Trajectories of Mental Distress Among US Women by Sexual Orientation and Racialized Group During the First Year of the COVID-19 Pandemic.

Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohort of US adults embedded within the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. We fit generalized estimating equation Poisson models to estimate trends in depressive and anxiety symptoms by sexual orientation (gay or lesbian, bisexual, mostly heterosexual, completely heterosexual); subsequent models explored further differences by racialized group (Asian, Black, Latine, White, other or unlisted). Results. Relative to completely heterosexual peers, gay or lesbian, bisexual, and mostly heterosexual women had a higher prevalence of depressive and anxiety symptoms at each study wave and experienced widening inequities over time. Inequities were largest for sexual minority women of color, although confidence intervals were wide. Conclusions. The COVID-19 pandemic may have exacerbated already-glaring mental health inequities affecting sexual minority women, especially those belonging to marginalized racialized groups. Future research should investigate structural drivers of these patterns to inform policy-oriented interventions. (Am J Public Health. 2024;114(5):511-522. https://doi.org/10.2105/AJPH.2024.307601).

Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men: A Latent Class Analysis of a Discrete Choice Experiment.

Daily pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV among gay, bisexual, and other men who have sex with men (GBMSM), although uptake remains suboptimal. By identifying the features of PrEP that appeal to various subgroups of GBMSM, this study aimed to improve PrEP uptake by examining preferences for PrEP use. Adults ≥ 18 years old in six New England states completed an online discrete choice experiment survey. A latent class analysis (LCA) was conducted to identify groups of GBMSM based on four attributes of choices for PrEP (cost, time, side effects, and mode of administration). Multinominal logistic regression was conducted to compare the association between sociodemographic and behavioral characteristics and class memberships. Data from 675 GBMSM were analyzed. A 3-Class model was selected as the best fit model. Class 1 (47.7% of individuals) was identified as having "no specific preferences". Class 2 (18.5% of individuals) were "Cost- and time-conscious" and were significantly more likely to be older, have prior sexually transmitted infection (STI) testing, have low household income, private insurance, and have extreme concerns about HIV risk than those with no specific preference (Class 1). Finally, Class 3 (34.1% of individuals) were "Side effects-conscious" and were more likely to have low income, private insurance, and have moderate and extreme concerns about HIV risk than those with no specific preference (Class 1). Findings indicate that outreach to GBMSM who have never used PrEP should emphasize low cost and short travel times to increase potential PrEP use.

Looking under the lamp-post: quantifying the performance of contact tracing in the United States during the SARS-CoV-2 pandemic.

Contact tracing forms a crucial part of the public-health toolbox in mitigating and understanding emergent pathogens and nascent disease outbreaks. Contact tracing in the United States was conducted during the pre-Omicron phase of the ongoing COVID-19 pandemic. This tracing relied on voluntary reporting and responses, often using rapid antigen tests due to lack of accessibility to PCR tests. These limitations, combined with SARS-CoV-2's propensity for asymptomatic transmission, raise the question "how reliable was contact tracing for COVID-19 in the United States"? We answered this question using a Markov model to examine the efficiency with which transmission could be detected based on the design and response rates of contact tracing studies in the United States. Our results suggest that contact tracing protocols in the U.S. are unlikely to have identified more than 1.65% (95% uncertainty interval: 1.62-1.68%) of transmission events with PCR testing and 1.00% (95% uncertainty interval 0.98-1.02%) with rapid antigen testing. When considering a more robust contact tracing scenario, based on compliance rates in East Asia with PCR testing, this increases to 62.7% (95% uncertainty interval: 62.6-62.8%). We did not assume presence of asymptomatic transmission or superspreading, making our estimates upper bounds on the actual percentages traced. These findings highlight the limitations in interpretability for studies of SARS-CoV-2 disease spread based on U.S. contact tracing and underscore the vulnerability of the population to future disease outbreaks, for SARS-CoV-2 and other pathogens.

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study.

