ABSTRACTDespite advancements in HIV prevention and treatment, disparities persist across the U.S. that are geographically and demographically unique. This study analyzed HIV burden and prevention efforts in three urban counties, Suffolk County, MA (Boston), Orange County, FL (Orlando), and Philadelphia County, PA (Philadelphia), using AIDSVu data. We assessed HIV prevalence, new diagnoses, Pre-Exposure Prophylaxis (PrEP) use, PrEP-to-Need Ratio (PnR), and key social and structural determinants of health (SSDoH) to contextualize local trends within national patterns. Findings revealed significant disparities. For the three counties, Philadelphia exhibited the highest overall HIV prevalence and lowest PrEP uptake, while Orange County reported the highest rate of new diagnoses. Demographic groups, socioeconomic factors, including poverty, insurance coverage and housing instability, further shaped HIV outcomes across these regions. These results highlight the need for evidence-driven interventions, expanded PrEP access, and policy reforms to HIV prevention and care in high-burden communities.

In the United States, COVID-19 vaccines are widely available, but vaccine hesitancy and vaccine disparities remain. Healthcare providers and community organizational leaders who serve as frontline workers and interact with vaccine-hesitant people, can provide important insights on factors that perpetuate vaccine hesitancy. These perspectives may be especially important for vaccine-hesitant people with intersecting social vulnerabilities, including racial and ethnic minorities who are also LGBTQ+ individuals, immigrants, or pregnant people. While predictors of COVID-19 vaccine hesitancy have been examined, there has been comparatively less research on healthcare providers’ and organizational leaders’ perspectives about factors influencing vaccine hesitancy. Responsive to this gap, the purpose of this study was to identify healthcare providers’ and organizational leaders’ perspectives about factors influencing COVID-19 vaccine hesitancy among Latinx people in North Texas who identify as (1) LGBTQ+, (2) immigrants, or (3) pregnant or postpartum individuals. We conducted in-depth interviews with 13 participants that serve these groups. Data were collected in 2022, and interviews were thematically analyzed using MaxQDA software. Participants described misinformation, interpersonal context, and pregnancy concerns as main reasons for vaccine hesitancy among their patients. Findings from this study contribute to overall knowledge of vaccine hesitancy among minoritized people, demonstrating how multilevel factors contribute to vaccine hesitancy. Further, the findings suggest potential pathways where misinformation may operate through interpersonal networks to amplify intrapersonal concerns. Due to current changes in COVID-19 vaccine recommendations, research that focuses on vaccines and misinformation is critical in preventing vaccine hesitancy.

Objectives: In 2025, Florida officials announced plans to end vaccine mandates, including school-based vaccine requirements. This study assessed whether Florida parents/caregivers reported changes in pediatric vaccination intentions related to the state's announcement and identified correlates of reported changes.Methods: We conducted an online survey with 519 Florida parents/caregivers of school-aged children in December 2025. Eligibility criteria included being aged 18 or older, having at least one school-aged child, residing in Florida, and speaking English. Measures included sociodemographic characteristics, political affiliation, vaccine hesitancy, and self-reported changes in vaccination intention following the policy announcement. Descriptive statistics and multivariate regression models examined correlates of vaccine hesitancy and vaccination intention change.Results: Overall, 42% of participants reported being more likely to vaccinate children following the announcement, 38% reported no change, and 20% reported being less likely. Vaccine hesitancy was the only variable independently associated with reported intention change. Hesitant respondents were more likely than non-hesitant respondents to report decreased vaccination intentions (44% vs 13%) and less likely to report increased intentions (16% vs 50%).Conclusions: Findings suggest vaccine hesitancy shapes responses to vaccine policy change. Such policies may reinforce existing vaccination attitudes, resulting in divergent vaccination intentions among caregivers with differing levels of hesitancy.

