PURPOSE:The objective of this study was to evaluate cross-sectional and longitudinal associations between contact with the criminal legal system (CCLS) and substance use among transgender women of color in New York City. METHODS:Data came from the Trying to Understand Relationships, Networks and Neighborhoods among Transgender Women of Color Study in New York City (2020-2023, analytic baseline n = 311). CCLS included arrest and incarceration and was measured at baseline, 6 months, and 12 months. Substance use included recreational substance use (any), alcohol use (any), and specific substance use (cannabis, cocaine, and methamphetamine). Generalized estimating equations were used to assess longitudinal associations between baseline CCLS and substance use over time. RESULTS:At baseline, 50.5% of participants reported having been arrested, and 28.0% reported experiencing incarceration. In multivariable analyses, CCLS was associated with substance use after controlling for confounders. In particular, at baseline, incarceration was associated with a 1.73 times (95% confidence interval: 1.06-2.81) likelihood of recreational substance use. We found no significant associations between CCLS and alcohol or specific substance use. CONCLUSION:The findings suggest that CCLS was associated with recreational substance use among transgender women of color at baseline. Substance use prevention and treatment programs should consider screening for substance use during reentry after incarceration and providing additional support for individuals with criminal legal system involvement.

Purpose: Experiences with the criminal legal system can increase the risk of HIV transmission and disrupt linkage to HIV care and prevention. This study quantified the association between criminal legal system involvement and HIV outcomes among transgender women of color (TWOC).Methods: We conducted a cross-sectional analysis using first-wave data from the Trying to Understand Relationships, Networks, and Neighborhoods Among Transgender Women of Color Cohort Study (n = 314). We investigated the association between measures of criminal legal system involvement (history of arrest and history of incarceration) and HIV care and prevention outcomes (serostatus, testing, condom use, pre-exposure prophylaxis use, and viral load suppression) among TWOC living in New York City from August 2020 to November 2022. We used modified Poisson regression models to calculate the adjusted prevalence ratios.Results: Among our cohort of TWOC, 50% had previously been arrested and 28% had previously been incarcerated. Half of the participants were living with HIV. History of incarceration was positively associated with living with HIV. Among those living with HIV, a history of incarceration was associated with an increased risk of having a detectable HIV viral load.Conclusions: Among TWOC in our study, criminal legal system involvement was significantly associated with HIV seropositivity and having a detectable viral load among those living with HIV. These findings highlight the negative health implications of the criminal legal system for a socially oppressed population and can potentially inform future directions to challenge policing practices that disproportionately target TWOC.

Background Social media use is ubiquitous, permeating nearly all populations globally, including men who have sex with men (MSM), despite there being mixed impacts to its use. To fill this gap, we sought to typologize social media usage, mental health, and sleep health among MSM in Paris, France, a city with a large LGBTQIA+ community and high social media usage. Methods Participants were recruited using broadcast advertisements on a popular geosocial networking application in Paris in October 2016. Consenting participants completed a self-administered survey online (French or English) that assessed: sleep characteristics; mental health; and social media use behaviors. We conducted a Latent Class Analysis (LCA) to characterize the number of distinct latent classes across the three primary constructs of interest. Results A total of 580 participants completed the survey and 539 (92.9%) provided complete data for the LCA. The four-class model fit our data best; thus, we assigned participants to one of four distinct latent classes: 1) MSM using social media for sex with stress and poor sleep (n=97), 2) MSM using social media generally with good mental and sleep health (n=172), 3) MSM using social media for sex with good mental and sleep health (n=147), and 4) MSM using social media for sex with distress and poor sleep (n=123). Conclusion Findings from this work may inform culturally-tailored interventions, public health messaging, and policy efforts to promote mental, behavioral, and digital health among MSM in France and beyond, while identifying opportunities to leverage digital platforms for sleep and mental health in digital communities.

