Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial.

BACKGROUND: HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. OBJECTIVE: To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. METHODS: In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. RESULTS: This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. CONCLUSIONS: This study has the potential to improve public health by preventing HIV/STI and substance use disorders. TRIAL REGISTRATION: ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47216.

Community's Perception on Ambient Air and Noise Pollution: A Qualitative Study in Southwest Detroit.

Background: Low-income urban communities of color, specifically African American and Hispanic populations living in industrial areas, are disproportionately affected by environmental health hazards, including exposure to air pollution and noise. In Southwest Detroit, a densely populated area with extensive industry and traffic, many residents are chronically exposed to air and noise pollution, contributing to a high prevalence of chronic illnesses such as asthma and cardiovascular disease. Materials and Methods: To better understand environmental health concerns and perceptions of environmental hazards, we conducted phone interviews with 22 residents in Southwest Detroit. During the interviews, participants were asked to reflect on reports of air and noise pollution based on monitoring inside and outside of their home, how their health might be affected, and to identify their main environmental health concerns. Results: Through qualitative analysis of phone interview notes, we identified truck traffic and inadequate mitigation efforts as concerns for Southwest Detroit residents. Our results suggested that study participants are aware of their disproportionate exposures to air and noise pollution and that while some residents are actively involved in environmental justice efforts, additional structural preventive measures including reduced pollutant emissions, are necessary to preserve public health. Conclusion: This study demonstrates that residents of Southwest Detroit are aware of high levels of both air pollutants and noise and perceive environmental exposures as critical components affecting health, both key aspects of environmental health literacy. This awareness, along with policy change, can facilitate community involvement in evaluating, understanding, and potentially abating air and noise pollution among minority populations.

Covid-19 Rates by Time since Vaccination during Delta Variant Predominance.

BACKGROUND: With the emergence of the delta variant, the United States experienced a rapid increase in Covid-19 cases in 2021. We estimated the risk of breakthrough infection and death by month of vaccination as a proxy for waning immunity during a period of delta variant predominance. METHODS: Covid-19 case and death data from 15 U.S. jurisdictions during January 3 to September 4, 2021 were used to estimate weekly hazard rates among fully vaccinated persons, stratified by age group and vaccine product. Case and death rates during August 1 to September 4, 2021 were presented across four cohorts defined by month of vaccination. Poisson models were used to estimate adjusted rate ratios comparing the earlier cohorts to July rates. RESULTS: During August 1 to September 4, 2021, case rates per 100,000 person-weeks among all vaccine recipients for the January to February, March to April, May to June, and July cohorts were 168.8 (95% confidence interval [CI], 167.5 to 170.1), 123.5 (95% CI, 122.8 to 124.1), 83.6 (95% CI, 82.9 to 84.3), and 63.1 (95% CI, 61.6 to 64.6), respectively. Similar trends were observed by age group for BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccine recipients. Rates for the Ad26.COV2.S (Janssen-Johnson & Johnson) vaccine were higher; however, trends were inconsistent. BNT162b2 vaccine recipients 65 years of age or older had higher death rates among those vaccinated earlier in the year. Protection against death was sustained for the mRNA-1273 vaccine recipients. Across age groups and vaccine types, people who were vaccinated 6 months ago or longer (January-February) were 3.44 (3.36 to 3.53) times more likely to be infected and 1.70 (1.29 to 2.23) times more likely to die from COVID-19 than people vaccinated recently in July 2021. CONCLUSIONS: Our study suggests that protection from SARS-CoV-2 infection among all ages or death among older adults waned with increasing time since vaccination during a period of delta predominance. These results add to the evidence base that supports U.S. booster recommendations, especially for older adults vaccinated with BNT162b2 and recipients of the Ad26.COV2.S vaccine. (Funded by the Centers for Disease Control and Prevention.).

Airborne volatile organic compounds at an e-waste site in Ghana: Source apportionment, exposure and health risks.

Informal e-waste recycling processes emit various air pollutants. While there are a number of pollutants of concern, little information exists on volatile organic compounds (VOCs) releases at e-waste sites. To assess occupational exposures and estimate health risks, we measured VOC levels at the Agbogbloshie e-waste site in Ghana, the largest e-waste site in Africa, by collecting both fixed-site and personal samples for analyzing a wide range of VOCs. A total of 54 VOCs were detected, dominated by aliphatic and aromatic compounds. Mean and median concentrations of the total target VOCs were 46 and 37 µg/m3 at the fixed sites, and 485 and 162 µg/m3 for the personal samples. Mean and median hazard ratios were 2.1 and 1.4, respectively, and cancer risks were 4.6 × 10-4 and 1.5 × 10-4. These risks were predominantly driven by naphthalene and benzene; chloroform and formaldehyde were also high in some samples. Based on the VOC composition, the major sources were industry, fuel evaporation and combustion. The concentration gradient across sites and the similarity of VOC profiles indicated that the e-waste site emissions reached neighboring communities. Our results suggest the need to protect e-waste workers from VOC exposure, and to limit emissions that can expose nearby populations.

A community noise survey in Southwest Detroit and the value of supplemental metrics for truck noise.

Noise exposure can affect sleep, health and cognitive performance, and it disproportionately affects communities of color. This study has the objective of evaluating both conventional and supplemental noise metrics in a community noise survey examining Southwest Detroit, Michigan, a densely populated and industrialized area with extensive truck traffic on residential streets. Sound pressure level (SPL) monitors were deployed at 21 residential sites within 900 m of a major interstate highway. With assistance from youth volunteers, continuous SPL measurements were obtained for 1.5-7 days at each site, and short-term vehicle counts on local roads were recorded. We calculated conventional noise metrics, including the day-evening-night average sound level LDEN and the 90th percentile 1-hr maximum L10(h), and evaluated the effect of distance from highways, traffic volume, time-of-day, and other factors. Supplemental metrics potentially appropriate for intermittent traffic noise were calculated, including fraction of time over specific SPL thresholds using a new metric called FDEN, which is the fraction of time over 60, 65 and 70 dB during night, evening and daytime periods, respectively, and a peak noise metric called L2P(h), which utilizes the 98th percentile SPL within time blocks to increase robustness. The conventional metrics indicated five sites that exceeded 70 dB, and the highest noise levels were found within ~50 m of truck routes, arterials and freeway ramps. The estimated impact of truck traffic ranged up to 17 dB for hourly averages and to 33 dB for 1-s peaks. The conventional metrics did not always capture short-term noise exposures, which may be especially important to annoyance and sleep issues. In addition to showing widespread exposure to traffic noise in the study community that warrants consideration of noise abatement strategies, the study demonstrates the benefits of supplemental noise metrics and community engagement in noise assessment.

Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial.

BACKGROUND: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. OBJECTIVE: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. METHODS: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. RESULTS: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI -0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI -0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI -0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI -0.39 to 0.72). CONCLUSIONS: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. TRIAL REGISTRATION: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410.