BACKGROUND: Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. METHODS AND FINDINGS: We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015-2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state's population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in "percent college educated" was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher "percent Black/Latino/Indigenous" and higher "percent essential workers" had lower vaccine coverage (-0.8, 95% CI -1.3 to -0.3, p < 0.01; -5.5, 95% CI -7.3 to -3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between "median household income" and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. CONCLUSIONS: Eighteen months into MA's general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

Sexually Transmitted Infections Risk and Interstate Sexual Networks Among Men Who Have Sex With Men in New England.

ABSTRACT: By investigating relationships between sexual mobility and sexual transmitted infection (STI) risk factors among men who have sex with men, we found that STI history, number of sexual partners, and substance use are associated with increased odds of interstate sexual encounters, suggesting that interjurisdictional approaches to STI prevention are needed.

Minor Consent Laws for Sexually Transmitted Infection and Human Immunodeficiency Virus Services in the United States: A Comprehensive, Longitudinal Survey of US State Laws.

Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397-407. https://doi.org/10.2105/AJPH.2022.307199).

Optimizing Uptake of Long-Acting Injectable Pre-exposure Prophylaxis for HIV Prevention for Men Who Have Sex with Men.

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool. Long-acting injectable PrEP (LAI-PrEP) offers another opportunity to reduce HIV. However, how at-risk individuals will consider LAI-PrEP over other modes of administration is unclear. We conducted a discrete choice experiment on preferences for PrEP among a sample of N = 688 gay, bisexual, and other men who have sex with men (GBMSM). We analyzed preferences for mode of administration, side-effects, monetary cost, and time cost using a conditional logit model and predicted preference for PrEP options. LAI-PrEP was preferred, despite mode of administration being the least important PrEP attribute. Side-effects were the most important attribute influencing preferences for PrEP (44% of decision); costs were second-most-important (35% of decision). PrEP with no side-effects was the most important preference, followed by monthly out-of-pocket costs of $0. Practitioners and policymakers looking to increase PrEP uptake should keep costs low, communicate clearly about PrEP side-effects, and allow the use of patient-preferred modes of PrEP administration, including LAI-PrEP.

RESUMEN: La profilaxis prexposición (PrEP) es una herramienta de prevención del VIH muy eficaz. La PrEP inyectable de acción prolongada (LAI-PrEP) ofrece otra oportunidad para reducir el VIH. Sin embargo, no está claro cómo las personas en riesgo considerarán LAI-PrEP sobre otros modos de administración. Realizamos un experimento de elección discreta sobre las preferencias por la PrEP entre una muestra de N = 688 hombres homosexuales, bisexuales y otros hombres que tienen sexo con hombres (GBMSM). Analizamos las preferencias por el modo de administración, los efectos secundarios, el costo monetario y el costo del tiempo mediante un modelo logit condicional y la preferencia prevista por las opciones de PrEP. Se prefirió LAI-PrEP, a pesar de que el modo de administración es el atributo de PrEP menos importante. Los efectos secundarios fueron el atributo más importante que influyó en las preferencias por la PrEP (44% de la decisión); los costos fueron los segundos más importantes (35% de la decisión). La PrEP sin efectos secundarios fue la preferencia más importante, seguida de costos de bolsillo mensuales de $0. Los médicos y legisladores que buscan aumentar la aceptación de la PrEP deben mantener los costos bajos, comunicar claramente los efectos secundarios de la PrEP y permitir el uso de los modos de administración de la PrEP preferidos por los pacientes, incluido LAI-PrEP.

Same-Sex Marriage Laws, Provider-Patient Communication, and PrEP Awareness and Use Among Gay, Bisexual, and Other Men Who have Sex with Men in the United States.