BackgroundEcological momentary assessment (EMA) enables repeated, real-time measurement of emotional states, behaviors, and contextual exposures in individuals’ daily lives. Although EMA has been increasingly used in health and behavioral research, evidence regarding the feasibility, compliance, and acceptability of smartphone-based EMA among older adults in Asian settings remains limited. ObjectiveThis study aimed to evaluate the feasibility, EMA compliance, usability, and acceptability of a 14-day smartphone-based EMA protocol among community-dwelling older adults in Singapore. MethodsThe data came from the Ecological Momentary Assessment in Ageing study, a smartphone-based EMA study designed to assess mental well-being, lifestyle behaviors, and perceived neighborhood environment among older adults. Adults aged 65 years or older in Singapore were enrolled and asked to complete 5 EMA prompts per day over 14 consecutive days using a smartphone app. Each EMA prompt remained available for up to 5 hours after delivery. EMA prompts assessed momentary mental well-being, sleep, physical activity, screen time, and perceived neighborhood environment. Feasibility indicators included recruitment and retention rates. EMA compliance was assessed as the proportion of completed EMA prompts out of all scheduled prompts. Usability and acceptability were assessed using a poststudy survey. ResultsBetween June 2025 and December 2025, a total of 186 individuals initially expressed interest in the study, of whom 139 (74.7%) scheduled an appointment, and 132 (95%) of the latter attended the appointment. Of those who attended, 98.5% (130/132) were enrolled. Participants had a mean age of 70.1 (SD 4.04) years; 65.4% (85/130) were female, 90.8% (118/130) were Chinese, and 65.4% (85/130) had postsecondary or university-level education. All enrolled participants completed the 14-day EMA protocol, resulting in 100% (130/130) retention. Across all participants, 99% (9007/9100) of the scheduled EMA prompts were completed. The poststudy usability survey was completed by 96.9% (126/130) of the participants. Among those who completed the poststudy usability survey, 88.1% (111/126) agreed or strongly agreed that the app was easy to use, 84.1% (106/126) agreed or strongly agreed that most people would learn to use it quickly, and 87.3% (110/126) preferred the app over face-to-face interviews. Overall, 91.3% (115/126) reported being satisfied or strongly satisfied with the app, and 100% (126/126) indicated willingness to be contacted for future research. ConclusionsA 14-day smartphone-based EMA protocol was highly feasible and acceptable among community-dwelling older adults in Singapore, with high retention and compliance and favorable usability ratings. These findings support the use of EMA methodologies in aging research within Asian contexts and suggest that older adults can successfully engage with repeated smartphone-based assessments when protocols are appropriately designed and supported.

Background As smoking prevalence declines, it is important to understand whether those who continue to smoke soften or harden (become more or less amenable to quitting, respectively) to inform the development of tobacco control programmes. This study examined quitting, softening and hardening, and the characteristics of those who quit or softened, from 2019/2020 to 2023 in a cohort of Singaporean smokers.Methods We analysed baseline (2019/20) and follow-up (2023) data from 1059 Singaporean adults who were currently smoking at baseline. We categorised them as having quit, softened, hardened or remained unchanged based on cigarettes per day, quit attempts and quit intentions. We used multinomial logistic regression to identify sociodemographic and behavioural traits associated with quitting or softening.Results From 2019/2020 to 2023, 19.5% of participants quit, 13.7% softened, 9.0% hardened and the proportion of 'middle' (not hardcore or soft) smokers decreased from 75.4% to 57.8%, primarily due to quitting or softening. Current vaping increased from 3.1% to 21.0% and was associated with softening (adjusted OR (AOR) 2.22; 95% CI 1.20 to 4.10), but not quitting. Quitting was independently associated with non-daily smoking (AOR=7.15), frequent physical activity (AOR=3.16), unemployment (AOR=2.36) and female gender (AOR=2.06).Conclusions As smoking declined, the cohort showed trends of quitting and softening but not hardening. Softening and quitting were associated with distinct characteristics, pointing to a need for targeted interventions to support quitting among 'softeners'. Vaping was associated with softening but not quitting, suggesting caution in interpreting vaping as a cessation aid.

