Recent Publications

HIV clustering in Mississippi: Spatial epidemiological study to inform implementation science in the Deep South
Stopka TJ, Brinkley-Rubinstein L, Johnson K, Chan PA, Hutcheson M, Crosby R, Burke D, Mena L, Nunn A. JMIR Public Health Surveill 2018;4(2):e35; DOI: 10.2196/publichealth.8773; PMID: 29615383; PMCID: 5904450.

Abstract
Background: In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering.

Objective: The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data.

Methods: We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases.

Self-reported environmental tobacco smoke exposure and avoidance compared with cotinine confirmed tobacco smoke exposure among pregnant women and their infants
Gavarkovs AG, Risica PM, Parker DR, Jennings E, Mello M, Phipps M. Int. J. Environ. Res. Public Health 2018, 15(5), 871; https://doi.org/10.3390/ijerph15050871.

Abstract
Background: Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation.

Methods: This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum.

Examining neighborhood and interpersonal norms and social support on fruit and vegetable intake in low-income communities
Dulin A, Risica PM, Mello J, Ahmed R, Carey KB, Cardel M, Howe CJ, Nadimpalli S, Gans KM. BMC Public Health. 2018 Apr 5;18(1):455. doi: 10.1186/s12889-018-5356-2.

Abstract
We examined whether neighborhood-, friend-, and family- norms and social support for consumption and purchase of fruits and vegetables (F&V) were associated with F&V intake among low-income residents in subsidized housing communities. We examined baseline data from a study ancillary to the Live Well/Viva Bien intervention. Participants included 290 residents in four low-income subsidized housing sites who were ≥ 18 years of age, English and/or Spanish speaking, and without medical conditions that prevented consumption of F&V.

Weight and weight control behaviors of Latinas and their social ties
Marquez B, Norman GJ, Fowler JH, Gans KM, Marcus BH. Health Psychol. 2018 Feb 1. doi: 10.1037/hea0000597. [Epub ahead of print]

Abstract
Shared behaviors have been implicated in the clustering of obesity among socially connected people. This study determined how weight and weight control behaviors of participants and their social ties are related and how these factors are associated with weight change in participants.

Adult Latinas participating in a lifestyle intervention completed an egocentric network measure of weight and weight control behaviors. Participant weight was objectively measured at baseline and 12 months. Multivariable regression models determined the relationship between weight and weight control behaviors of participants and their social ties.

Small sustainable monetary incentives versus charitable donations to promote exercise: Rationale, design, and baseline data from a randomized pilot study
Williams DM, Lee HH, Connell L, Boyle H, Emerson J, Strohacker K, Galárraga O. Contemp Clin Trials. 2018 Jan 24. pii: S1551-7144(17)30555-4. doi: 10.1016/j.cct.2018.01.005. [Epub ahead of print]

Abstract
Regular physical activity (PA) enhances weight-loss and reduces risk of chronic disease. However, as few as 10% of U.S. adults engage in regular PA. Incentive programs to promote PA have shown some promise, but have typically used incentives that are too large to sustain over time and have not demonstrated habit formation or been tested in community settings. This report presents the rationale and design of a randomized pilot study testing the feasibility and preliminary efficacy of small monetary incentives for PA (n=25) versus charitable donations in the same amount (n=25) versus control (n=25) over 12months among 75 low-active but otherwise healthy adults at a local YMCA.

A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the ‘Good to Go’ cluster randomized trial
Risica PM, Gorham G, Dionne L, Nardi W, Ng D, Middler R, Mello J, Akpolat R, Gettens K, Gans KM. Contemp Clin Trials. 2017 Dec 12;65:87-98. doi: 10.1016/j.cct.2017.12.002. [Epub ahead of print]

Abstract
Fruit and vegetable (F&V) consumption is an important contributor to chronic disease prevention. However, most Americans do not eat adequate amounts. The worksite is an advantageous setting to reach large, diverse segments of the population with interventions to increase F&V intake, but research gaps exist. No studies have evaluated the implementation of mobile F&V markets at worksites nor compared the effectiveness of such markets with or without nutrition education.

This paper describes the protocol for Good to Go (GTG), a cluster randomized trial to evaluate F&V intake change in employees from worksites randomized into three experimental arms: discount, fresh F&V markets (Access Only arm); markets plus educational components including campaigns, cooking demonstrations, videos, newsletters, and a web site (Access Plus arm); and an attention placebo comparison intervention on physical activity and stress reduction (Comparison). 

“But the moment they find out that you are MSM…”: a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana’s health care system
Kushwaha S,  Lalani Y,  Maina G, Ogunbajo A, Wilton L, Agyarko-Poku T, Adu-Sarkodie Y, Boakye F, Zhang N, Nelson LE. BMC Public Health. 2017; 17: 770. Published online 2017 Oct 3. doi: 10.1186/s12889-017-4799-1.

Abstract
The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM’s experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM’s use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities.

How do social capital and HIV/AIDS outcomes geographically cluster and which sociocontextual mechanisms predict differences across clusters?
Ransome Y, Dean LT, Crawford ND, Metzger DS, Blank MB, Nunn AS. J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):13-22. doi: 10.1097/QAI.0000000000001463.

Abstract
Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and 2 HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters.

Bivariate Local Moran's I evaluated geographical clustering in the association between social capital (participation in civic and social organizations, 2006, 2008, 2010) and [5-year (2007-2011) prevalence of late HIV diagnosis and linkage to HIV care] across Philadelphia, PA, census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (eg, racial composition) predict differences across clusters.