Background:Asian Americans are severely underrepresented in Alzheimer disease and related dementias research, and the cognitive aging of Asian Indians in the United States is poorly understood. There is a pressing need to bridge the gap in the literature concerning dementia and cognitive impairment among Asian Indians to reduce the current disparities. This study examines how knowledge, beliefs, and attitudes shape dementia disparities among older Asian Indian immigrants in the United States. Methods:In-depth interviews were conducted with Asian Indian adults, ages 50 years and older, who immigrated from India to the United States. Participants were recruited through cultural and faith-based organizations by using flyers and social media advertisements. Interviews explored perceptions of dementia and aging, barriers to receiving care, and beliefs related to aging. Interviews were audio-recorded and transcribed, and inductive thematic analysis was conducted by 2 investigators. Results:Participants (n=29) were mostly women (73%) and 65-74 years old (38%) and had been in the United States for an average of 35 years. Cognitive impairment and dementia were viewed as natural functions of aging, and participants were unaware of screening methods to detect cognitive impairment early. Participants perceived dementia as more prevalent among Asian Indians living outside of India due to loss of social support. Conclusion:Overall, this study shows challenges and opportunities to advancing culturally appropriate cognitive aging care among Asian Indian immigrants in the United States. Findings from this study provide valuable insights into this underresearched area and can inform culturally sensitive interventions and policies to support the cognitive health of Asian Indian immigrants as they age.

BACKGROUND:Collaborative research between researchers and community members can meaningfully address public health concerns. Collaboration can be complicated, however, due to unanticipated challenges stemming from academic institutions. This article describes how academic institutions can hinder and facilitate community-based research. OBJECTIVES:We evaluated a research partnership focused on structural determinants of COVID-19 vaccine hesitancy among Latinx people who (1) have a precarious immigration status; (2) are sexual and gender minorities; and (3) can become pregnant. METHODS:We completed a process evaluation with community organization partners who collaborated on the study. We asked community partners to describe benefits and challenges of collaborating with academic institutions. LESSONS LEARNED:Our evaluation revealed institutional challenges to successful community-based partnerships, including institutional review board delays and institutional expectations that failed to understand grassroots community organizations. Using the concept of bureaucratic violence, we describe how academic institutions can constrain community-based research and provide suggestions for how academic partners might overcome institutional hurdles.

Despite the advent of effective COVID-19 vaccines, COVID-19 vaccine hesitancy persists in the United States. Some minoritized populations, including Latinx individuals, experience elevated risk for COVID-19 due to numerous social and economic factors, but vaccination rates in this population are lower than white non-Latinx individuals. Further, Latinx individuals experiencing intersecting forms of social marginalization - such as identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+), having a precarious immigration status, or being capable of pregnancy - may encounter compounded barriers to COVID-19 vaccination. To examine why COVID-19 vaccination disparities persist among Latinx people, we surveyed 135 Latinx individuals in North Texas to assess their COVID-19 vaccination status, reasons for vaccine hesitancy, and vaccine intentions. We also examined the correlation between vaccine hesitancy and demographic factors, as well as trust in information sources regarding COVID-19. Most participants (77%) received at least one dose of the COVID-19 vaccine but over 21% expressed vaccine hesitancy. Trust in government institutions emerged as a significant factor influencing vaccine hesitancy. Among participants with children, both parental vaccination status and vaccine hesitancy significantly shaped decisions about vaccinating children for COVID-19. Vaccinated individuals also expressed greater support for vaccination mandates for engaging in public spaces, such as attending concerts or sporting events, and working outside the home, than unvaccinated individuals. Findings from our study offer a deeper understanding of the sociocultural and informational determinants of vaccine uptake, underscoring the need for targeted public health strategies to enhance vaccination rates among Latinx populations.

