York and Alabama were conducted to identify key factors to PrEP initiation and persistence. Thirty focus group participants completed a survey on demographics, PrEP choices and health care attitudes. Findings suggest provider competency significantly influences PrEP use due to stigmatization in medical settings. Participants noted benefits of PrEP including HIV protection and sexual empowerment, yet barriers like cost and side effects were prevalent. Our findings outline barriers and facilitators to PrEP use among young men who have sex with men in two high priority settings that will inform PrEP care updates in participating clinics.

Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study.

BACKGROUND: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. OBJECTIVE: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. METHODS: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. RESULTS: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. CONCLUSIONS: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients.

The Relationship Between Gender-Affirming Procedures, Body Image Quality of Life, and Gender Affirmation.

This study explored whether self-reported barriers to accessing a health care provider, gender-affirming procedures, and relevant psychosocial measures were related to experienced gender affirmation in a cross-sectional sample of trans individuals (N=101). Body image quality of life [b=0.181, t(4.277), p<0.001] and the number of gender-affirming procedures [b=0.084, t(2.904), p=0.005] were significant predictors of transgender congruence, a measure of gender affirmation, and accounted for 40% of the adjusted variance in transgender congruence scores F(2, 89)=31.363, p<0.001, R2=0.413. Results suggest that experiencing a barrier to gender-affirming health care is associated with anticipation of discrimination and provides further evidence that gender-affirming health care is associated with positive psychosocial outcomes.

Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study.

The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.

SARS-CoV-2 Vaccination Hesitancy and Behaviors in a National Sample of People Living with HIV.

As COVID-19 vaccinations became available in early 2021, we collected data from a US national sample of 496 people living with HIV (PLWH) to assess COVID-19 vaccination uptake and attitudes. The study was cross-sectional, and data were collected using an online survey between March and May 2021. At the time, 64% of the participants received at least one dose of a COVID-19 vaccine. Vaccine uptake was associated with older age and more years living with HIV, higher educational attainment, less vaccine hesitancy, and higher perceived COVID-19 vulnerability. Rates of vaccination uptake were highest among sexual and gender minority (SGM) cisgender men and transgender participants as well as those more likely to report undetectable viral load. Among the 166 unvaccinated, intention to receive the vaccine was related to older age and years living with HIV as well as lower vaccine hesitancy. Among the unvaccinated, SGM individuals demonstrated higher intent than non-SGM individuals. Findings indicate relatively high levels of vaccination in PLWH, although uptake and intent are not monolithic in the population. Patterns of vaccination are consistent with the health behavior literature in so much as those with higher levels of perceived heath vulnerability due to age as well as higher levels of proactivity about their HIV health are more likely to be vaccinated or intend to be vaccinated. Ongoing vigilance is required to vaccinate the US population, particularly those with underlying conditions such as HIV, as is the need to tailor health messaging to the highly diverse population of PLWH, with particular emphasis on the intersection of HIV and SGM status.

Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study.

Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10-16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41-35.95). Those who completed bachelor's degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17-0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.

Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015-2020.

Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients.

Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient-oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.

Healthcare beliefs, health information seeking, and healthcare setting preferences among women who inject drugs by community supervision status.

OBJECTIVE: Women on community supervision who inject drugs have significant unmet healthcare needs. However, it remains unclear how the intersection of community supervision and injection drug use influences healthcare experiences and service setting preferences. The present study examines whether the intersection of community supervision and injection drug use is associated with differences in women's healthcare beliefs, healthcare experiences, and service setting preferences. METHODS: A secondary analysis was conducted on a previously collected sample of women who inject drugs recruited from a syringe exchange and social service organization for a cross-sectional survey. Participants (N = 64) were mostly White (75%), and more than a quarter were currently on probation or parole (26%). RESULTS: Independent samples t-tests and chi-square tests revealed no significant differences on sociodemographic variables by community supervision status. There were no significant differences by community supervision status across seven indicators of healthcare confidence (ps > .05). However, results revealed significant differences in past experiences and beliefs about healthcare, health information seeking, and healthcare setting preferences by community supervision status (ps < .05), where women on community supervision less frequently sought health information and medical care outside of emergency departments. CONCLUSIONS: Findings provide preliminary evidence about differences in the healthcare experiences and setting preferences of women who inject drugs on community supervision.