Geospatial perspectives on health: The PrEP4Love campaign and the role of local context in health promotion messaging.

Pre-exposure prophylaxis (PrEP) remains one of the most effective biomedical interventions for the prevention of HIV transmission. However, uptake among populations most impacted by the HIV epidemic remains low. La rge-scale awareness and mobilization campaigns have sought to address gaps in knowledge and motivation in order to improve PrEP diffusion. Such campaigns must be cognizant of the historical, physical, and structural contexts in which they exist. In urban contexts, neighborhood segregation has the potential to impact health outcomes and amplify disparities. Therefore, we present novel geospatial approaches to the evaluation of a Chicago-based PrEP messaging campaign (PrEP4Love) in a 2018 cohort of men who have sex with men and transgender women, contextualizing results within the localized infrastructure and public health landscape, and examining associations between geographic location and campaign efficacy. Results revealed notable variance in rates of PrEP uptake associated with campaign exposure by Chicago planning area, which are likely explained by the historical and contemporary impacts of racist structures on physical environment and city infrastructure. Findings have important implications for the evaluation and implementation of future messaging campaigns, which should take the unique historical, structural, and geospatial factors of their particular settings into account in order to achieve maximum impact.

Association of HIV Education with HIV Testing and Sexual Risk Behaviors Among US Youth, 2009-2017: Disparities Between Sexual Minority and Sexual Majority Youth.

HIV remains a serious concern among youth, particularly among sexual minority youth (SMY). Risk behaviors including low rates of HIV testing and inconsistent condom use as well as use of substances before sex contribute to these disparities. Therefore, HIV education in schools may be a valuable tool for reducing HIV-related risk behaviors. Using a large, pooled sample of youth (N = 169,468) from the 2009-2017 Youth Risk Behavior Survey (YRBS), we conducted the first population-level assessment of associations between HIV education and risk behavior prevalence among high school-aged youth by sexual behavior (i.e., sex of sexual partner [s]) in the USA. Results demonstrated that racial/ethnic minority youth and SMY were less likely to have received HIV education than White or heterosexual peers. HIV education was associated with less substance use at last sex. Among males, HIV education was associated with increased condom use and HIV testing, emphasizing its promise as a potential intervention for risk behavior reduction. Results are discussed in light of current literature with future recommendations.

Engagement with LGBTQ community moderates the association between victimization and substance use among a cohort of sexual and gender minority individuals assigned female at birth.

BACKGROUND: Research has documented higher levels of substance use among sexual and gender minority (SGM) individuals - particularly sexual minority women (SMW) and transgender people - than among their heterosexual and cisgender peers. Because SGM substance use is linked to stigma-based victimization, it is crucial to identify social contexts that may buffer the association between victimization and substance use among SGM. METHODS: We explored how engagement with LGBTQ-specific community influences victimization experiences and substance use among 488 SGM individuals assigned female at birth (FAB-SGM; ages 16-32; 26% White) in a large Midwestern city. We tested whether participants who used LGBTQ community spaces differed from those who do not in levels of victimization and substance use, and whether use of LGBTQ spaces buffered SGM from the negative effects of victimization on substance use. RESULTS: Results demonstrated significant associations between victimization and alcohol and use of specific drugs. Contrary to expectations, participants who used LGBTQ spaces reported more victimization and more use of certain substances; however, when controlling for being out about non-heterosexual identity, this association remained only for LGBTQ community centers and school groups. Evidence was mixed for community engagement as a moderator of the association between victimization and substance use. CONCLUSIONS: Overall, results indicated that LGBTQ spaces may be associated with adaptive and maladaptive coping functions and should be considered a potential target for health interventions. Findings emphasize the need for increased research on FAB-SGM, including SMW and transgender individuals, and provide actionable recommendations to reduce incidence of victimization and substance use.

Knowledge, attitudes, intentions, and behavior related to green infrastructure for flood management: A systematic literature review.