BackgroundCOVID-19 vaccination disparities persist in the US, but few studies focus on Latinx sexual and gender minority (SGM) people. This study aimed to examine the factors shaping COVID-19 vaccine uptake and hesitancy among Latinx SGM people in North Texas.MethodIn a cross-sectional study from June to July 2023, 134 Latinx participants completed a survey on COVID-19 vaccine rate, confidence, and hesitancy. Vaccination rates and hesitancy among SGM and cisgender heterosexual individuals were compared using the chi-square test. Fisher's exact test was used to examine the association between confidence in vaccine safety and (1) vaccine uptake and (2) vaccine hesitancy.ResultsAmong Latinx SGM participants, 27.8% were unvaccinated and 24% were vaccine hesitant. Furthermore, 25.9% demonstrated no likelihood of receiving the vaccine in the future. No significant difference was observed in vaccine uptake and hesitancy between SGM and cisgender heterosexual individuals. Latinx SGM individuals with high confidence in COVID-19 vaccine safety were more likely to be vaccinated than those with low confidence.ConclusionConfidence in vaccine safety is strongly correlated with vaccination status, highlighting the need for interventions to build trust and address concerns among Latinx SGM people. Such interventions must focus on intersectional sources of social vulnerability among Latinx SGM people and the diversity of Latinx and SGM identities.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and can cause anogenital and oropharyngeal cancers. While HPV-related cancers are preventable through vaccination, vaccine initiation and completion rates remain suboptimal compared to other vaccines. Provider recommendation is the strongest predictor for vaccine uptake, and while oral health providers are well-positioned to recommend HPV vaccination to patients given the connection between HPV and oropharyngeal cancers, they may face unique barriers to implementation. Previous studies focused primarily on improving dental hygienists’ knowledge and confidence regarding HPV vaccination discussions rather than examining HPV vaccine beliefs and their impact on practice behaviors. This study sought to assess dental hygienists’ beliefs and behaviors related to HPV vaccine education guidelines. Data were collected from dental hygienists who attended an HPV-related continuing education (CE) course at a large regional dental conference. Approximately 26

The COVID-19 pandemic contributed to an increase in online recruitment of research participants as in-person interactions were limited. For quantitative and self-administered surveys, fraud and bot detection methods have been initiated to verify intended participants. However, there is limited information on participant authentication during recruitment process for qualitative studies. This study aimed to describe the recruitment and verification process for focus groups and interview participants for two qualitative studies. Participants were recruited through social media, emails, and snowball sampling online. All participants for both studies were screened based on the eligibility criteria. In the first project, 134 respondents met the eligibility criteria. Among those eligible, 46% were suspected to be fraudulent (i.e., fake identity or posed as meeting inclusion criteria when they do not) and up to 39% did not show up for their scheduled focus groups. Suspected participants were identified during screening and identification stage prior to the focus groups. In the second project, 102 respondents met the eligibility criteria for one of the samples; however, 54% of respondents were suspected to be fraudulent. In the second sample, 211 respondents met the eligibility criteria and 88% were suspected to be fraudulent. Additional protocols, such as ReCAPTCHA, ID checks, monitoring recruitment during social media posts, were initiated to further authenticate participants. This paper highlights the challenges of virtual and online recruitment strategies. Findings emphasize the need for researchers to put in place effective and innovative strategies to recruit and authenticate study participants.

Purpose of Review The events of September 11th, 2001 (9/11) triggered a surge of Islamophobia in the United States (U.S.), further marginalizing Muslims and individuals associated with Islam. This review examines the persistent discrimination and harassment faced by Muslim Americans post-9/11, the resultant mental health challenges, and the need for further research on this topic. Recent Findings Post-9/11, Muslim Americans, including those who consider themselves American citizens, have faced persistent discrimination and harassment. This violent harassment has significantly impacted the mental health of Muslim Americans and their future generations. Muslim women, due to their visible religious attire like the hijab, are particularly targeted, leading to a marked decline in their mental health. Additionally, Muslim immigrants face heightened scrutiny and special security checks, exacerbating their mental health challenges. Despite 59% of Muslims in America being African Americans, their experiences of Islamophobia receive less visibility compared to South Asian and Arab Muslims, who are more commonly associated with Islam in public perception. The changing political climate has intensified the discrimination faced by Muslim immigrants, further deteriorating their mental well-being. Summary The surge of Islamophobia post-9/11 has had lasting negative impacts on the mental health of Muslim Americans, particularly women and immigrants. Despite the significant challenges faced by Muslim Americans, public health research has not adequately addressed the long-term effects of Islamophobia on their mental health. This review highlights the need for comprehensive research to understand the scope of Islamophobia and its enduring impacts on Muslim Americans, addressing the current gaps in the scholarship on this critical issue.

