FORWARD: Building a Model to Hold Schools of Public Health Accountable for Antiracism Work.

Schools of public health have increasingly adopted programs, praxis, and competencies for antiracist work. Fighting Oppression, Racism and White Supremacy through Action, Research and Discourse (FORWARD) was founded to accelerate antiracist work at the Columbia University Mailman School of Public Health in New York City. Seven action corps reporting to an accountability cabinet were established with 183 participants. FORWARD achieved progress across five core pillars. We describe how an iterative, dynamic structure and explicit framework for accountability can guide future antiracism work. (Am J Public Health. 2023;113(10):1086-1088. https://doi.org/10.2105/AJPH.2023.307356).

Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support.

IMPORTANCE: Initial guidelines recommended prompt endotracheal intubation rather than non-invasive ventilation (NIV) for COVID-19 patients requiring ventilator support. There is insufficient data comparing the impact of intubation versus NIV on patient-centered outcomes of these patients. OBJECTIVE: To compare all-cause 30-day mortality for hospitalized COVID-19 patients with respiratory failure who underwent intubation first, intubation after NIV, or NIV only. DESIGN: Retrospective study of patients admitted in March and April of 2020. SETTING: A teaching hospital in Brooklyn, New York City. PARTICIPANTS: Adult COVID-19 confirmed patients who required ventilator support (non-invasive ventilation and/or endotracheal intubation) at discretion of treating physician, were included. EXPOSURES: Patients were categorized into three exposure groups: intubation-first, intubation after NIV, or NIV-only. PRIMARY OUTCOME: 30-day all-cause mortality, a predetermined outcome measured by multivariable logistic regression. Data are presented with medians and interquartile ranges, or percentages with 95% confidence intervals, for continuous and categorical variables, respectively. Covariates for the model were age, sex, qSOFA score ≥ 2, presenting oxygen saturation, vasopressor use, and greater than three comorbidities. A secondary multivariable model compared mortality of all patients that received NIV (intubation after NIV and NIV-only) with the intubation-first group. RESULTS: A total of 222 were enrolled. Overall mortality was 77.5% (95%CI, 72-83%). Mortality for intubation-first group was 82% (95%CI, 73-89%; 75/91), for Intubation after NIV was 84% (95%CI, 70-92%; 37/44), and for NIV-only was 69% (95%CI, 59-78%; 60/87). In multivariable analysis, NIV-only was associated with decreased all-cause mortality (odds ratio [OR]: 0.30, 95%CI, 0.13-0.69). No difference in mortality was observed between intubation-first and intubation after NIV. Secondary analysis found all patients who received NIV to have lower mortality than patients who were intubated only (OR: 0.44, 95%CI, 0.21-0.95). CONCLUSIONS & RELEVANCE: Utilization of NIV as the initial intervention in COVID-19 patients requiring ventilatory support is associated with significant survival benefit. For patients intubated after NIV, the mortality rate is not worse than those who undergo intubation as their initial intervention.

The impact of obesity on COVID-19 complications: a retrospective cohort study.

BACKGROUND: Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19. OBJECTIVE: To elucidate the association between obesity and COVID-19 outcomes. DESIGN: Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020. SETTING: SUNY Downstate Health Sciences University, a COVID-only hospital in New York. PARTICIPANTS: In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50-24.99), overweight (BMI 25.00-29.99), and obese (BMI ≥ 30.00). MEASUREMENTS: Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI). RESULTS: There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1-1.9) and obese groups (RR 1.3, 95% CI 1.0-1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2-3.3) and obese groups (RR 2.4, 95% CI 1.5-4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0, P = 0.03), but not in females (RR 1.2, 95% CI 0.77-1.9, P = 0.40). CONCLUSION: This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.

Adjournment in Community HIV Prevention: Exploring Transitions in Community-Academic Partnerships.

Barbershop-based interventions have been increasingly implemented as a means to support culturally relevant and community-accessible health promotion and disease prevention efforts. Specifically, in neighborhoods of Brooklyn, New York, with high HIV seroprevalence rates, barbers have volunteered to support an initiative to help reduce sexual risk behavior. After implementing the Barbershop Talk With Brothers program for 5 years, we explored how program participation has affected barbers' HIV prevention and counseling skills to promote their clients' health, and assessed their views of next stages of the community-academic partnership, once the specific project ended. Through employing rigorous qualitative research methods with personnel at participating barbershops, key results include that although barbers self-identify as community leaders and even as health educators, they want ongoing support in educating customers about other topics like nutrition and physical activity, including upstream social determinants of health, such as housing and employment. They are also concerned regarding how best to support continuity of efforts and maintenance of partnerships between projects. These findings provide insight toward adjourning community-based participatory research projects, which can inform other academic researchers, organizations, and businesses that partner with community members.