Introduction: Transgender women of color (TWOC) face elevated rates of substance use, driven in part by intersecting systems of discrimination and structural inequities. Previous research has highlighted the connection between discrimination and substance use, but few studies have explored this relationship among TWOC. This study examines cross-sectional and longitudinal associations between perceived discrimination and substance use among TWOC in New York City.Methods: Data were drawn from the Trying to Understand Neighborhoods and Networks Among Transgender Women of Color Cohort Study, a prospective study of TWOC followed over 1 year (August 2020 to November 2022; analytic N = 293). Discrimination was measured using a modified Everyday Discrimination Scale and categorized as low, moderate, or high. Substance use outcomes, including recreational substance use and frequent alcohol use, were measured at baseline, 6 months, and 12 months. Associations were assessed using multivariable modified Poisson regression and generalized estimating equations, adjusting for covariates.Results: At baseline, 38.2% of participants reported moderate discrimination, and 25.3% reported high discrimination. Recreational substance use was reported by 34.8% at baseline, 19.1% at 6 months, and 22.6% at 12 months. Moderate and high discrimination were significantly associated with substance use at baseline (adjusted prevalence ratios [aPRs] = 1.75 and 1.77, respectively) and 12 months (aPRs = 3.14 and 3.06, respectively). In adjusted longitudinal models, both moderate (adjusted odds ratio [aOR] = 2.97) and high (aOR = 2.39) discrimination were associated with increased recreational substance use over time. No significant associations were observed with frequent alcohol use.Conclusion: Discrimination is associated with increased substance use among TWOC. Interventions are needed to address discrimination and its effects as a determinant of individual and public health.

Objectives. To examine how one's community connectedness may act as a source of resilience and promote HIV prevention and care behaviors among transgender women of color. Methods. We analyzed survey data from 313 transgender women of color living in New York City collected from August 2020 to November 2022. The Community Connectedness Scale asks participants about their baseline feelings of connection, feelings of inclusion, feelings of belonging, feelings of isolation, and feelings of being unlike in relation to the transgender community. The HIV prevention and care outcomes of interest were measured at 6-month follow-up and included consistent condom usage, recent testing for sexually transmitted infections (STIs), current preexposure prophylaxis use, and HIV viral load suppression. Results. Those with a high (compared to low) community connectedness were 62% more likely to consistently use condoms and 16% more likely to test for STIs. Conclusions. Community connectedness was associated with a greater likelihood of HIV prevention behaviors. Public Health Implications. Future interventions could include strategies to strengthen community connectedness to improve HIV status neutral care continuums. (Am J Public Health. 2025;115(10):1631-1641. https://doi.org/10.2105/AJPH.2025.308144)

Allostatic load (AL) is a composite biomarker that reflects the cumulative burden of chronic stress on cardiovascular, metabolic, immune, and renal function, and is increasingly recognized as a potential contributor to cancer development. Yet, studies exploring the role of AL in cancer risk among Asian populations remain limited. This study examined the sociodemographic predictors of AL and prospectively evaluated its association with colorectal cancer (CRC) risk in a multi-ethnic Asian population. We analyzed data from the Singapore Population Health Studies (SPHS) multi-ethnic cohort of Chinese, Malays and Indians living in Singapore. AL was assessed using a composite score of nine biomarkers (BMI, SBP, DBP, HbA1C, TC, HDL, TC/HDL ratio, CRP and creatinine), with high-risk cutoffs set at the 75th percentile (≥p75) for all biomarkers except HDL, which used the 25th percentile (≤p25). High AL was categorized as a total score ≥3 (with one point for each high-risk indicator). Multivariable modified Poisson regression was conducted to assess the associations of sociodemographic factors (age, gender, ethnicity, income, education, work status) and smoking status with high AL. Cox proportional hazard regression models were used to evaluate the association between AL and CRC risk, controlling for these covariates. Overall, 30, 447 participants were included in this study, with a median follow-up of 7.2 years. Two-fifths (39.7%) of the participants were categorized as having high AL, and there were 154 incident cases of CRC recorded. In multivariable analyses, older age, male gender, ethnicity (Indian or Malay compared with Chinese), ever smoking, lower education (but not household income) and being unemployed were associated with higher allostatic load scores. Participants with a university education were significantly less likely to have high AL compared to those with no formal education (aPR=0.66; 95% CI=0.63, 0.70). High AL was associated with a more than twofold increased risk of CRC in unadjusted analyses (crude HR=2.09; 95% CI=1.53, 2.85). After adjusting for sociodemographic characteristics and smoking status, high AL remained significantly associated with 47% increased risk of CRC (aHR=1.47; 95% CI=1.06, 2.05). These findings are consistent with prior research pointing to a positive association between allostatic load and risk of CRC. AL may serve as a valuable biomarker for the early identification of at-risk individuals and the implementation of targeted CRC prevention strategies in Asian populations. A better understanding of how demographic, lifestyle and other factors influence levels of chronic physiologic stress may also reveal important potential targets for cancer preventive interventions. Su Hyun Park, Isaiah Soh, Xueling Sim, Adeline Seow. Allostatic load and risk of colorectal cancer in a multi-ethnic Asian cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1193.

