A 2-Year, Randomized, Clinical Trial Examining the Effects of Speed of Processing Cognitive Training on Quality-of-Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in Birmingham, Alabama: Results of the Think Fast Study.

ABSTRACT: Speed of processing (SOP) cognitive training may improve indicators of the quality of life (QoL) in people living with HIV. In this 2-year, longitudinal, randomized, controlled trial, 216 participants ages 40 years and older with HIV-associated neurocognitive disorder or borderline HIV-associated neurocognitive disorder were assigned to one of three groups: (a) 10 hr of SOP training (n = 70); (b) 20 hr of SOP training (n = 73), or (c) 10 hr of internet navigation control training (a contact control group; n = 73). Participants completed several QoL measures at baseline, posttest, and Year 1 and Year 2 follow-ups. Using linear mixed-effect models, no strong pattern of training effects across QoL outcomes was apparent, with small-magnitude, nonsignificant, between-group differences in depression, locus of control, and Medical Outcomes Study-HIV scales. In conclusion, despite prior work showing some transfer of SOP cognitive training improving QoL, that was not observed. Implications for research and practice are posited.

Does Insurance Provide Adequate Coverage for Physical Therapy Visits for Common Orthopedic Diagnoses? A Survey Study.

OBJECTIVES: This study aimed to analyze the association between physical therapists' recommended number of visits for a full recovery from common orthopedic injuries/surgeries and the extent of insurance coverage for these visits. METHODS: A prospective observational study was conducted with board-certified physical therapists. A qualitative questionnaire was used to gather physical therapists' demographics and the recommended number of physical therapy visits to achieve a full recovery after 11 common orthopedic diagnoses. Physical therapists also were asked to report whether they believe that insurance provides an adequate number of visits overall. In addition to the qualitative survey, insurance coverage details of major Alabama companies were obtained for comparison. Descriptive statistics of the participating therapists were analyzed for sex, age, degree/training, and years of experience. Kruskal-Wallis statistics were used to analyze variance between the aforementioned groupings when compared with the reported average number of sessions. RESULTS: The survey (N = 251) collected data on the average number of physical therapy sessions that are necessary for a complete recovery as recommended by physical therapists for 11 common orthopedic diagnoses. From this survey, the average number of necessary visits ranged from 11.3 visits (ankle sprains) to 37.3 visits (anterior cruciate ligament reconstruction), with the overall average number of visits being 23.8. Only 24% of physical therapists believed that insurance companies provided enough coverage. Insurance coverage varied but often required additional procedures to allocate the adequate number of visits for the studied orthopedic pathologies. CONCLUSIONS: The majority of practicing physical therapists in Alabama perceive insufficient insurance coverage for physical therapy visits for most orthopedic diagnoses. This study has implications for healthcare decision making and patient-centered rehabilitation goals. Physicians and physical therapists can use this information to optimize treatment decisions and rehabilitation goals. Patients will benefit from improved physical and economic well-being. This study has the potential to drive further research and influence national insurance policies to better serve patients' needs.

FOUR CASES OF SEVERED PEDUNCLES IN BOTTLENOSE DOLPHINS (TURSIOPS TRUNCATUS) ALONG THE ALABAMA COAST.

Alabama (AL) is a hotspot in the Gulf of Mexico (GoM) for human interaction-related cetacean strandings, including harassment, vessel strikes, and fisheries interactions. We examined four bottlenose dolphins (Tursiops truncatus) stranded dead along the AL coast during 2012-2017 with severed peduncles suspected to be related to human interaction (HI). Evidence from each case, including photographs, gross necropsy results, and histopathologic findings when available, was reviewed to determine the mode of severance and whether it contributed to death. In each case, the severance site had smooth, clean edges on at least one side, indicating the use of a sharp instrument to remove the caudal peduncle and flukes. Three cases also had evidence of fisheries interactions, including linear impressions around the rostrum, fins and/or flukes, indicating that these animals may have been entangled in fisheries gear prior to death. Histopathology in one of these cases revealed that the severance occurred perimortem; speculatively, the caudal peduncle and flukes may have been cut off to facilitate removing the dolphin from its entanglement. Although cases of amputation and mutilation are not uncommon globally among stranding reports, few cases have been described and analyzed in the literature. This paper is the first to document and compare multiple cases of severed peduncles with evidence of HI, including fisheries, in the GoM. This case series enhances our understanding of the types of HI occurring in bottlenose dolphins and highlights the need for continued public education, policy, and management to address cases like these.