Mental health among college students is a significant public health issue. Although mental health disparities by race, ethnicity, and sexual orientation have been well documented among college students, the exploration of mental health among multiple minoritized college students is lacking. This study aimed to address a gap in college health research by assessing how mental health issues among college students differ by the intersectionality of race/ethnicity with sexual and gender identity. A secondary analysis of American College Health Association-National College Health Assessment III data was employed. Participants comprised 1,465 students attending a large research university. Differences were observed for hazing (p<.01), microaggression (p<.001), sexual harassment (p<.001), and discrimination (p<.001) such that participants identified as double minority reported more experiences compared with double majority, single minority- race/ethnicity, and single minority-sexual/gender. Double minority and single minority- sexual/gender participants were also observed with higher rates of poor/fair health (p<.05), psychological distress, loneliness, suicide risk, and self-injury (all p<.001) and lower rates of belonging, flourishing, and resiliency (all p<.001). This study highlights the need for research and evaluation to shift from a focus on one layer of stratification, such as race/ethnicity, gender identity, or sexual orientation to a focus on the impact of multiple minoritized identities when exploring college student mental health.

Compared to other age groups, 18- to 25-year olds (young adults) are more likely to engage in heavy alcohol use and inconsistent contraceptive use, increasing their susceptibility to sexually transmitted infections (STIs) and unintended pregnancy. The Studying Alcohol and Related Risks (STARR) intervention was efficacious in reducing young adult alcohol-related risky sexual behavior, including reducing the number of casual sexual partners and alcohol use prior to sex. We conducted a qualitative study to guide the adaptation of the STARR intervention to include additional content on contraceptive use and prepare for dissemination of the intervention to a community audience. We conducted 10 focus groups with young adults (n = 16) and semistructured interviews with local community stakeholders (n = 12) to examine: (a) intervention characteristics, such as compatibility, adaptability, and design and packaging and (b) dissemination and communication channels. Focus groups and interviews were audio-recorded, transcribed, and thematically analyzed. Participants found the proposed intervention acceptable and highlighted the need to promote STI prevention among young adults. Participants viewed text-based interventions as accessible and effective. Key considerations included developing personalized messages from credible sources, using gender-inclusive language, and sending messages at strategic timepoints. Social media (Instagram, Twitter, Snapchat, TikTok), events, and campus resources were described as avenues to create awareness and disseminate information about the proposed intervention. Findings demonstrate the need for innovative and tailored young adult health programs that incorporate multilevel dissemination strategies. This study highlights the need for implementation activities that will improve the adoption and dissemination of evidence-based programs, particularly among young adults.

Human papillomavirus is the most common sexually transmitted infection and causes anogenital and oropharyngeal cancers. Although HPV-related cancers can be prevented through vaccination, HPV vaccination rates are low compared to other vaccines. One of the strongest indicators for vaccination is provider recommendation, and dental health providers are well positioned to promote HPV vaccination among their patients. The purpose of this study was to determine if a continuing education (CE) course could improve dental hygienists’ HPV-related knowledge and self-efficacy related to HPV vaccination recommendations. Data were collected from a sample of participants (n = 202) at a large dental hygiene conference in the southern US. A pre- and post-tests were administered with the CE course and differences in HPV vaccine knowledge and self-efficacy in counseling, recommending, and referring for the HPV vaccine were analyzed using SAS. HPV vaccine knowledge overall significantly increased post-CE (p < .001) and improvement was seen among several specific knowledge areas. However, knowledge regarding the common sites of HPV-related oral and oropharyngeal cancers remained moderate (82