HIV Prevention for Black Heterosexual Men: The Barbershop Talk with Brothers Cluster Randomized Trial.

Objectives. To identify the impact of a strengths-focused HIV prevention program among high-risk heterosexual Black men. Methods. Barbershops in Brooklyn, New York, neighborhoods with high rates of heterosexually transmitted HIV were randomized to the intervention or an attention control program. Men were recruited from barbershops between 2012 and 2016 and participated in a single small group, peer-led session focused on HIV risk reduction skills and motivation, community health empowerment, and identification of personal strengths and communication skills. The outcome was defined as 1 or more acts of condomless anal or vaginal sex in the preceding 90 days at a 6-month interview. Results. Fifty-three barbershops (24 intervention, 29 control) and 860 men (436 intervention, 424 control) were recruited; follow-up was completed by 657 participants (352 intervention, 305 control). Intervention exposure was associated with a greater likelihood of no condomless sex (64.4%) than control group participation (54.1%; adjusted odds ratio = 1.61; 95% confidence interval = 1.05, 2.47). Conclusions. Program exposure resulted in reduced sexual risk behaviors, and the program was acceptable for administration in partnership with barbershops. Public Health Implications. Dissemination of similar programs could improve public health in communities with high rates of HIV attributable to heterosexual transmission.

A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population.

BACKGROUND: Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. METHODS: The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2-19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. RESULTS: The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was - 3.0 (95% CI: - 5.0, - 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was - 0.15 (95% CI: - 0.2, - 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of - 15.3 mmHg (p < 0.0001) and - 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and - 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043). CONCLUSIONS: Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.

Correction to: Introducing Students of Color to Health Sciences Research: An Evaluation of the Health Disparities Summer Internship Program.

The original version of this article unfortunately contained a mistake.

Introducing Students of Color to Health Sciences Research: An Evaluation of the Health Disparities Summer Internship Program.

The goal of this analysis is to assess the effectiveness of a summer program designed to introduce high school students of color to health disparities research. A total of 73 students (69.9% Black, 68.5% female and 80.6% either junior/senior) participated in the 4-week Health Disparities Summer Internship Program (HDSIP) during the years 2012-2015. Students attended lectures covering topics such as health disparities, community-based participatory research (CBPR), immigrant health, and policy and advocacy. While working with community-based organizations, students gained hands-on experience related to issues discussed in class. Students completed research projects and provided suggestions for health policy change. Pre/post surveys were completed to evaluate the program. After participating in the HDSIP, students demonstrated heightened awareness of the social determinants of health, especially in regards to racial discrimination (p = .023); borderline statistically significant increases were shown for income (p = .082), community safety (p = .058), and healthcare access (p = .076). Most students (82.1%) planned to advocate for changes in their community; an increase from the initial 65.2% (p = .052). About nine out of ten students (89.6%) reported being satisfied with the summer program; the majority reported improvement in analytical skills, CBPR methods, and oral/communication skills. Increasing diversity in the health workforce has widely been proposed as a means of addressing health disparities. Introducing minority students to health professions can serve as a catalyst for lasting changes in health outcomes. The HDSIP has increased students' awareness of social determinants of health and has fostered their interest in improving the health of minority populations.

Correction to: Examining the Associations Between Immigration Status and Perceived Stress Among HIV-Infected and Uninfected Women.

The original version of this article unfortunately published with the incorrect article title.

Examining the Associations Between Immigration Status and Perceived Stress Among HIV-Infected and Uninfected Women.

Stress is associated with poor mental and physical health outcomes. In the United States (U.S.), little is known about perceived stress and associated factors among HIV-infected and immigrant women. Here, we examine these associations within a sample of 305 HIV-infected and uninfected, U.S.-born and non-U.S.-born women who were part of the Women's Interagency HIV Study (WIHS) at three sites (New York, Chicago, and Los Angeles). Perceived stress was measured using the 10-item Perceived Stress Scale (PSS-10); HIV infection was serologically confirmed, and nativity status was self-reported. Bivariate and multivariable logistic regression were used to identify associations with perceived stress. The majority of participants were U.S.-born (232, 76.1%) and were HIV-infected (212, 68.5%). Mutlivariable analyses found the odds of perceived stress to be lower for those employed [adjusted odds ratio (AOR) = 0.31, 95% confidence interval (CI) = (0.15-0.63)], with high levels of social support (AOR = 0.45, 95% CI 0.26-0.79), and HIV-infected (AOR = 0.44, 95% CI 0.24-0.79). Perceived stress was positively associated with living in unstable housing (AOR = 2.54, 95% CI 1.17-5.51). Here, immigration status was not associated with perceived stress. We identified stress to be higher among women who were unemployed, unstably housed, or who had low social support. Community-based programs should tailor interventions to include stress reduction strategies for participants with identified risk factors to improve mental and physical health outcomes.