Rapid Response to the Legalization of Fentanyl Test Strips in Alabama: An Academic-Community Partnership.

In June 2022, Alabama legalized fentanyl test strips (FTS). In response to this new opportunity to prevent overdoses, Project Linkage, Education, and Prevention (LEAP)-an academic-community partnership providing substance use prevention services-quickly purchased FTS and started distributing them in the Birmingham area. We describe how the Addiction Prevention Coalition, a substance use education and harm reduction provider, distributed 7300 FTS in the first year of legalization via Project LEAP and discuss its efforts to decrease substance use among young people. (Am J Public Health. 2024;114(8):785-788. https://doi.org/10.2105/AJPH.2024.307681).

Vegetable Gardening and Health Outcomes in Older Cancer Survivors: A Randomized Clinical Trial.

Importance: Cancer survivors experience accelerated functional decline that threatens independence and quality of life. Previous studies have suggested that vegetable gardening may improve diet, physical activity, and physical function in this vulnerable population, which comprises more than 5% of the US population. Objective: To assess whether diet, physical activity and functioning, and other outcomes improved in older cancer survivors assigned to a vegetable gardening intervention compared with a waitlist. Design, Setting, and Participants: From May 11, 2016, to May 2, 2022, a 2-arm, assessor-blinded, crossover-designed, intent-to-treat, randomized clinical trial was conducted at cancer survivors' homes across Alabama. Medicare-eligible survivors of cancers with 5-year survival of 60% or more were registry ascertained and screened for suboptimal vegetable and fruit consumption (<5 servings per day), physical activity (<150 moderate-to-vigorous minutes per week), and physical function (36-Item Short Form Health Survey [SF-36] subscale score ≤90). Consented participants underwent baseline assessments, were randomly assigned to intervention or waitlisted arms, and were reassessed at 1-year follow-up. Intervention: One-year, home-based vegetable gardening intervention providing gardening supplies and mentorship by cooperative extension-certified master gardeners to plant and maintain spring, summer, and fall gardens. Waitlisted participants received the identical intervention after 12 months. Main Outcomes and Measures: The main outcome was a composite index of improvements in self-reported vegetable and fruit consumption, physical activity, and physical function corroborated by plasma α-carotene levels, accelerometry, and physical performance assessments, respectively. Results: Of 381 enrolled participants (mean [SD] age, 69.8 [6.4] years; range, 50-95 years; 263 [69.0%] female), 194 were assigned to the gardening intervention and 187 were waitlisted (attrition rates, 7.2% and 7.0%, respectively). Intent-to-treat analyses did not detect a significant improvement in the composite index of vegetable and fruit intake, moderate-vigorous physical activity, and physical function (intervention arm vs waitlisted arm, 4.5% vs 3.1%; P = .53) or between-arm differences in vegetable and fruit intake (mean difference, 0.3 [95% CI, -0.1 to 0.7] servings per day; P = .10). The intervention arm experienced a significant improvement in vegetable and fruit intake (mean increase, 0.3 [95% CI, 0.0-0.6] servings per day; P = .04). Significant improvements also were observed in the intervention arm vs waitlisted arm in physical performance (mean difference for 2-minute step test, 6.0 [95% CI, 0.8-11.2] steps; P = .03; for 30-second chair stand, 0.8 [95% CI, 0.1-1.5] repetitions; P = .02), perceived health (8.4 [95% CI, 3.0-13.9] points on a 100-point scale [higher scores indicate better health]; P = .003), and gut microbiome alpha diversity (84.1 [95% CI, 20.5-147.6] more observed species; P = .01). The COVID-19 pandemic significantly moderated effects (eg, odds of improvement in self-reported physical functioning were greater before vs during the pandemic: odds ratio, 2.17; 95% CI, 1.12-4.22; P = .02). Conclusions and Relevance: In this randomized clinical trial including older cancer survivors, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; however, survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in perceived health and physical performance. Further study in broader populations and during pandemic-free periods is needed to determine definitive benefits. Trial Registration: ClinicalTrials.gov Identifier: NCT02985411.

