Julie M. Croff

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.

How gay and bisexual men compensate for the lack of meaningful sex education in a socially conservative state

Abstract The information shared in schools on sex education in the USA is highly variable depending on the state and sometimes city in which a student lives. Gay and bisexual students living in a socially conservative, primarily rural state such as Oklahoma often receive little information about sexual health information that pertains to their behaviours unless it is discussing the dangers of sex. Using a qualitative approach, 20 gay and bisexual men currently residing in Oklahoma completed semi-structured interviews about their experiences with sex education and alternate ways to compensate for lack of information provided. Participants noted an awareness of the lack of meaningful sex education or if it was offered, a primary focus on abstinence-only until marriage heteronormative curricula. Participants described various ways they compensated for lack of sex education including accessing pornography and information from the internet. With the current socio-political environment of Oklahoma, it is unlikely wholesale changes to the sex education curricula can be made. The importance of public health professionals using the internet and peer educators to deliver inclusive and informative sexual health information remains salient and viable for men who reside in socio-politically conservative areas like Oklahoma.

Examining health disparities by gender: A multimorbidity network analysis of electronic medical record

PROBLEM Multimorbidity health disparities have not been well examined by gender. Co-occurring diseases may be mutually deleterious, co-occurring independently, or co-occurring from a common antecedent. Diseases linked by a common antecedent may be caused by biological, behavioral, social, or environmental factors. This paper aims to address the co-occurrences of diseases using network analysis. METHODS In this study, we identify these multi-morbidities from a large electronic medical record (EMR) containing diagnoses, symptoms and treatment data on more than 22.1 million patients. We create multimorbidity networks from males and females medical records and compare their structural properties. RESULTS Our macro analysis at the organ-level indicates that females have a stronger multimorbidity network than males. For example, the female multimorbidity network includes six linkages to mental health, wherein the male multimorbidity network includes only two linkages to mental health. The strength of some disease associations between lipid metabolism and chronic heart disorders is stronger in males than females. CONCLUSION Our multimorbidity network analysis by gender identifies specific differences in disease diagnosis by gender, and presents questions for biological, behavioral, clinical, and policy research.

Opportunities to use drugs and the transition to drug use among adolescents from Caracas, Venezuela

ABSTRACT Few studies have examined exposure to drug use and the lag between exposure and use. This paper estimates prevalence of opportunity to use a substance, for use, and for use given an opportunity to use among a sample of Venezuelan adolescents. Several covariates on the opportunity to use and the transition to use are also examined. Findings show that lifetime prevalence of substance use among Venezuelan adolescents increases dramatically and more closely resembles rates among US and European samples when having had an opportunity to use was taken into account. A majority of youth who transitioned to use did so the same year exposure occurred, and females had a shorter time difference compared to males. Covariates primarily predicted exposure rather than having used after controlling for exposure, and their effects varied by substance. Implications for prevention efforts are discussed.

It's Game Time: Drinking Intentions, Alcohol Consumption, and Consequences at College Tailgates

ABSTRACT Background: Alcohol consumption and related consequences is a problem on many college campuses. Tailgating parties before college sporting events may be contributing, however, little recent research has investigated alcohol consumption at these events. Objective: The purpose of this study is to evaluate the drinking behaviors of college game day tailgate attendees and subsequent alcohol-related consequences. Methods: Participants (N = 89; 44.9% female) were recruited from tailgates at a university in the Midwest United States on college football game days during fall 2014. Participants provided a breath sample, completed a questionnaire, and were given the opportunity to participate in a follow-up survey (n = 62) to assess resulting alcohol-related consequences. Results: Over half of participants had BrACs greater than 0.000. However, one in three participants reported intentions to abstain from alcohol or to drink but not enough to get buzzed. Intoxication intentions were a significant and unique predictor of alcohol consumption and experience with alcohol-related consequences at follow-up. Conclusions/Importance: This study updates and extends the literature on alcohol-related consequences in the context of college football tailgates. The results suggest that consequences may be prevented through changes in intentions to become intoxicated.

Proximal predictors of breath alcohol level at venues primarily serving sexual minority patrons

Purpose The purpose of this paper is to assess the proximal predictors of breath alcohol content (BrAC) at exit of a venue that primarily served sexual minority patrons. Contrary to prior research that relies on self-report of alcohol consumption, participants’ BrAC level was measured prior to entering the venue and again at exit. Design/methodology/approach A portal method was used to assess individuals before and after attending a sexual minority bar. Participants (n=96) were randomly selected for participation on weekends from four bars. Findings A multivariate path model was conducted to predict BrAC at exit from the bar. Individuals who drank before coming to the bar had a mean BrAC of 0.093 (SD=0.065) at exit from the bar and those who did not drink before attending the bar had a mean BrAC 0.030 (SD=0.050) at exit (t=5.47 (99), p<0.001). Drinking before bar attendance, BrAC at entrance, planning to drive, and drinking intentions were significant predictors of BrAC at exit from the bar. There were no significant variations in BrAC by sexual identity. Research limitations/implications BrAC levels at exit were mainly influenced by the BrAC levels at entrance and were not significantly changed while at the venue. Originality/value While previous research has demonstrated a higher incidence of problematic drinking behaviors in nonheterosexual populations, the current study suggests that bars and clubs who serve sexual minority patrons might not be adding to these problematic behaviors, and instead serve as a place of community for LGB individuals.

Association between breath alcohol concentration and waterpipe lounge patrons’ carbon monoxide exposure: A field investigation

BACKGROUND AND AIMS Concurrent alcohol use and waterpipe (WP) smoking is common among young adults. WP smokers are more than twice as likely to use alcohol as non-users and frequently consume alcohol immediately before and during a WP smoking session. It is unclear what impact alcohol has on WP smoking patterns and resultant exposure to tobacco-related toxicants. The current research aimed to understand the association between alcohol consumption and WP smoke exposure among WP lounge patrons. METHODS Seventy-one lounge patrons (66.2% male; Mage=27.03, SD=5.32) completed pre- and post-WP session self-report measures and biomarkers of smoking (expired carbon monoxide; eCO) and alcohol consumption (breath alcohol concentration; BrAC) upon entering and exiting the WP lounge. RESULTS After controlling for number of bowls and charcoals smoked, greater consumption of alcohol was associated with greater smoke exposure among WP lounge patrons (p<0.05), such that a 0.1 unit increase in BrAC was associated with an eCO increase of 19.44ppm. This relationship was mediated by time spent in the WP lounge. CONCLUSIONS Concurrent alcohol use resulted in greater eCO, likley due to participants spending a greater amount of time in the WP lounge and experiencing longer sustained exposure to secondhand smoke. These findings illustrate a need for further research on the impact of alcohol consumption on WP smoking to assess the potential need for regulation of these products in WP lounges.