State-level structural stigma and its consequences in healthcare settings shape access to pre-exposure prophylaxis (PrEP) for HIV prevention among gay, bisexual, and other men who have sex with men (GBMSM). Our objective was to assess the relationships between same-sex marriage laws, a measure of structural stigma at the state level, provider-patient communication about sex, and GBMSM awareness and use of PrEP. Using data from the Fenway Institute's MSM Internet Survey collected in 2013 (N = 3296), we conducted modified Poisson regression analyses to evaluate associations between same-sex marriage legality, measures of provider-patient communication, and PrEP awareness and use. Living in a state where same-sex marriage was legal was associated with PrEP awareness (aPR 1.27; 95% CI 1.14, 1.41), as were feeling comfortable discussing with primary care providers that they have had sex with a man (aPR 1.63; 95% CI 1.46, 1.82), discussing with their primary care provider having had condomless sex with a man (aPR 1.65; 95% CI 1.49, 1.82), and discussing with their primary care provider ways to prevent sexual transmission of HIV (aPR 1.39; 95% CI 1.26, 1.54). Each of these three measures of provider-patient communication were additionally associated with PrEP awareness and use. In sum, structural stigma was associated with reduced PrEP awareness and use. Policies that reduce stigma against GBMSM may help to promote PrEP and prevent HIV transmission.

Recommendations for Using Causal Diagrams to Study Racial Health Disparities.

There have been calls for race to be denounced as a biological variable and for a greater focus on racism, instead of solely race, when studying racial health disparities in the United States. These calls are grounded in extensive scholarship and the rationale that race is not a biological variable, but instead socially constructed, and that structural/institutional racism is a root cause of race-related health disparities. However, there remains a lack of clear guidance for how best to incorporate these assertions about race and racism into tools, such as causal diagrams, that are commonly used by epidemiologists to study population health. We provide clear recommendations for using causal diagrams to study racial health disparities that were informed by these calls. These recommendations consider a health disparity to be a difference in a health outcome that is related to social, environmental, or economic disadvantage. We present simplified causal diagrams to illustrate how to implement our recommendations. These diagrams can be modified based on the health outcome and hypotheses, or for other group-based differences in health also rooted in disadvantage (e.g., gender). Implementing our recommendations may lead to the publication of more rigorous and informative studies of racial health disparities.

A database of US state policies to mitigate COVID-19 and its economic consequences.

BACKGROUND: Since COVID-19 first appeared in the United States (US) in January 2020, US states have pursued a wide range of policies to mitigate the spread of the virus and its economic ramifications. Without unified federal guidance, states have been the front lines of the policy response. MAIN TEXT: We created the COVID-19 US State Policy (CUSP) database ( https://statepolicies.com/ ) to document the dates and components of economic relief and public health measures issued at the state level in response to the COVID-19 pandemic. Documented interventions included school and business closures, face mask mandates, directives on vaccine eligibility, eviction moratoria, and expanded unemployment insurance benefits. By providing continually updated information, CUSP was designed to inform rapid-response, policy-relevant research in the context of the COVID-19 pandemic and has been widely used to investigate the impact of state policies on population health and health equity. This paper introduces the CUSP database and highlights how it is already informing the COVID-19 pandemic response in the US. CONCLUSION: CUSP is the most comprehensive publicly available policy database of health, social, and economic policies in response to the COVID-19 pandemic in the US. CUSP documents widespread variation in state policy decisions and implementation dates across the US and serves as a freely available and valuable resource to policymakers and researchers.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality.

The coronavirus disease 2019 (COVID-19) pandemic and associated economic crisis have placed millions of US households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals' ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in US states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 US states that instituted eviction moratoriums, followed from March 13 to September 3, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and expiration was associated with a doubling of COVID-19 incidence (incidence rate ratio = 2.1; 95% confidence interval (CI): 1.1, 3.9) and a 5-fold increase in COVID-19 mortality (mortality rate ratio = 5.4; CI: 3.1, 9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI: 365,200, 502,200) and 10,700 excess deaths (CI: 8,900, 12,500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.

State-level prescription drug monitoring program mandates and adolescent injection drug use in the United States, 1995-2017: A difference-in-differences analysis.