Fulfillment of Permanent Contraception among Patients with Cesarean Delivery in a Multi-Site Cohort.

OBJECTIVES: This study aimed to assess the association between insurance type and permanent contraception fulfillment among those with cesarean deliveries. Additionally, we sought to examine modification by the scheduled status of the cesarean. STUDY DESIGN: We used data from a multi-site cohort study of patients who delivered in 2018-2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier. RESULTS: Compared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88). CONCLUSIONS FOR PRACTICE: Compared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery.

Service Provider Perspectives on Advance Care Planning Use in Rural Dementia Patients and Caregivers: A Qualitative Study.

Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants' recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings.

An analysis of ICAR recommendations for long-term care facilities in Alabama.

The Alabama Long-Term Care Strike Team was established in 2022 to help long-term care facilities build and maintain infection prevention and control (IPC) systems. Infection preventionists use CDC's Infection Control Assessment and Response (ICAR) tools to provide IPC-specific recommendations. Analysis of ICAR recommendations identified the 3 greatest training needs in Alabama: source control, hand hygiene, and environmental cleaning. The ICAR provides a standardized and objective way to monitor and mitigate IPC risk.

Healthcare Provider Perceptions of the Use of Medical Interpretation in Primary Care.

OBJECTIVES: Sixty-three percent of Latinos/as/x in Alabama, speak English "not well" or "not at all." Effective provider-patient communication is the foundation of successful clinical interactions. Medical interpretation is important to the healthcare provision for patients with limited English proficiency (LEP). We examined Alabama providers' perceptions of working with medical interpreters to identify strategies to improve healthcare provision for LEP patients. METHODS: We conducted nine semistructured qualitative interviews with primary healthcare providers in western Alabama. We used NVivo to conduct thematic coding and content analysis. RESULTS: Of the nine providers, one self-identified as Latina and the others identified as White. Four participants worked in community clinics and five worked at university-based clinics. Four themes emerged: preference for in-person interpreters over technology-based interpretation; providers' perceptions and expectations of the roles of professional interpreters; challenges in the communication process; and use of family members or other ad hoc interpreters. CONCLUSIONS: To meet the needs of Latino/a/x communities, clinical settings should invest in adequate staffing of in-person interpreters, infrastructure and workflow improvements, and the hiring and training of polylingual providers. Capacity-building opportunities to establish team building between interpreters and providers could be useful tools in improving healthcare provision for LEP patients.

Water and Sanitation Access for Children in Alabama.

BACKGROUND AND OBJECTIVES: Safe drinking water and closed sanitation are fundamental to health and are assumed in the United States, however, gaps remain, disproportionately affecting marginalized communities. We sought to describe household sanitation access for children in rural Alabama and local health provider knowledge of sanitation related health concerns. METHODS: Data were collected from self-administered surveys obtained from children enrolled in a larger cross-sectional study to determine soil transmitted helminthiasis prevalence in Alabama, from a survey of health providers from local federally qualified health centers and from a baseline knowledge check of Alabama health providers enrolled in an online sanitation health course. RESULTS: Surveys completed on 771 children (approximately 10% of county pediatric population) revealed less than half lived in homes connected to centralized sewers; 12% reported "straight-pipes," a method of discharging untreated sewage to the ground outside the home, and 8% reported sewage contamination of their home property in the past year. Additionally, 15% of respondents were likely to use well water. The local health providers surveyed did not include routine screening for water and sanitation failures or associated infections. Regional healthcare providers have limited knowledge of soil transmitted helminthiasis. CONCLUSIONS: A significant number of children from rural counties of Alabama with high rates of poverty reside in homes with water and sanitation challenges that predominantly affect African American families. This is an under-recognized health risk by local health providers, and its contribution to well-documented health disparities in this region is poorly understood.

In Vitro Fertilization, State Wrongful Death Statutes and State Fetal Homicide Statutes: The Reaction to LePage v. Center for Reproductive Medicine.