A Comparison of Alternative Tobacco Product Usage, Knowledge and Beliefs Between the New York City Lesbian, Gay, Bisexual, and Transgendered Community and Heterosexuals.

Within the United States, alternative tobacco product (ATP) and varies by geographic region, gender and age. Few articles have been published on the usage of these products among the lesbian, gay, bisexual, transgender or queer (LGBTQ) population. A web-based anonymous survey administered through Google Forms, was used to collect data on current tobacco usage, knowledge and beliefs from adult heterosexuals, homosexuals, bisexuals and transgendered persons residing in New York City from May 2014 to July 2014. Sixty-four individuals completed the survey; 30 were heterosexual and 32 identified as either lesbian, gay, bisexual, transgender or queer. Heterosexuals were found to have tried cigarettes, on average, almost a year before the LGBTQ respondents. Social networks were influential to LGBTQ respondents for an introduction to smoking; 48.00% were introduced by friends, 28.00% by family, 12.00% by a significant other and 9.09% by someone else. For heterosexuals, 73.68% reported that friends introduced them to smoking. More heterosexuals reported trying hookah (N = 10), snus (N = 4) and roll your own cigarettes (N = 5). On average respondents knew of eight different tobacco products, regardless of sexual identity. To our knowledge, we present for the first time a comparison of people who tried, current and former users of ATPs, beliefs and knowledge about ATPs, and sources of knowledge of ATPs by sexual identity from NYC. More research is needed to examine the impact of social networks and the upcoming FDA regulations on ATPs have on the overall prevalence of usage among the LGBTQ community.

Diverse ecological relations of male gametophyte populations in stylar environments.

PREMISE OF STUDY: Pollen on a stigma represents a local population of male gametophytes vying for access to female gametophytes in the associated ovary. As in most populations, density-independent and density-dependent survival depend on intrinsic characteristics of male gametophytes and environmental (pistil) conditions. These characteristics and conditions could differ among flowers, plants, populations, and species, creating diverse male-gametophyte population dynamics, which can influence seed siring and production. METHODS: For nine species, we characterized the relations of both the mean and standard deviation of pollen-tube number at the style base to pollen receipt with nonlinear regression. Models represented asymptotic or peaked relations, providing information about the incidence and magnitude of facilitation and competition, the spatial and temporal characteristics of competition, and the intensity and relative timing of density-independent mortality. KEY RESULTS: We infer that pollen tubes of most species competed sequentially, their tips ceasing growth if earlier tubes had depleted stylar space/resources; although two species experienced simultaneous competition. Tube success of three species revealed positive density dependence (facilitation) at low density. For at least four species, density-independent mortality preceded competition. Tube success varied mostly within plants, rather than among plants or conspecific populations. Pollen quality influenced tube success for two of three species; affecting density-independent survival in one and density-dependent performance in the other. CONCLUSIONS: The diverse relations of pollen-tube success to pollen receipt evident among just nine species indicate significant contributions of the processes governing pollen germination and tube growth to the reproductive diversity of angiosperms.

Perceived financial need and sexual risk behavior among urban, minority patients following sexually transmitted infection diagnosis.

