Work-related factors of mental health among Chicago residents two years into the COVID-19 pandemic.

The COVID-19 pandemic led to widespread consequences for economic, social, and general wellbeing with rates of anxiety and depression increasing across the population and disproportionately for some workers. This study explored which factors were the most salient contributors to mental health through a cross-sectional 68-item questionnaire that addressed topics related to the pandemic. Data were collected through an address-based sampling frame over the two months from April 2022 to June 2022. A total of 2,049 completed surveys were collected throughout Chicago's 77 Community Areas. Descriptive statistics including frequency and percentages were generated to describe workplace characteristics, work-related stress, and sample demographics and their relationship to psychological distress. Independent participant and workplace factors associated with the outcomes were identified using multivariable logistic regression. The weighted prevalence of persons experiencing some form of psychological distress from mild to serious was 32%. After adjusting for potential confounding factors, certain marginalized communities experienced psychological distress more than others including females, adults over the age of 25 years of age, and people with higher income levels. Those who had been laid off, lost pay, or had reduced hours had increased odds of psychological distress (aOR = 1.71, CI95% 1.14-2.56; p = 0.009) as did people that reported that their work-related stress was somewhat or much worse as compared to before the COVID-19 pandemic (aOR = 2.22, CI95% 1.02-4.82; p = 0.04, aOR = 11.0, CI95% 4.65-26.1; p < 0.001, respectively). These results warrant further investigation and consideration in developing workplace and mental health interventions.

The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago.

OBJECTIVES: To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship. METHODS: We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income. RESULTS: Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization. CONCLUSIONS FOR PRACTICE: Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Transitioning the Healthy Chicago Survey From a Telephone Mode to Self-administered by Mail Mode.

CONTEXT: As response rates to health surveys conducted by telephone continue to decline and costs continue to increase, practitioners are increasingly considering a transition to self-administered mail contact modes. OBJECTIVE: To compare empirical differences observed across adjacent administrations of the Healthy Chicago Survey (HCS) conducted by telephone versus self-administered via mail contact. DESIGN: Data from the 2016, 2018, and 2020 administrations of the HCS are contrasted, and demographic distributions are benchmarked against the American Community Survey to investigate differences that may be linked to the HCS' transition from a telephone to self-administered mail mode between 2018 and 2020. SETTING: All survey data were collected from adult residents of Chicago, Illinois, between 2016 and 2020. MAIN OUTCOME MEASURES: Costs, response rates, key health statistics, demographic distributions, and measures of precision generated from the HCS. RESULTS: The mail mode led to a response rate increase of 6.8% to 38.2% at half the cost per complete. Mail respondents are more likely to be nonminority, female, and hold a college degree. Key health statistic differences are mixed, but design effects are larger in the mail mode, which we attribute to more detailed geographic stratification and weighting employed in 2020. CONCLUSIONS: The mail mode is a less costly data collection strategy for the HCS, but it comes with trade-offs. The quasi-random selection of an individual in the household exacerbates sociodemographic distribution disparities.

Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015.

We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13-18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population.

Validation of a Machine Learning Model to Predict Childhood Lead Poisoning.

Importance: Childhood lead poisoning causes irreversible neurobehavioral deficits, but current practice is secondary prevention. Objective: To validate a machine learning (random forest) prediction model of elevated blood lead levels (EBLLs) by comparison with a parsimonious logistic regression. Design, Setting, and Participants: This prognostic study for temporal validation of multivariable prediction models used data from the Women, Infants, and Children (WIC) program of the Chicago Department of Public Health. Participants included a development cohort of children born from January 1, 2007, to December 31, 2012, and a validation WIC cohort born from January 1 to December 31, 2013. Blood lead levels were measured until December 31, 2018. Data were analyzed from January 1 to October 31, 2019. Exposures: Blood lead level test results; lead investigation findings; housing characteristics, permits, and violations; and demographic variables. Main Outcomes and Measures: Incident EBLL (≥6 µg/dL). Models were assessed using the area under the receiver operating characteristic curve (AUC) and confusion matrix metrics (positive predictive value, sensitivity, and specificity) at various thresholds. Results: Among 6812 children in the WIC validation cohort, 3451 (50.7%) were female, 3057 (44.9%) were Hispanic, 2804 (41.2%) were non-Hispanic Black, 458 (6.7%) were non-Hispanic White, and 442 (6.5%) were Asian (mean [SD] age, 5.5 [0.3] years). The median year of housing construction was 1919 (interquartile range, 1903-1948). Random forest AUC was 0.69 compared with 0.64 for logistic regression (difference, 0.05; 95% CI, 0.02-0.08). When predicting the 5% of children at highest risk to have EBLLs, random forest and logistic regression models had positive predictive values of 15.5% and 7.8%, respectively (difference, 7.7%; 95% CI, 3.7%-11.3%), sensitivity of 16.2% and 8.1%, respectively (difference, 8.1%; 95% CI, 3.9%-11.7%), and specificity of 95.5% and 95.1% (difference, 0.4%; 95% CI, 0.0%-0.7%). Conclusions and Relevance: The machine learning model outperformed regression in predicting childhood lead poisoning, especially in identifying children at highest risk. Such a model could be used to target the allocation of lead poisoning prevention resources to these children.

Exposure to HIV partner counseling and referral services and notification of sexual partners among persons recently diagnosed with HIV.

