A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations.

OBJECTIVE: To identify recommendations for conducting public health research with trauma-exposed populations. METHODS: Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps. RESULTS: We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research. CONCLUSIONS: Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

Trajectories of and disparities in HIV prevalence among Black, white, and Hispanic/Latino men who have sex with men in 86 large U.S. metropolitan statistical areas, 1992-2013.

PURPOSE: The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas. METHODS: This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States. RESULTS: Our estimates indicate that HIV prevalence among MSM increased, from an across-metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions. CONCLUSIONS: The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.

Factors Associated with Black Cancer Patients' Ability to Obtain Their Opioid Prescriptions at the Pharmacy.

Background: Black cancer patients experience pain. Barriers to opioid medications for pain may include geographic factors. This study examines neighborhood factors associated with difficulties receiving prescription opioids from pharmacies for black cancer patients. Design: A secondary data analysis of a study on opioid adherence was used to examine neighborhood-level and individual factors related to difficulties filling prescriptions for opioids. Setting/Subjects: Patients being treated for cancer pain with opioids (n = 104) were recruited. All self-identified as black, were 21 years or older, had cancer diagnoses, and had been prescribed extended release opioids. Measurements: A seven-item survey to identify problems filling opioids was completed by 98 participants along with a nine-item scale to assess perceived neighborhood characteristics. Scales of neighborhood amenities and neglect were created from the perceived neighborhood characteristics scale using principal components analysis. The 2009-2013 American Community Survey data were used to estimate the census tract percentage of non-Hispanic black residents, residents ≥25 years of age without a high school degree or equivalent, and households earning below the federal poverty level within the past 12 months. Results: Nearly 51% reported problems getting their opioids filled: 28% had to wait days and 24% had to return to the pharmacy multiple times. The main theme identified in analysis of an open-ended question was pharmacies not stocking medication. Neighborhood locations that rated higher on the amenities scale were protective for pharmacies sufficiently stocking opioids. Conclusions: Additional research on pharmacies sufficiently stocking opioid pain and neighborhood perceptions is warranted.

Place-based predictors of HIV viral suppression and durable suppression among heterosexuals in New York city.

Scant research has explored place-based correlates of achieving and maintaining HIV viral load suppression among heterosexuals living with HIV. We conducted multilevel analyses to examine associations between United Hospital Fund (UHF)-level characteristics and individual-level viral suppression and durable viral suppression among individuals with newly diagnosed HIV in New York City (NYC) who have heterosexual HIV transmission risk. Individual-level independent and dependent variables came from NYC's HIV surveillance registry for individuals diagnosed with HIV in 2009-2013 (N = 3,159; 57% virally suppressed; 36% durably virally suppressed). UHF-level covariates included measures of food distress, demographic composition, neighborhood disadvantage and affluence, healthcare access, alcohol outlet density, residential vacancy, and police stop and frisk rates. We found that living in neighborhoods where a larger percent of residents were food distressed was associated with not maintaining viral suppression. If future research should confirm this is a causal association, community-level interventions targeting food distress may improve the health of people living with HIV and reduce the risk of forward transmission.

State minimum wage laws and newly diagnosed cases of HIV among heterosexual black residents of US metropolitan areas.

This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and inflation, were associated with rates of new HIV diagnoses among heterosexual black residents of metropolitan statistical areas (MSAs; n=73), between 2008 and 2015. Findings suggest that an inverse relationship exists between baseline state minimum wages and initial rates of newly diagnosed HIV cases among heterosexual black individuals, after adjusting for potential confounders. MSAs with a minimum wage that was $1 higher at baseline had a 27.12% lower rate of newly diagnosed HIV cases. Exploratory analyses suggest that income inequality may mediate this relationship. If subsequent research establishes a causal relationship between minimum wage and this outcome, efforts to increase minimum wages should be incorporated into HIV prevention strategies for this vulnerable population.

Place-Based Predictors of HIV Viral Suppression and Durable Suppression Among Men Who Have Sex With Men in New York City.

We explore relationships between place characteristics and HIV viral suppression among HIV-positive men who have sex with men (MSM) in New York City (NYC). We conducted multilevel analyses to examine associations of United Hospital Fund (UHF)-level characteristics to individual-level suppression and durable suppression among MSM. Individual-level independent and dependent variables came from MSM in NYC's HIV surveillance registry who had been diagnosed in 2009-2013 (N = 7159). UHF-level covariates captured demographic composition, economic disadvantage, healthcare access, social disorder, and police stop and frisk rates. 56.89% of MSM achieved suppression; 35.49% achieved durable suppression. MSM in UHFs where 5-29% of residents were Black had a greater likelihood of suppression (reference: ≥30% Black; adjusted relative risk (ARR) = 1.07, p = 0.04). MSM in UHFs with <30 MSM-headed households/10,000 households had a lower likelihood of achieving durable suppression (reference: ≥60 MSM-headed households/10,000; ARR = 0.82; p = 0.05). Place characteristics may influence viral suppression. Longitudinal research should confirm these associations.

Antiretroviral medication treatment for all HIV-infected individuals: a protocol using innovative multilevel methodologies to evaluate New York City's universal ART policy among problem substance users.