Green infrastructure (GI), which mimics natural hydrological systems, is a promising solution for flood management at the intersection of urban built infrastructure and natural systems. However, it has not yet achieved widespread uptake, due in part to insufficient understanding of human dimensions of the broader socio-ecological-technical system. We therefore conducted a multidisciplinary systematic literature review to synthesize research on people's existing knowledge about flood risk and GI, and how that shapes their attitudes and motivation to adopt new solutions. We systematically screened 21,207 studies on GI for flood management; 85 met our inclusion criteria. We qualitatively analyzed these studies to extract results on knowledge, attitudes, intentions, and behavior relating to GI for flood management. Overall, knowledge of GI was low across the 44 studies in which it was evaluated. Seventy studies assessed attitudes about GI, including the functional, aesthetic, health and safety, recreational, conservation, financial, and cultural value of GI, albeit their measurement was inconsistent. Willingness to implement or pay for GI varied considerably across 55 studies in which it was measured. Twenty studies measured and documented behavior relating to GI use, and these found low rates of adoption. Few studies systematically assessed the role of demographic, socio-economic, or geographic characteristics that could influence individuals' knowledge, attitudes, intentions or behavior, and thereby the success of GI programs. We recommend that researchers should more systematically capture data on human dimensions of GI (i.e. knowledge, attitudes, intentions, and behavior) across diverse settings to improve program design and uptake, especially among vulnerable populations. Greater attention to the social component of the socio-ecological-technical system will help ensure that GI programs are equitable, inclusive, and sustainable.

PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women.

BACKGROUND: Despite high efficacy, use of pre-exposure prophylaxis (PrEP) remains low among young men who have sex with men (MSM) and transgender women (TW), primarily because of barriers such as stigma and resource awareness. We evaluated a social marketing campaign known as PrEP4Love that works to eliminate PrEP stigma; and awareness gaps through targeted advertising. SETTING: Chicago, Illinois. METHODS: Participants were enrolled within a cohort study of young MSM and TW (RADAR). Data were collected between June 2017 and April 2018 from HIV-negative individuals attending a follow-up visit. Surveys assessed demographics, PrEP attitudes and perceptions, and PrEP4Love campaign awareness. Associations between PrEP4Love awareness and PrEP perceptions, uptake, and behaviors were assessed using multiple logistic regression controlling for age, race/ethnicity, gender, sexual identity, and ever having used PrEP. RESULTS: Of 700 participants, the majority (75.9%) indicated seeing PrEP4Love ads in Chicago. Those who had seen ads were more likely to be out to their providers (odds ratio = 1.95; 95% confidence interval: 1.17 to 3.23) than those who had not, and those who had conversations were significantly more likely to have initiated the conversation themselves. Individuals who had seen ads were more likely to have taken PrEP in the last 6 months (odds ratio = 1.87; 95% confidence interval: 1.15 to 3.16) and more likely to believe their friends and the general public approved of and used PrEP. CONCLUSION: Social marketing campaigns are promising interventions that have the potential to alleviate barriers to HIV prevention, particularly among MSM and TW. Future research should evaluate the impact of these initiatives at multiple time points.

A systematic review of the human health and social well-being outcomes of green infrastructure for stormwater and flood management.

BACKGROUND: The increase in frequency and intensity of urban flooding is a global challenge. Flooding directly impacts residents of industrialized cities with aging combined sewer systems, as well as cities with less centralized infrastructure to manage stormwater, fecal sludge, and wastewater. Green infrastructure is growing in popularity as a sustainable strategy to mimic nature-based flood management. Although its technical performance has been extensively studied, little is known about the effects of green stormwater infrastructure on human health and social well-being. METHODS: We conducted a multidisciplinary systematic review of peer-reviewed and gray literature on the effects of green infrastructure for stormwater and flood management on individuals', households', and communities' a) physical health; b) mental health; c) economic well-being; and d) flood resilience and social acceptance of green infrastructure. We systematically searched databases such as PubMed, Web of Science, and Scopus; the first 300 results in Google Scholar; and websites of key organizations including the United States Environmental Protection Agency. Study quality and strength of evidence was assessed for included studies, and descriptive data were extracted for a narrative summary. RESULTS: Out of 21,213 initial results, only 18 studies reported health or social well-being outcomes. Seven of these studies used primary data, and none allowed for causal inference. No studies connected green infrastructure for stormwater and flood management to mental or physical health outcomes. Thirteen studies were identified on economic outcomes, largely reporting a positive association between green infrastructure and property values. Five studies assessed changes in perceptions about green infrastructure, but with mixed results. Nearly half of all included studies were from Portland, Oregon. CONCLUSIONS: This global systematic review highlights the minimal evidence on human health and social well-being relating to green infrastructure for stormwater and flood management. To enable scale-up of this type of infrastructure to reduce flooding and improve ecological and human well-being, widespread acceptance of green infrastructure will be essential. Policymakers and planners need evidence on the full range of benefits from different contexts to enable financing and implementation of instfrastructure options, especially in highly urbanized, flood-prone settings around the world. Therefore, experts in social science, public health, and program evaluation must be integrated into interdisciplinary green infrastructure research to better relate infrastructure design to tangible human outcomes.