BACKGROUND: Previous studies have shown that racial/ethnic and gender disparities in human immunodeficiency virus (HIV)/sexually transmitted infections (STI) may be due in part to factors such as poverty and income-inequality. Little has been published in the HIV/STI literature on the effect of the perception of having unmet basic needs on sexual risk behavior. METHODS: Data on perceived financial need and sexual risk were collected as part of a behavioral intervention aimed at promoting STI partner notification and reducing sexual behavior among minority patients presenting for care at 1 of 2 STI treatment centers in Brooklyn, NY, between January 2002 and December 2004. Data from 528 participants collected at the 6-month follow-up visit were used for the current study. RESULTS: Forty-three percent of participants were categorized as having unmet needs. Those with unmet needs were more likely to report unprotected anal or vaginal sex (unprotected anal or vaginal intercourse [UAVI]; 62%) versus those who had met needs (53%). This association was significant (adjusted odds ratio=1.28; 95% confidence interval=1.04-1.53), after controlling for age, sex, site of recruitment, intervention group membership, and country of origin. Stratified analyses indicated that, in the group that did not receive the intervention, there was a statistically significant interaction between sex and basic needs such that women with unmet needs were more likely to report any UAVI (78%) than those with met needs (54%) (adjusted odds ratio=1.18; 95% confidence interval=1.07-1.24). No such relationship was detected for men in this sample. CONCLUSIONS: The significant association between perceived unmet needs and UAVI appears to be particularly relevant for women. These findings provide preliminary evidence that HIV/STI intervention components that seek to directly deal with issues of reduction in partner conflict might be beneficial to women with high perceived unmet basic needs, and for whom a potential dissolution of a relationship may represent a further loss in ability to meet basic needs.

Acute coronary syndrome: factors affecting time to arrival in a diverse urban setting.

This study seeks to better understand how individuals of different cultural/ethnic backgrounds in an urban setting assess the signs and symptoms of Acute Coronary Syndrome (ACS) and the ensuing decision to take urgent action. Few studies exist which examine these differences and enhance understanding of how to address these differences and, ultimately, reduce morbidity and mortality from ACS. Face-to-face interviews were conducted with a convenience sample of urban patients of different cultural and socioeconomic backgrounds regarding their actions upon recognition of ACS signs and symptoms. Patients (423) with presumed or diagnosed ACS were interviewed within 12 h of arrival at the urban emergency rooms. Among the different cultural groups, Haitians delayed the longest (median) from symptom onset to hospital arrival (8.24 h), followed by Caribbeans (7.83 h), African Americans (6.62 h) and Hispanics (6.00 h). Although these delay intervals were not statistically significant across groups, each racial/ethnic group sought care well beyond the recommended time period of 3 h after initial recognition of ACS signs and symptoms. Among all the cultural groups, the two key factors motivating early arrival were being employed and taking positive actions. ACS symptom perception by different cultural groups appears to play an important role in the decision to seek emergency treatment. This is an area that has not been widely studied among or within different cultural/ethnic groups. As such, further research is needed to delineate these concepts and actions and to provide opportunities for appropriate education.

Work Characteristics, Body Mass Index, and Risk of Obesity: The National Quality of Work Life Survey.

OBJECTIVES: To examine work characteristics in relation to body mass index (BMI) and risk of obesity. METHODS: We analyzed data from 1150 participants working 20+ h week-1 from the 2014 National NIOSH Quality of Work Life Survey, based on a representative sample of US workers. We used multiple linear regression for BMI and multiple logistic regression for obesity to estimate associations with 19 different work characteristics plus one set of occupational categories controlling for age, gender, race/ethnicity, education, marital status, job physical exertion, and television watching. RESULTS: We found significant positive linear associations between BMI and night shift (versus day shift) schedule (B = 2.28, P = 0.008) and blue-collar (versus management/professional) work (B = 1.75, P = 0.008). Night shift schedule [odds ratio (OR) = 2.19, P = 0.029], sales/office work (OR = 1.55, P = 0.040), and blue-collar work (OR = 2.63, P = 0.006) were associated with increased risk of obesity versus 'healthy weight'. No other statistically significant associations between work characteristics and BMI or obesity were observed. CONCLUSIONS: Night shift schedule and blue-collar work were related to increased BMI and obesity risk in US workers in 2014. Identifying risk factors in blue-collar work and redesigning jobs to reduce those risk factors, and reducing night shift work, could play a role in reducing the prevalence of obesity in the USA.

HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men.

In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors among Black heterosexual men in Brooklyn, New York. Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33 years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.

Association between Urinary Triclosan and Serum Testosterone Levels in U.S. Adult Males from NHANES, 2011-2012.

Triclosan was introduced into the market in the 1970s and has since been used as an antimicrobial agent in a diverse array of consumer and personal care products. Although it has been widely used over a number of years, there is growing concern and debate over its safety and efficacy and its potential as an endocrine disruptor. Although prior animal toxicology studies have shown an association between triclosan and decreased testosterone levels, human studies have been limited, particularly for adult men. Using the National Health and Nutrition Examination Survey data (NHANES, 2011-2012), we examined the association of urinary triclosan on testosterone levels in adult men 18-65 years of age. Multivariable linear regression analysis failed to show an association between triclosan and serum testosterone (ß = 0.0003, p = 0.98, 95% CI = -0.024, 0.025). The results suggest there is no association or that triclosan concentrations are too low to cause a significant impact on testosterone levels. Additionally, longitudinal studies would provide a more comprehensive understanding of the direction of change and magnitude of causal relationships over time.