OBJECTIVE: Among HIV-infected persons, we evaluated use of client partner notification (CPN) and health-department partner notification strategies to inform sex partners of possible HIV exposure, and prior exposure to partner counseling and referral services. METHODS: We conducted a cross-sectional, observational study of 590 persons diagnosed with HIV in the prior 6 months at 51 HIV test, medical, and research providers in Chicago and Los Angeles in 2003 and 2004. Logistic regression was used to identify independent correlates of using CPN to notify all locatable partners. RESULTS: Participants reported a total of 5091 sex partners in the 6 months preceding HIV diagnosis; 1253 (24.6%) partners were locatable and not known to be HIV-positive. Of 439 participants with ≥1 locatable partners, 332 (75.6%) reported notifying 696 (55.5%) partners by CPN (585, 84.1%), health-department partner notification (94, 13.5%), or other means (17, 2.4%); 208 (47.4%) used CPN to notify all locatable partners. Independent correlates of CPN included having fewer locatable partners and discussing the need to notify partners with an HIV medical-care provider (black and Hispanic participants only). Many participants reported that their HIV test or medical-care provider did not discuss the need to notify partners (48.8%, 33.7%, respectively) and did not offer health-department partner-notification services (60.8%, 52.8%). CONCLUSION: Many locatable sex partners who might benefit from being notified of potential HIV exposure are not notified. In accordance with national policies, HIV test and medical-care providers should routinely provide partner counseling and referral services to HIV-infected clients so that all locatable partners are notified and provided an opportunity to learn their HIV status.

Expanded HIV Testing and Linkage to Care: Conventional vs. Point-of-Care Testing and Assignment of Patient Notification and Linkage to Care to an HIV Care Program.

OBJECTIVE: The University of Chicago Medicine (UCM) led the Expanded Testing and Linkage to Care (X-TLC) program for disproportionately affected populations on the South Side of Chicago. The X-TLC program aimed to expand routine HIV testing to high-prevalence communities with disproportionately affected populations (i.e., minority men and women, men who have sex with men, and intravenous drug users) according to CDC guidelines at multiple clinical sites. METHODS: The X-TLC program used standard blood-based laboratory testing vs. point-of-care rapid testing or rapid laboratory testing with point-of-care results notification. Site coordinators and the linkage-to-care coordinator at UCM oversaw testing, test notification, and linkage to care. RESULTS: From February 1, 2011, through December 31, 2013, the X-TLC program completed 75,345 HIV tests on 67,153 unique patients. Of the total tests, 48,044 (63.8%) were performed on patients who self-identified as African American and 6,606 (8.8%) were performed on patients who self-identified as Hispanic. Of the 67,153 patients tested, 395 (0.6%) tested positive and 176 (0.3%) were previously unaware of their HIV-positive status. Seroprevalence was even higher for EDs, where 127 of 12,957 patients tested positive for HIV (1.0% seroprevalence), than for other patient care sites, including for new diagnoses, where 50 of 12,957 patients tested positive for HIV (0.4% seroprevalence). Of the 176 newly diagnosed patients, 166 of 173 (96.0%) patients who were still alive when testing was complete received their test results, and 148 of the 166 patients who were eligible for care (89.0%) were linked to care. Patients linked to X-TLC physicians did well with respect to the continuum of care: 77 of 123 (62.6%) patients achieved HIV viral load of <200 copies/milliliter. CONCLUSION: Lead organizations such as UCM were able to assist and oversee HIV screening and linkage to care for HIV patients diagnosed at community sites. HIV screening and linkage to care can be accomplished by incorporating standard testing for HIV into routine medical care.

Willingness of US men who have sex with men (MSM) to participate in Couples HIV Voluntary Counseling and Testing (CVCT).

BACKGROUND: We evaluated willingness to participate in CVCT and associated factors among MSM in the United States. METHODS: 5,980 MSM in the US, recruited through MySpace.com, completed an online survey March-April, 2009. A multivariable logistic regression model was built using being "willing" or "unwilling" to participate in CVCT in the next 12 months as the outcome. RESULTS: Overall, 81.5% of respondents expressed willingness to participate in CVCT in the next year. Factors positively associated with willingness were: being of non-Hispanic Black (adjusted odds ratio [aOR]: 1.5, 95% confidence interval [CI]: 1.2-1.8), Hispanic (aOR: 1.3, CI: 1.1-1.6), or other (aOR: 1.4, CI: 1.1-1.8) race/ethnicity compared to non-Hispanic White; being aged 18-24 (aOR: 2.5, CI: 1.7-3.8), 25-29 (aOR: 2.3, CI: 1.5-3.6), 30-34 (aOR: 1.9, CI: 1.2-3.1), and 35-45 (aOR: 2.3, CI: 1.4-3.7) years, all compared to those over 45 years of age; and having had a main male sex partner in the last 12 months (aOR: 1.9, CI: 1.6-2.2). Factors negatively associated with willingness were: not knowing most recent male sex partner's HIV status (aOR: 0.81, CI: 0.69-0.95) compared to knowing that the partner was HIV-negative; having had 4-7 (aOR: 0.75, CI: 0.61-0.92) or >7 male sex partners in the last 12 months (aOR: 0.62, CI: 0.50-0.78) compared to 1 partner; and never testing for HIV (aOR: 0.38, CI: 0.31-0.46), having been tested over 12 months ago (aOR: 0.63, CI: 0.50-0.79), or not knowing when last HIV tested (aOR: 0.67, CI: 0.51-0.89), all compared to having tested 0-6 months previously. CONCLUSIONS: Young MSM, men of color, and those with main sex partners expressed a high level of willingness to participate in couples HIV counseling and testing with a male partner in the next year. Given this willingness, it is likely feasible to scale up and evaluate CVCT interventions for US MSM.