Transgender women of color (TWOC) are disproportionately impacted by psychological distress. Though gender-affirming care (GAC) has been recommended to alleviate this distress, research examining associations between perceived access to GAC, specific gender-affirming medical interventions (GAMIs), and mental health among TWOC in the United States remains limited. In this study, we examine cross-sectional and longitudinal associations between perceived access to GAC, completion of specific GAMIs, and psychological distress among TWOC, using modified Poisson regression and multilevel linear modeling. Data came from the Trying to Understand Relationships, Networks and Neighborhoods Among Transgender Women of Color (TURNNT) Cohort Study. In multivariable analyses, increased access to GAC was associated with reduced psychological distress risk. All assessed GAMIs suggested protective effects against psychological distress (aRR < 1), with statistical significance found for breast augmentation and facial feminization surgery. On average, those with unmet GAMI needs experienced higher distress risk than those without. Longitudinally, those experiencing reduced access to GAC over 6 months faced the highest distress risk among all trajectory groups (aRR: 1.40, 95% CI, 1.08-1.82). Our findings support the need for further inquiry in this area and suggest that policies protecting and increasing access to GAC may improve mental health among TWOC. This article is part of a Special Collection on Methods in Social Epidemiology.

Background:Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. Objective:This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. Methods:University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. Results:Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m(2), and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index <= 50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale >= 13; 109/776, 14.1%). Conclusions:The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. Trial Registration:ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227 International Registered Report Identifier (IRRID):DERR1-10.2196/56749

With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped “high-quality,” which included high intakes of three or more of the following food groups: 1) fruits and vegetables, 2) whole grains, 3) healthy protein sources (legumes and nuts, fish and seafood, low-fat dairy, and lean meat and poultry), and 4) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped “low-quality,” which included high intakes of two or more of the following: 5) ultraprocessed food, 6) beverages and foods with added sugars, 7) foods high in salt, and 8) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled “animal-based,” and studies using dietary diversity scores were labeled “diet diversity indices.” Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-specific effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile defined by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD.The systematic review and meta-analysis was registered at PROSPERO as CRD42021244318.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC’s mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT (“Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color”) Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18–55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

Background Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals’ health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. Objective This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. Methods University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. Results Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%). Conclusions The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. Trial Registration ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227 International Registered Report Identifier (IRRID) DERR1-10.2196/56749

Background: Transgender women of color in the US are disproportionately vulnerable to HIV risks. Pre-Exposure Prophylaxis (PrEP) has demonstrated effectiveness in preventing HIV transmission among transgender women of color. However, factors across multiple levels can hinder oral PrEP adherence. Methods: We analyzed the baseline data from The Trying to Understand Neighborhoods and Networks Among Transgender Women of Color (TURNNT) Cohort Study of women not living with HIV. We analyzed questionnaire responses to identify why participants stopped using PrEP and if they would consider taking it again. To identify multi-level determinants that were associated with PrEP discontinuation, we conducted bivariate analysis and created multivariable modified Poisson models comparing factors between former users and current users. Results: Among 140 transgender women of color included in this analysis, 44.3% were currently on PrEP, 25.0% were on formerly on the regimen, and 30.7% had never used it. Participants reported many reasons for discontinuing PrEP, notably, 22.9% reported being concerned about interactions with hormones. 60.0% reported that they were likely to take PrEP again in the future. Discontinuation was positively associated with history of sexual assault (Prevalence Ratio: 1.78; 95% CI: 1.01, 3.14) and negatively with having a primary care provider (PR: 0.43; 95% CI: 0.25, 0.73). Conclusion: Many factors can influence PrEP discontinuation among transgender women of color. A majority of those who discontinued PrEP were interested in restarting it again, indicating a potential for reengagement. We recommend a holistic approach to HIV prevention to reduce PrEP discontinuation.