Reciprocal within-day associations between incidental affect and exercise: An EMA study
Emerson JA, Dunsiger S, Williams DM. Psychol Health. 2017 Jun 30:1-14. doi: 10.1080/08870446.2017.1341515. [Epub ahead of print]

Abstract
Previous research suggests that how people feel throughout the course of a day (i.e. incidental affect) is predictive of exercise behaviour. A mostly separate literature suggests that exercise can lead to more positive incidental affect.

MSM at highest risk for HIV acquisition express greatest interest and preference for injectable antiretroviral PrEP compared to daily, oral medication
Biello, KB, Mimiaga, MJ, Santostefano, CM et al. AIDS Behav (2017). https://doi.org/10.1007/s10461-017-1972-6.

Abstract
Men who have sex with men (MSM) account for nearly 70% of new HIV diagnoses, with young black MSM at the highest risk for infection in the United States. Pre-exposure prophylaxis (PrEP) can decrease HIV acquisition in at-risk individuals by over 90%. However, therapeutic efficacy requires a daily pill, posing adherence challenges. Experimental modalities, including injectable PrEP given once every 2 months, may improve adherence among those most in need.

Infant feeding decisions and behaviours among low-income smoke-exposed women: timing and change during pregnancy
Risica PM, McCausland K. Public Health Nutr. 2017 Oct;20(15):2796-2805.doi: 10.1017/S1368980017001690. Epub 2017 Aug 3. PMID: 28768563.

Abstract
The present study aimed to describe change in feeding intentions and predictors of breast-feeding intentions during the course of pregnancy. Analysis of prospectively collected data from a larger randomized controlled trial of a health education intervention to reduce environmental smoke exposure among women during and after pregnancy. Participants were recruited from prenatal clinics, but all further communication occurred with participating women living in the community.

A pilot randomized controlled trial of an integrated in-person and mobile phone delivered counseling and text messaging intervention to reduce HIV transmission risk among male sex workers in Chennai, India
Mimiaga MJ, Thomas B, Biello K, Johnson BE, Swaminathan S, Navakodi P, Balaguru S, Dhanalakshmi A, Closson EF, Menon S, O'Cleirigh C, Mayer KH, Safren SA.
AIDS Behav. 2017 Aug 22. doi: 10.1007/s10461-017-1884-5. [Epub ahead of print]
PMID: 28831618

Abstract
Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. 

Exploring strategies for PrEP adherence and dosing preferences in the context of sexualized recreational drug use among MSM: a qualitative study
Closson EF, Mitty JA, Malone J, Mayer KH, Mimiaga MJ. AIDS Care. 2017 Aug 22:1-8. doi: 10.1080/09540121.2017.1360992. [Epub ahead of print] PMID: 28830220

Abstract
The use of recreational drugs while having sex is associated with increased HIV incidence among men who have sex with men (MSM). Taking a daily antiretroviral pill, or pre-exposure prophylaxis (PrEP) is a biomedical intervention to prevent HIV. However, the efficacy of PrEP is closely tied with high levels of adherence. While PrEP has the potential to reduce HIV acquisition, the use of recreational drugs may impede adherence. We explored perceptions of PrEP utilization and regimen preferences among 40 HIV-negative, MSM who reported concurrent recreational drug use and condomless anal sex with a man.

Optimal HIV postexposure prophylaxis regimen completion with single tablet daily Elvitegravir/Cobicistat/Tenofovir Disoproxil Fumarate/Emtricitabine compared with more frequent dosing regimens
Mayer KH, Jones D, Oldenburg C, Jain S, Gelman M, Zaslow S, Grasso C, Mimiaga MJ. J Acquir Immune Defic Syndr. 2017 Aug 15;75(5):535-539. doi: 10.1097/QAI.0000000000001440. 

Abstract
HIV-exposed individuals may benefit from PEP, but completion rates have been suboptimal because of regimen complexity and side effects. Newer antiretroviral combinations coformulated as single daily pills may optimize PEP adherence. One hundred HIV-uninfected individuals who presented to a Boston community health center after an acute HIV sexual exposure were enrolled and initiated PEP with the daily, single-pill combination Quad pill for a 28-day course.

Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention
Patel RR, Mena L, Nunn A, McBride T, Harrison LC, Oldenburg CE, Liu J, Mayer KH, Chan PA. PLoS One. 2017 May 30;12(5):e0178737. doi: 10.1371/journal.pone.0178737. eCollection 2017.

Abstract
Pre-exposure prophylaxis (PrEP) can reduce U.S. HIV incidence. We assessed insurance coverage and its association with PrEP utilization. We reviewed patient data at three PrEP clinics (Jackson, Mississippi; St. Louis, Missouri; Providence, Rhode Island) from 2014-2015. The outcome, PrEP utilization, was defined as patient PrEP use at three months. Multivariable logistic regression was performed to determine the association between insurance coverage and PrEP utilization. Of 201 patients (Jackson: 34%; St. Louis: 28%; Providence: 28%), 91% were male, 51% were White, median age was 29 years, and 21% were uninsured; 82% of patients reported taking PrEP at three months. Insurance coverage was significantly associated with PrEP utilization. After adjusting for Medicaid-expansion and individual socio-demographics, insured patients were four times as likely to use PrEP services compared to the uninsured (OR: 4.49, 95% CI: 1.68-12.01; p = 0.003). Disparities in insurance coverage are important considerations in implementation programs and may impede PrEP utilization.