BACKGROUND: The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of "treatment as prevention," in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The "ART for ALL" (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use. METHODS/DESIGN: The AFA Study is informed by two complementary frameworks: Glasgow and colleagues' RE-AIM model, a multi-level framework developed to guide the evaluation of implementation of new policies, and Bronfrenbrenner's ecological systems model, which conceptualizes the bi-directional interplay between people and their environment. Using multi-level data and mixed methods, the primary aims of the AFA Study are to assess rates of viral load suppression, using the NYC HIV Surveillance Registry, within 12 months of HIV diagnosis with (a) yearly cohorts of high-risk-to-transmit, difficult-to-treat, substance using patients recruited from NYC Sexually Transmitted Disease clinics and a large detoxification unit and (b) yearly cohorts of all newly HIV diagnosed people in NYC. Further goals include (c) recruiting cross-sectional samples of HIV/AIDS service providers to assess ART initiation with problem substance users and d) examining geographic factors that influence rates of viral load suppression. An Implementation Collaborative Board meets regularly to guide study procedures and interpret results. DISCUSSION: The AFA Study has the unique strength of accessing and analyzing data at multiple levels using mixed methodology, taking advantage of NYC DOHMH biomedical surveillance data. If successful, others may benefit from lessons learned to inform local and state policies to improve the health of PLWH and further reduce HIV transmission.

Living under surveillance: Gender, psychological distress, and stop-question-and-frisk policing in New York City.

A growing body of research highlights the collateral consequences of mass incarceration, including stop-and-frisk policing tactics. Living in a neighborhood with aggressive policing may affect one's mental health, especially for men who are the primary targets of police stops. We examine whether there is an association between psychological distress and neighborhood-level aggressive policing (i.e., frisking and use of force by police) and whether that association varies by gender. The 2009-2011 New York City (NYC) Stop, Question, and Frisk Database is aggregated to the neighborhood-level (N = 34) and merged with individual data from the 2012 NYC Community Health Survey (N = 8066) via the United Hospital Fund neighborhood of respondents' residence. Weighted multilevel generalized linear models are used to assess main and gendered associations of neighborhood exposures to aggressive police stops on psychological distress (Kessler-6 items). While the neighborhood stop rate exhibits inconsistent associations with psychological distress, neighborhood-level frisk and use of force proportions are linked to higher levels of non-specific psychological distress among men, but not women. Specifically, men exhibit more non-specific psychological distress and more severe feelings of nervousness, effort, and worthlessness in aggressively surveilled neighborhoods than do women. Male residents are affected by the escalation of stop-and-frisk policing in a neighborhood. Living in a context of aggressive policing is an important risk factor for men's mental health.

Collateral Damage: The Health Effects of Invasive Police Encounters in New York City.

The health effects of police surveillance practices for the community at-large are unknown. Using microlevel health data from the 2009-2012 New York City Community Health Survey (NYC-CHS) nested within mesolevel data from the 2009-2012 NYC Stop, Question, and Frisk (NYC-SQF) dataset, this study evaluates contextual and ethnoracially variant associations between invasive aspects of pedestrian stops and multiple dimensions of poor health. Results reveal that living in neighborhoods where pedestrian stops are more likely to become invasive is associated with worse health. Living in neighborhoods where stops are more likely to result in frisking show the most consistent negative associations. More limited deleterious effects can be attributed to living in neighborhoods where stops are more likely to involve use of force or in neighborhoods with larger ethnoracial disparities in frisking or use of force. However, the health effects of pedestrian stops vary by ethnoracial group in complex ways. For instance, minorities who live in neighborhoods with a wider ethno racial disparity in police behavior have poorer health outcomes in most respects, but blacks have lower odds of diabetes when they live in neighborhoods where they face a higher risk that a stop will involve use of force by police than do whites. The findings suggest that the consequences of the institutionalization of the carceral state are far-reaching.

Transgender women of color: discrimination and depression symptoms.

PURPOSE: Trans women of color contend with multiple marginalizations; the purpose of this study is to examine associations between experiencing discriminatory (racist/transphobic) events and depression symptoms. It uses a categorical measure of combined discrimination, and examines a protective association of transgender identity on depression symptoms. DESIGN/METHODOLOGY/APPROACH: Data from a subset of trans women of color participants in the Sheroes study were analyzed with linear and logistic regression. Associations of depression symptoms with racist and transphobic events, combined discrimination, coping self-efficacy, and transgender identity were assessed with odds ratios. FINDINGS: Exposure to discriminatory events and combined discrimination positively associated with depression symptom odds. Increased transgender identity associated with increased coping self-efficacy, which negatively associated with depression symptom odds. RESEARCH LIMITATIONS/IMPLICATIONS: Cross-sectional study data prohibits inferring causality; results support conducting longitudinal research on discrimination's health effects, and research on transgender identity. Results also support operationalizing intersectionality in health research. The study's categorical approach to combined discrimination may be replicable in studies with hard to reach populations and small sample sizes. PRACTICAL IMPLICATIONS: Health programs could pursue psychosocial interventions and anti-discrimination campaigns. Interventions might advocate increasing participants' coping self-efficacy while providing space to explore and develop social identity. SOCIAL IMPLICATIONS: There is a need for policy and health programs to center trans women of color concerns. ORIGINALITY/VALUE: This study examines combined discrimination and identity in relation to depression symptoms among trans women of color, an underserved population. PAPER TYPE: Research paper.