The Alabama Supreme Court recently held, in LePage v. Center for Reproductive Medicine, that the parents of human embryos that were negligently destroyed at a fertility clinic could bring an action for damages under the State's wrongful death statute. Although the Alabama legislature promptly enacted a law essentially overturning the state supreme court's decision, concerns have been raised that the court's decision might influence courts in other States to interpret their wrongful death statutes, or possibly even their fetal homicide statutes, to apply in similar circumstances, thereby threatening the availability of in vitro fertilization (IVF) technology. This article addresses those concerns.With respect to wrongful death statutes, only fourteen States (excluding Alabama) have interpreted their statutes to apply to unborn children without regard to their stage of gestation or development. The majority of States impose a gestational requirement (typically, viability) which would preclude their application to the destruction of human embryos. Even with respect to the minority of States that impose no limitation on the cause of action, those statutes, either by their express language or by fair interpretation, would not apply to unimplanted human embryos.With respect to the fetal homicide statutes in thirty-one States that do not have any gestational or developmental limitation, the statutes in twenty-six of those States apply only to acts causing the death of an unborn child in utero. As to the statutes in the other five States, the structure of the statute, considered in light of the applicable case law, strongly suggests that there would be no liability for causing the death of an unborn child before implantation. In sum, the Alabama Supreme Court's decision in LePage is not likely to be followed as a precedent in interpreting either the wrongful death statutes or the fetal homicide statutes of any other State.

A new perspective on water quality: Exploring spatial and temporal patterns of impaired waters.

Managing surface water quality is a global challenge, and understanding spatial and temporal patterns of water quality is a key component to effective management. However, analysis of spatiotemporal patterns of impaired waters over broad areas is sparse due to disparate water quality data and variable water quality standards. Thus, here we leverage the Alabama 303(d) List of impaired waters to present a new perspective for investigating spatiotemporal water quality patterns. Every two years, each state in the United States is required to assess its surface water quality and compile a list of impaired waterbodies, meaning waters that do not meet water quality standards for their designated usage - referred to as the 303(d) List. The purpose of the 303(d) List is to identify impaired waters so that corrective action can be taken to reduce pollutant loads and, ultimately, improve water quality. Using GIS, a space time cube was created to analyze and visualize spatiotemporal patterns of the impaired rivers added to the Alabama 303(d) Lists from 1996 to 2022. For this analysis, the percentage of river length impaired out of the total river length, and number of times each impairment cause was listed, were summarized within Alabama sub-basins (Hydrologic Unit Code 8) (n = 51). Trend and hot spot analyses were conducted on the river impairment and causes. There was an up trend in river impairment for eight sub-basins across the state and a downtrend in one sub-basin. Over half of the sub-basins with an up trend in impairment also had an up trend in the number of times pathogens was listed as a cause of impairment. Additionally, coastal sub-basins were found to be a hot spot for river impairment. Interestingly, there was a down trend in the number of times nutrients, ammonia, and siltation were listed as a cause of impairment at the state and sub-basin scales of analysis. Altogether, these findings show the use of spatiotemporal pattern analysis of impaired waters and can indicate where, both spatially and by pollutant, management should prioritize water quality improvement efforts.

Partnering With Churches to Address COVID-19 Vaccine Hesitancy and Uptake in Trustworthy Contexts.

The Black church has long been seen as a crucial partner in addressing public health issues. This paper describes the development, implementation, and evaluation of a community-engaged church intervention addressing COVID-19 vaccine hesitancy in underserved Black communities in Jefferson County, Alabama. We partnered with churches to implement and evaluate the intervention between March and June of 2022 and found that our church partners were capable of significant messaging reach, particularly through electronic means. (Am J Public Health. 2024;114(S5):S392-S395. https://doi.org/10.2105/AJPH.2024.307683).

Smart device interest, perceived usefulness, and preferences in rural Alabama seniors.