BACKGROUND: Prescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). Few studies have evaluated strategies for preventing opioid or IDU initiation among adolescents. We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates. METHODS AND FINDINGS: This difference-in-differences analysis used biannual Youth Risk Behavioral Surveillance System (YRBSS) data representative of adolescents 17 to 18 years old across 47 states from 1995 to 2017. We compared changes in adolescent IDU in 18 states with and 29 states without PDMP mandates. Among 331,025 adolescents, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, and 14.6% as Hispanic. Overall, 3.5% reported IDU during the 2 years prior to PDMP mandates. In the final multivariable difference-in-differences model, we included individual age, sex, and race/ethnicity, as well as state and year as covariates from the YRBSS. We also included state- and year-specific poverty rates based on US Census Bureau data. Additionally, we controlled for state implementation of (non-mandated) PDMPs before states subsequently implemented mandates and pill mill laws. We conducted several sensitivity analyses, including repeating our main analysis using a logistic, rather than linear, model, and with a lead indicator on PDMP mandate implementation, a lag indicator, and alternative policy implementation dates. PDMP mandates were associated with a 1.5 percentage point reduction (95% CI -2.3 to -0.6 percentage points; p = 0.001) in adolescent IDU, on average over the years following mandate implementation, a relative reduction of 42.9% (95% CI -65.7% to -17.1%). The association of PDMP mandates with this reduction persisted at least 4 years beyond implementation. Sensitivity analyses were consistent with the main results. Limitations include the multi-stepped causal pathway from PDMP mandate implementation to changes in IDU and the potential for omitted state-level time-varying confounders. CONCLUSIONS: Our analysis indicated that PDMP mandates were associated with a reduction in adolescent IDU, providing empirical evidence that such mandates may prevent adolescents from initiating IDU. Policymakers might consider PDMP mandates as a potential strategy for preventing adolescent IDU.

Human Immunodeficiency Virus (HIV) Viral Suppression After Transition From Having No Healthcare Coverage and Relying on Ryan White HIV/AIDS Program Support to Medicaid or Private Health Insurance.

Among 1942 persons with human immunodeficiency virus (HIV) without healthcare coverage in 2012-2015, transitioning to Medicaid (adjusted prevalence ratio, 0.95 [0.87, 1.04]) or to private health insurance (1.04 [0.95, 1.13]) was not associated with a change in consistent HIV viral suppression compared to continued reliance on the Ryan White HIV/AIDS Program.

Gonorrhoea and chlamydia in persons with HIV: number needed to screen.

OBJECTIVES: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. METHODS : We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). RESULTS : A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24). CONCLUSIONS: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years).

Changes in Patient Visits After the Implementation of Insurance Billing at a Sexually Transmitted Diseases Clinic in a Medicaid Expansion State.

BACKGROUND: Medicaid expansion has led to unique opportunities for sexually transmitted disease (STD) clinics to improve the sustainability of services by billing insurance. We evaluated changes in patient visits after the implementation of insurance billing at a STD clinic in a Medicaid expansion state. METHODS: The Rhode Island STD Clinic offered HIV/STD screening services at no cost to patients until October 2016, when insurance billing was implemented. Care for uninsured patients was still provided for free. We compared the clinic visits in the preinsurance period with the postinsurance period using t-tests, Poisson regressions, and a logistic regression. RESULTS: A total of 5560 patients were seen during the preinsurance (n = 2555) and postinsurance (n = 3005) periods. Compared with the preinsurance period, the postinsurance period had a significantly higher average number of patient visits/month (212.9 vs. 250.4, P = 0.0016), including among patients who were black (36.8 vs. 50.3, P = 0.0029), Hispanic/Latino (50.8 vs. 65.8, P = 0.0018), and insured (106.3 vs. 130.1, P = 0.0025). The growth rate of uninsured (+0.10 vs. +4.11, P = 0.0026) and new patients (-4.28 vs. +1.07, P = 0.0007) also increased between the two periods. New patients whose first visit was before the billing change had greater odds (adjusted odds ratio, 2.68, 95% confidence interval, 2.09-3.44; P < 0.0001) of returning compared with new patients whose first visit was after the billing change. CONCLUSIONS: Implementation of insurance billing at a publicly funded STD clinic, with free services provided to uninsured individuals, was associated with a modest increase in patient visits and a decline in patients returning for second visits.

Racial and Ethnic Disparities in HIV Pre-exposure Prophylaxis Awareness Among Men Who have Sex with Men.

