Exploring the impacts of neighborhood disadvantage on Medicare beneficiaries' early COVID-19 vaccine uptake.

A variety of factors influenced the American public's experiences with the COVID-19 pandemic and initial availability and uptake of COVID-19 vaccines. To examine variation in early COVID-19 vaccine uptake based on neighborhood disadvantage along with individual sociodemographic and health characteristics, we used Spring 2021 data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative, longitudinal survey of the Medicare population conducted by the Centers for Medicare & Medicaid Services. Bivariate analyses showed that beneficiaries in disadvantaged neighborhoods were less likely to have received at least one vaccine dose than those in less disadvantaged neighborhoods (49.7%, SE = 1.6 versus 66.6%, SE = 1.0, p < 0.0001). After accounting for individual characteristics, the relationship between neighborhood disadvantage and vaccine uptake was not statistically significant. However, interaction effects of neighborhood disadvantage by urbanicity showed a more complex picture, where those in disadvantaged urban areas had the lowest odds of vaccine uptake (p < 0.01). The relationship between neighborhood disadvantage and vaccination is multifaceted, requiring further research to inform future vaccination efforts targeting the most vulnerable beneficiaries.

Strategies to Support LGBTQ+ Students in High Schools: What Did We Learn in Chicago Public Schools?

In 2013, the Chicago Public Schools district received funding from the Division of Adolescent and School Health at the Centers for Disease Control and Prevention (CDC) to implement a series of strategies aimed to reduce HIV, STIs (sexually transmitted diseases), and related risk behaviors among students. One such set of strategies included "safe and supportive environments" (SSE), aimed to support lesbian, gay, bisexual, transgender, questioning, and other LGBTQ+ students. SSE strategies included professional development and technical assistance provided to K-12 school staff (teachers, administrators, social workers, etc.) to implement the following practices: support for transgender and gender nonconforming students in accordance with district guidelines, use of LGBTQ+ inclusive curricula, posting of signs and symbols of support, and creation of Genders and Sexualities Alliance student clubs. To monitor progress and performance, both quantitative and qualitative process measure data were collected. Quantitative data consisted of key metrics such as number of staff trained and surveillance data collected through school health profiles in collaboration with the CDC. Qualitative data were gathered to understand barriers and facilitators to implementation of SSE practices via interviews with 55 school staff members and four focus groups with 31 high school students. Results indicated an increased uptake of all SSE activities across the 5-year funding period. Findings also reveal additional needed supports, such as increased availability and offering of professional development for all staff, support for staff in engaging parents, and ensuring the LGBTQ+ inclusive sexual health education curriculum is experienced as such by students. Current work to address these needs is described.

Awareness and Intent to Use Pre-exposure Prophylaxis (PrEP) Among African American Women in a Family Planning Clinic.

Due to the gap between cisgender women eligible for and those accessing pre-exposure prophylaxis (PrEP) for HIV prevention, it is critical to understand knowledge of and attitudes toward PrEP among HIV-vulnerable women. PrEP utilization is particularly low among African American women in the USA. Family planning clinics provide key access points to reach HIV-vulnerable African American women as well as to translate research findings into clinical practice. Our study aimed to (1) describe the awareness of and interest in PrEP among African American cisgender women attending a family planning clinic and (2) document the barriers and facilitators to PrEP uptake among these women. A cross-sectional survey was conducted with sexually active African American women of reproductive age attending a family planning clinic. Descriptive statistics were used to characterize the sample, and bivariate analysis was used to detect difference between categorical and outcome variables. In our survey (N = 109), over 80% of participants listed not knowing PrEP was available as the primary reason for not currently taking PrEP. Seventy percent reported they would probably or definitely like to take PrEP - demonstrating that barriers to uptake might stem from knowledge deficits rather than attitudes toward prevention. Study findings have the potential to inform strategies to increase awareness of PrEP as an HIV prevention option as well as to equip women with greater self-efficacy to access PrEP in family planning settings.