Antihypertensive Medications and Change in Stages of Chronic Kidney Disease.

OBJECTIVES: The goal of this study is to estimate the change in the relationships between use of five classes of antihypertensive medications and stages of Chronic Kidney Disease (CKD) in American adults treated for hypertension. METHODS: The US National Health and Nutrition Examination Survey (NHANES) data sets 1999-2012 were used with the final analytical sample of 3,045 participants. Population prevalence estimates were calculated using the NHANES survey design weights. Inferential analyses were done with binomial logistic regression models. RESULTS: The odds of advanced (3, 4, and 5 combined) versus early CKD stages (1 and 2 combined) were significantly higher among patients treated with Angiotensin Receptor Blockers (ARB) versus those not treated with ARB in 2009-2012 (adjusted odds ratio (95% confidence interval) = 2.52 (1.32-4.80)). From 1999 to 2012, the increase in this relationship was significant (p = 0.0023) for users of ARB polytherapy and in users of ARB in patients with albuminuria (p = 0.0031). CONCLUSION: Aggressive pharmacological management of hypertension with ARB as add-on therapy may have accelerated kidney damage in American adults. However, prospective longitudinal studies are needed to establish proper temporal sequence in this relationship.

Stress, Socializing, and Other Motivations for Smoking Among the Lesbian, Gay, Bisexual, Transgender, and Queer Community in New York City.

PURPOSE: This study contributes to the emerging literature on lesbian, gay, bisexual, transgendered, and queer (LGBTQ) health disparities and tobacco use by examining the motivations for smoking among the New York City (NYC) LGBTQ population. APPROACH: We used grounded theory and blended methods from 3 grounded theorists-Strauss, Corbin, and Charmaz-for data collection, coding, and analysis. SETTING: NYC has extensive legislation to prevent smoking; however, the current smoking prevalence of homosexuals is double that of heterosexuals. PARTICIPANTS: Study participants were leaders from 23 NYC LGBTQ organizations. Leaders were chosen to establish a relationship with community and to ensure cultural sensitivity. Eligibility criteria required holding a leadership position in an organization serving the NYC LGBTQ community. METHODS: Interviews were transcribed verbatim and uploaded into Dedoose for analysis. An initial code list was developed from the interview guide. Key themes were identified as the themes with the most number of quotes. RESULTS: Three key themes emerged from our interviews: image, socializing, and stress. Smoking was reported to be a socialization aid and a maladaptive coping technique for stress arising from interactions of conflicting identities. CONCLUSION: Future smoking cessation interventions among the LGBTQ community should equip smokers with healthy coping mechanisms that address the stressors that arise from the intersections of smokers' many identities.

Perceived effectiveness of antiretroviral therapy, self-rated health and treatment adherence among HIV-positive people who inject drugs in Estonia.

The HIV epidemic in Estonia affects the population of people who inject drugs (PWID) the most, but factors associated with adherence to antiretroviral therapy (ART) among PWID have not been thoroughly examined in Estonia, with particularly limited data regarding beliefs and attitudes of PWID. The objective of this study was to explore the association between ART adherence and individual beliefs, perceived effectiveness of ART, and self-rated health in particular, in this specific population. The study used baseline survey data from a longitudinal intervention study of HIV prevention among PWID in Estonia, in which 107 HIV-infected participants reported current use of ART. Current adherence was measured through the use of a visual analog scale. Approximately half (49%) of the participants reported optimal (≥95%) adherence. The vast majority (81%) believed in the effectiveness of ART. Less than a quarter of the participants (22%) rated their health as good or very good, and a half (52%) reported average health. Individual beliefs and self-reported health were not associated with ART adherence in both bivariate and multivariable analyses. Participants with problem drinking reported significant suboptimal adherence to ART (adjusted odds ratio [AOR] 0.42, 95% CI 0.19-0.97). Daily injection drug use was also associated with suboptimal adherence (AOR 0.34, 95% CI 0.13-0.91). Problem drinking has not been commonly reported as a factor of suboptimal ART adherence among PWID; further research would be useful to identify the pathways that might be involved.