Limited attention has been given to the role of cultural orientation towards different ethnic groups in multi-ethnic settings without a dominant host culture. We evaluated whether acculturation levels, reflecting cultural orientation towards other ethnic groups, were associated with obesity and related lifestyle behaviors in a cosmopolitan Asian population. We conducted the current study based on data from the Singapore Multi-Ethnic Cohort (N = 10,622) consisting of ethnic Chinese, Malays, and Indians aged 21 to 75 years. Multivariable linear and logistic regression analyses were used to examine associations between the acculturation level (z-score), obesity, and related lifestyle behaviors, including dietary habits and physical activity. A higher acculturation level was directly associated with a higher prevalence of obesity among Chinese, whereas an inverse association was found for ethnic Indians, and no significant association in Malays. In ethnic Malays, greater acculturation was significantly associated with higher dietary quality and less sedentary time. Furthermore, a high acculturation level was significantly associated with higher sugar-sweetened beverage consumption and more leisure-time PA in all ethnic groups. Our findings suggest that greater cultural orientation towards other ethnic groups was associated with convergence in obesity levels. More research is required to understand how acculturation affects obesity-related lifestyle factors in multi-ethnic settings.

BACKGROUND:Although there is limited literature on medication adherence (including HIV care engagement) and COVID-19 vaccine hesitancy in general populations (i.e., non-sexual or gender minority populations), even less is known about whether HIV care engagement correlates with COVID-19 vaccine hesitancy among sexual and gender minorities, especially those from intersectional backgrounds. The objective of the current study was to examine if an association exists between HIV status neutral care (i.e., current pre-exposure prophylaxis [PrEP] or antiretroviral therapy [ART] use) and COVID-19 vaccination hesitancy among Black cisgender sexual minority men and transgender women at the initial peak of the pandemic.METHODS:We conducted the N2 COVID Study in Chicago from 20 April 2020 to 31 July 2020 (analytic n = 222), including Black cisgender sexual minority men and transgender women who were vulnerable to HIV as well as those who were living with HIV. The survey included questions regarding HIV care engagement, COVID-19 vaccination hesitancy and COVID-19 related socio-economic hardships. Multivariable associations estimated adjusted risk ratios (ARRs) using modified Poisson regressions for COVID vaccine hesitancy adjusting for baseline socio-demographic characteristics and survey assessment time period.RESULTS:Approximately 45% of participants reported COVID-19 vaccine hesitancy. PrEP and ART use were not associated with COVID-19 vaccine hesitancy when examined separately or combined (p > 0.05). There were no significant multiplicative effects of COVID-19 related socio-economic hardships and HIV care engagement on COVID-19 vaccine hesitancy.CONCLUSIONS:Findings suggest no association between HIV care engagement and COVID-19 vaccine hesitancy among Black cisgender sexual minority men and transgender women at the initial peak of the pandemic. It is therefore essential that COVID-19 vaccine promotion interventions focus on all Black sexual and gender minorities regardless of HIV care engagement and COVID-19 vaccine uptake is likely related to factors other than engagement in HIV status neutral care.

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population.

Objective: To investigate a) daily patterns of park use, leisure-time physical activity and stress, b) relationship of daily park use and leisure-time physical activity with stress; and c) the combined effects of daily park use and leisure-time physical activity on stress, and whether associations of daily park use and leisure-time physical activity with stress are independent. Methods: Singapore citizens/permanent residents 21-75 years-of-age from the Multi-Ethnic Cohort were enrolled into this study. Participants received mobile Ecological Momentary Assessment (mEMA) mini-surveys for up to nine days via their smartphone, with daily questions on park use and leisure-time physical activity, and perceived stress level in the evening. Descriptive statistics summarized demographics, day-to-day variation in park use, leisure-time physical activity and stress. Logistic regression models using generalized estimating equations assessed relationships of daily park use and leisure time physical activity with stress. Results: A total of 605 participants providing 4678 EMA responses to mini-surveys were included in the analyses. Participants who visited parks during a day were less stressed on the same evening than those who did not visit parks (OR = 0.67; 95% CI = 0.58-0.77). Likewise, participants who were physically active during a day were less stressed on the same evening than those who were not physically active (OR = 0.73; 95% CI = 0.64-0.82). Daily park use and leisure-time physical activity on the same day was also associated with less stress (OR = 0.58; 95% CI = 0.49-0.69), and this measure of association was lower than those comparing daily engagement in only 1 of the 2 activities. The effects of park use and physical activity on lower perceived stress were independent. Conclusions: Both daily park use and leisure time physical activity during the day were associated with reduced evening stress. These relationships were independent of one another, suggesting that each activity on its own is beneficial to reducing stress amongst adults in urban settings.