Limited data exist on the preferences for smart home devices in rural Americans. We examined the interest, usefulness, and pleasantness of various smart home interfaces and determined whether they differed by ethnicity, rurality, age, and gender. A total of 118 older adults living in the rural Deep South completed a survey instrument that assessed interest in various smart home applications and was queried about the perceived usefulness and perceived ease of use of screen, voice, and robot interfaces in 7 distinct scenarios. Personality data was collected via the Big Five Inventory. Technology readiness was measured using a technological readiness instrument. Participants were primarily female (81%), rural (76%), African American (69%), and aged 65-74 years old (51%). Participants were recruited from a total of 5 cities in West Alabama within the Black Belt. Data was collected before COVID-19 (July 2018 through July 2019).

Irregular Cycles, Ovulatory Disorders, and Cardiometabolic Conditions in a US-Based Digital Cohort.

Importance: Polycystic ovary syndrome (PCOS), characterized by irregular menstrual cycles and hyperandrogenism, is a common ovulatory disorder. Having an irregular cycle is a potential marker for cardiometabolic conditions, but data are limited on whether the associations differ by PCOS status or potential interventions. Objective: To evaluate the association of PCOS, time to regularity since menarche (adolescence), and irregular cycles (adulthood) with cardiometabolic conditions. Design, Setting, and Participants: This cross-sectional study used a large, US-based digital cohort of users of the Apple Research application on their iPhone. Eligibility criteria were having ever menstruated, living in the US, being at age of consent of at least 18 years (or 19 years in Alabama and Nebraska or 21 years in Puerto Rico), and being able to communicate in English. Participants were enrolled between November 14, 2019, and December 13, 2022, and completed relevant surveys. Exposures: Self-reported PCOS diagnosis, prolonged time to regularity (not spontaneously establishing regularity within 5 years of menarche), and irregular cycles. Main Outcomes and Measures: The primary outcome was self-reported cardiometabolic conditions, including obesity, prediabetes, type 1 and 2 diabetes, high cholesterol, hypertension, metabolic syndrome, arrhythmia, congestive heart failure, coronary artery disease, heart attack, heart valve disease, stroke, transient ischemic attack (TIA), deep vein thrombosis, and pulmonary embolism measured using descriptive statistics and logistic regression to estimate prevalence odds ratios (PORs) and 95% CIs. Effect modification by lifestyle factors was also estimated. Results: The study sample (N = 60 789) had a mean (SD) age of 34.5 (11.1) years, with 12.3% having PCOS and 26.3% having prolonged time to regularity. Among a subset of 25 399 participants who completed the hormonal symptoms survey, 25.6% reported irregular cycles. In covariate-adjusted logistic regression models, PCOS was associated with a higher prevalence of all metabolic and several cardiovascular conditions, eg, arrhythmia (POR, 1.37; 95% CI, 1.20-1.55), coronary artery disease (POR, 2.92; 95% CI, 1.95-4.29), heart attack (POR, 1.79; 95% CI, 1.23-2.54), and stroke (POR, 1.66; 95% CI, 1.21-2.24). Among participants without PCOS, prolonged time to regularity was associated with type 2 diabetes (POR, 1.24; 95% CI, 1.05-1.46), hypertension (POR, 1.09; 95% CI, 1.01-1.19), arrhythmia (POR, 1.20; 95% CI, 1.06-1.35), and TIA (POR, 1.33; 95% CI, 1.01-1.73), and having irregular cycles was associated with type 2 diabetes (POR, 1.36; 95% CI, 1.08-1.69), high cholesterol (POR, 1.17; 95% CI, 1.05-1.30), arrhythmia (POR, 1.21; 95% CI, 1.02-1.43), and TIA (POR, 1.56; 95% CI, 1.06-2.26). Some of these associations were modified by high vs low body mass index or low vs high physical activity. Conclusions and Relevance: These findings suggest that PCOS and irregular cycles may be independent markers for cardiometabolic conditions. Early screening and intervention among individuals with irregular menstrual cycles may be beneficial.

Will a changing climate affect hatching success in cavity-nesting birds: A case study with Eastern Bluebirds (Sialia sialis)?