Objective: Although persons who are pregnancy-capable and experiencing homelessness may have a strong desire to avoid pregnancy, they face unique barriers to contraception. This multimethod qualitative study aimed to identify preferences for, barriers to, and facilitators of contraceptive access and use among women experiencing homelessness in the United States using a systems perspective.Study design: We conducted semistructured interviews with women experiencing homelessness (n = 19), healthcare providers (n = 6), and social service providers (n = 6). We recruited participants from commu-nity-based, housing, and medical organizations in North Texas in the United States. Two coders conducted thematic analysis and reached consensus for codes.Results: Women participants were in emergency shelter, unsheltered, or transitional/rapid rehousing. We stratified themes using the Socioecological Framework to illustrate factors affecting contraception access at individual, interpersonal, organizational and community, and societal levels. Notable results include wo-men's preferences for long-acting reversible contraception, difficulties healthcare providers face in in-itiating contraceptive counseling, and the underutilized role of social service providers in reproductive healthcare. Insurance policies, connections between health clinics and community organizations, and or-ganizational priorities both facilitated and hindered women experiencing homelessness's access to wo-men's healthcare services.Conclusion: This study identified opportunities throughout the healthcare and social service systems to support contraceptive access for women experiencing homelessness. Future interventions should strengthen and leverage these connections to promote access among this vulnerable population with the goal of supporting reproductive autonomy. Implications: This study explored the reproductive health needs of women experiencing homelessness.Multilevel interventions, such as interdisciplinary care, patient-centered approaches, and an emphasis on health literacy, are needed to adequately provide the preferred methods of contraception for women ex-periencing homelessness, thus enabling reproductive autonomy for this population. (c) 2023 Elsevier Inc. All rights reserved.

Background: With the widespread legalization of cannabis and use among all age groups, location and source of cannabis remains to be researched, especially among minority populations. Methods: We pooled data from the 2018-2019 National Survey on Drug Use and Health and investigated differences by sexual minority status of where individuals obtained cannabis. Results: Results found that gay/lesbian and bisexual individuals who reported use were more likely to get marijuana from buying it, trading it for something else and getting it for free or sharing someone else's, compared to heterosexual individuals. Furthermore, more than one in five lesbian/gay individuals reported obtaining marijuana from someone they just met while nearly 25% of bisexual women reported obtaining marijuana from a friend. Conclusions: Findings from the present study may inform harm reduction and policy initiatives.

Background Direct-to-consumer screening options for sexually transmitted infections (STIs) may be an innovative, trauma-informed approach to consider for survivors of sexual assault, however, little research has explored women’s perceptions. The purpose of this paper is to explore the perspectives of direct-to-consumer STI screening as a potential method for college women who have experienced sexual assault. Methods Sexually active college women, age 18-24 were interviewed (n=24) regarding their overall perceptions of direct-to-consumer methods for STI screening. Interviews were analyzed thematically by two coders (Kappa=.83). The data generated an emergent theme that was not included in the a-priori theory-based coding. This theme focused on the potential acceptability of direct-to-consumer methods for women survivors of sexual assault. Results Participants discussed that women who survived sexual assault as among those who would benefit from the availability of direct-to-consumer methods for STI screening. They placed survivors at an intersection of barriers that often prevent people from seeking traditional screenings. Subthemes demonstrate that participants considered the survivor’s intrapersonal decision-making and how the survivor must navigate the sociocultural environment of the university. Results indicate that availability of direct-to-consumer methods for STI screening may mitigate sexual assault-related stigma and discomfort associated with reporting or seeking care, such as seeing a physician. Discussion Direct-to-consumer methods may mitigate challenges associated with the current medicolegal approach to sexual assault care by removing potential areas for re-traumatization and providing access to supportive health services. However, further research is necessary to understand the role of direct-to-consumer methods for survivors of sexual assault. Conclusion Although direct-to-consumer methods may provide useful STI screening opportunities, social factors contributing to the disparities in sexual assault and sexually transmitted infection rates on college campuses remain priorities for future interventions.