CONTEXT:The prevalence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs) is increasing in Asia and several countries are adopting preventive policies to reduce consumption of sugar-sweetened beverages (SSBs). However, evidence on the relation between SSB consumption and cardiometabolic health in Asian populations has not been summarized.OBJECTIVE:In this systematic review, the associations between consumption of SSBs and cardiometabolic outcomes, including obesity, T2DM, and CVD, are examined in Asian populations.DATA SOURCES:The PubMed, Scopus, and Web of Science databases, and gray literature were searched up to October, 2020 to identify relevant articles.DATA EXTRACTION:Two investigators independently extracted data from included studies.DATA ANALYSIS:When sufficient studies were available, a random-effects meta-analysis was used to calculate the pooled estimates (expressed as risk ratio [RR] and 95% confidence interval [CI]). Heterogeneity was tested and quantified using the Cochrane Q test and I2 statistic, respectively.RESULTS:Of the 17 studies included, 8 provided results about measures of adiposity (3 on weight change, 4 on body mass index (BMI), 2 on percent body fat, and 1 on abdominal obesity), 6 reported results about T2DM, and 3 reported on different CVD outcomes. High SSB consumption was significantly associated with greater weight gain and with a higher risk of selected CVD outcomes as compared with low consumption. In the meta-analysis, high SSB consumption was associated with greater T2DM risk before (RR, 1.51; 95%CI, 1.15-1.98 for highest vs lowest category; I2 = 76%) and after (RR, 1.38; 95%CI, 1.09-1.73; I2 = 56%) adjustment for BMI.CONCLUSIONS:These findings suggest that high SSB consumption is directly associated with weight gain, risk of T2DM, and, possibly, selected CVD outcomes in Asian populations. Public health strategies to reduce SSB consumption in Asian countries are warranted.SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42019129456.Keywords: adiposity. cardiovascular disease, Asia, sugar-sweetened beverages, type 2 diabetes.

Objectives: To determine the association between individual, network, and structural COVID-19-related stres-sors and changes in sleep duration and quality among Black cisgender sexual minority men (SMM) and Black transgender women during the COVID-19 peak infectivity rate in Chicago. Methods: From April 20, 2020 to July 31, 2020, we conducted the N2 COVID Study in Chicago (n = 226). The survey included questions regarding multi-level COVID-19-related stressors (eg, food unavailabil-ity, partner violence, housing instability, concern about neighborhood COVID-19), sleep duration, and sleep quality. Results: About 19.5% of our sample reported a shorter duration of sleep during the initial peak COVID-19 infectivity, while 41.2% reported more sleep and 38.9% reported about the same. Compared to the prepan-demic period, 16.8% reported that their sleep quality worsened in the COVID-19 pandemic, while 27.9% reported their sleep quality had improved and 55.3% reported it was about the same. In multivariable mod-els, we found that >1 day of physical stress reaction, worrying about being infected with COVID-19, traveling during COVID-19 being a financial burden, not having enough medication, knowing someone who was diag-nosed with COVID-19, partner violence and housing instability were associated with poor sleep health in the COVID-19 pandemic (adjusted risk ratio: 1.82-3.90, p < .05). Conclusions: These data suggest that COVID-19-related stressors impacted poor sleep duration and quality during the pandemic among this cohort. Multi-level interventions to reduce COVID-19-related stressors (eg, meditation, intimate partner violence prevention and housing programs) may be useful for improving sleep health among Black cisgender sexual minority men and Black transgender women.(c) 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.