A significant body of evidence indicates that climate change is influencing many aspects of avian ecology. Yet, how climate change is affecting, and is expected to influence some aspects of the breeding ecology of cavity-nesting birds remains uncertain. To explore the potential linkage between timing of first clutch, and the influence of ambient temperature on hatching success, we used Eastern Bluebird (Sialia sialis) nest records over a nine-year period from Alabama, USA. We investigated changes to annual clutch initiation dates, as well as variability in hatching success associated with ambient air temperatures during the incubation period. Using a simple linear model, we observed earlier annual egg laying dates over the nine years of this study with a difference of 24 days between earliest egg-laying date of the season. Daily temperature minima increased 2 °C across the nine-year time frame of this study. These data also indicate that Eastern Bluebird hatching success was the highest when mean ambient air temperature during incubation was between 19 °C and 24 °C (78%, as opposed to 69% and 68% above and below this temperature range, respectively). Our findings of increasing maxima, earlier maxima each year, and the lower minima of temperatures within our study area could expand the breadth of temperatures experienced by nesting Eastern Bluebirds possibly exposing them to temperatures outside of what promotes nesting success. These findings with a cavity-nesting bird highlight an optimal range of ambient temperatures associated with highest hatching success, conditions likely to be affected by climate change.

Proximity to Hospital-Based Obstetric Care in a Maternity Desert in the Deep South.

Objectives. To examine the accessibility of hospital facilities with maternity care services in 1 rural county in Alabama in preparation for the initiation of prenatal care services at a federally qualified health center. Methods. We analyzed driving distance (in miles) from maternal city of residence in Conecuh County, Alabama to hospital of delivery, using 2019-2021 vital statistics data and geographic information system (GIS) software. Results. A total of 370 births to mothers who have home addresses in Conecuh County were reported, and 368 of those were in hospital facilities. The majority of deliveries were less than 30 miles (median = 23 miles) from the maternal city of residence. Some women traveled more than 70 miles for obstetrical care. Conclusions. Pregnant patients in Conecuh County experience significant geographic barriers related to perinatal care access. Using GIS for this analysis is a promising approach to better understand the unique challenges of pregnant individuals in this rural population. Public health policy efforts need to be geographically tailored to address these disparities. (Am J Public Health. 2024;114(S4):S330-S333. https://doi.org/10.2105/AJPH.2024.307692).

"Nobody Wants to Have Conversation About HIV." A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention.

BACKGROUND: Black adolescent girls and young women (AGYW) in the US Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low preexposure prophylaxis uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including preexposure prophylaxis. METHODS: In-depth interviews (IDIs) were conducted with Black AGYW aged 14 to 24 years and health care providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. In-depth interviews were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings. RESULTS: Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21 years, representing 9 Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included the following: (1) improve sexual health education for providers and adolescents, (2) normalize conversations in clinical settings, and (3) engage communities to continue these conversations outside of clinical settings. CONCLUSIONS: Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.

Evaluation of the Genetic Diversity, Haplotype, and Virulence of Fusarium oxysporum f. sp. vasinfectum Field Isolates from Alabama.

The United States is the third largest producer of cotton and the largest exporter of cotton globally. Fusarium wilt, caused by the soilborne fungal pathogen Fusarium oxysporum f. sp. vasinfectum (Fov), was estimated to cause a $21 million cotton yield loss in 2022. Historically, Alabama was an important producer of cotton in the Southeastern United States and was the first state in which Fusarium wilt on cotton was described. To assess the genetic diversity of Fov field isolates in Alabama, 118 field isolates were collected from six counties across the state from 2014 to 2016. Phylogenetic analysis using TEF1 and RPB2 placed the Fov field isolates into 18 haplotypes. Upon profiling the Tfo1 transposon insertion in the NAT gene, it was determined that no race 4 isolates were recovered in Alabama. Representatives of all field isolate haplotypes caused disease on Upland cotton variety Rowden in a hydroponic test tube assay. Two haplotype A isolates were the most aggressive isolates recovered, and haplotype A isolate TF1 was more aggressive than the race 4 isolate 89-1A on Upland cotton and had similar symptom severity on Pima cotton. Karyotype profiling indicted an abundance of small chromosomes characteristic of karyotypes that include accessory chromosomes, with considerable variability between isolates. Collectively, our study indicates that Fov isolates from Alabama are genetically diverse, which may have been promoted by its persistence in cotton fields.