Racial and ethnic disparities exist in HIV pre-exposure prophylaxis (PrEP) awareness and care. We evaluated how racial and ethnic disparities in PrEP awareness among MSM presenting to a sexually transmitted disease clinic changed from 2013 to 2016. Among 1243 MSM (68% non-Hispanic White, 22% Hispanic, and 10% non-Hispanic Black), PrEP awareness increased overall, but awareness was lower among Hispanic and non-Hispanic Black MSM relative to non-Hispanic White MSM. Awareness converged among non-Hispanic Black and White MSM by 2016, but remained consistently lower among Hispanic MSM. Improved efforts are needed to address disparities in PrEP awareness.

Structural stigma and sexual orientation-related reproductive health disparities in a longitudinal cohort study of female adolescents.

INTRODUCTION: Sexual minority female adolescents have worse reproductive health than heterosexual peers; research into the origins of these disparities is limited. Our objective was to examine whether exposure to structural stigma (e.g., societal-level conditions, cultural norms, institutional policies/practices that constrain the lives of the stigmatized) is associated with sexually transmitted infections (STIs) and teen pregnancy in sexual minority female adolescents. METHODS: Longitudinal data were utilized from 6581 female adolescents aged 9-14 years at baseline (1996) in the U.S.-based Growing Up Today Study and followed through 2007. We used a previously-validated structural stigma scale composed of four state-level items (e.g., employment non-discrimination policies) with one item added relevant to reproductive health. Risk ratios were generated from multivariate models. RESULTS: Sexual minority female adolescents were significantly more likely than heterosexual peers to have an STI diagnosis and teen pregnancy. Sexual minority female adolescents living in states with lower, compared to higher, levels of structural stigma were significantly less likely to have an STI diagnosis, after adjustment for individual- and state-level covariates (relative risk [RR] = 0.70, 95% confidence interval [CI]: 0.51, 0.97). In contrast, among completely heterosexual adolescents, structural stigma was not associated with STI diagnosis. Teen pregnancy risk-a rare outcome-did not vary by level of structural stigma for sexual minority or heterosexual adolescents. CONCLUSIONS: Structural stigma is a potential risk factor for adverse reproductive health among sexual minority female adolescents. Changing laws and policies to be inclusive of all people, regardless of sexual orientation, can help alleviate entrenched reproductive health disparities.

Race and Ethnicity of Reproductive-Age Females Affected by US State Abortion Bans.

This study compares the race and ethnicity of reproductive-age females between states that implemented restrictive abortion policies after the Dobbs v Jackson Women's Health Organization decision and states that did not.

A Network Analysis of Sexually Transmitted Diseases and Online Hookup Sites Among Men Who Have Sex With Men.

BACKGROUND: Sexually transmitted diseases (STDs) are increasing among gay, bisexual, and other men who have sex with men (MSM). Little is known about the use of websites and mobile phone applications to meet sexual partners ("hookup sites") and association with STD diagnoses. METHODS: We performed a demographic and behavioral assessment of 415 MSM presenting to the Rhode Island STD clinic. Bivariate and multivariable analyses assessed associations between using hookup sites and testing positive for syphilis, gonorrhea, or chlamydia. Venue-based affiliation networks were created to evaluate hookup sites and their association with STD diagnoses. RESULTS: Among 415 MSM, 78% reported meeting a partner online in the last 12 months, and 25% tested positive for at least one STD. Men who met partners online were more likely to be white (67% vs. 54%, P = 0.03) and have more than 10 lifetime partners (87% vs. 58%, P < 0.05). The most commonly used hookup sites included Grindr (78%), Scruff (35%), and Tinder (22%). In the multivariable analysis, only Scruff use was associated with testing positive for an STD (odds ratio, 2.28; 95% confidence interval, 1.09-4.94). However, among men who met partners online, 75% of men diagnosed as having an STD had met a sexual partner on Grindr, including 100% of those who were diagnosed as having gonorrhea. CONCLUSIONS: Use of hookup sites was nearly ubiquitous among MSM undergoing STD screening. Specific hookup sites were significantly associated with STD diagnoses among MSM. Greater efforts are needed to promote STD screening and prevention among MSM who meet partners online.