Torsten B. Neilands’s research while affiliated with University of California, San Francisco and other places

Background Residence in a disadvantaged neighborhood (e.g., high poverty rate, poor housing, etc.) is associated with greater dementia risk and possibly greater postmortem Alzheimer’s pathology. It remains unknown if neighborhood disadvantage is associated with in vivo beta‐amyloid positron emission tomography (PET) for Alzheimer’s. We examined this using data from the Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study. Methods IDEAS captured >18,000 PET scans among cognitively impaired Medicare beneficiaries from 595 US dementia clinics between 2016‐2018. We defined neighborhood disadvantage using Area Deprivation Index (ADI), a validated composite of 17 social determinants measures captured in American Community Survey and US Census data. IDEAS participant zip code data was linked to census block group for ADI value calculation through geocoding. Association between visual interpretation of PET in IDEAS (positive/negative) and state‐level ADI (1‐10; 10 being greatest disadvantage) was examined via logistic regression controlling for covariates (age, sex, education, level of impairment (MCI vs dementia), race/ethnicity, comorbid conditions) with cluster adjusted standard errors by practice location. Results Among 13,961 cognitively impaired participants, 61.6% were amyloid positive, 56.5% had MCI, and 50.4% were female (Table 1). The majority (90.2%) were non‐Latino White with 4.7% Latino, 3.2% Black, and 1.9% Asian representation (Table 1). Participants were highly educated (68.1% beyond high school) and 31.0% (4,333/13,961) resided in neighborhoods of greater disadvantage (ADI ≥ 6) (Figure 1). Greater ADI was associated with lower odds of amyloid positivity (aOR 0.61, 95% CI 0.51‐0.73, p<.001 for ADI 10 vs ADI 2 and aOR 0.87, 0.76‐1.00, p .051 for ADI 2 vs. ADI 1(ref)). Latino (aOR 0.62, 0.48‐0.80, p<.001), Black (aOR 0.58, 0.48‐0.72, p<.001), and Asian (aOR 0.42, 0.31‐0.58, p<.001) identity was associated with lower odds of amyloid positivity along with multiple comorbidities (Table 2). Conclusion We observed a relationship between residence in a more disadvantaged neighborhood (higher ADI) and lower rates of amyloid positivity. Given this finding and known association between neighborhood disadvantage and postmortem AD pathology, it is possible non‐amyloid pathology also contributes towards cognitive impairment among individuals from disadvantaged neighborhoods and among diverse groups. This has implications for clinical use of novel amyloid lowering therapies.

Background Residence in a disadvantaged neighborhood (e.g., high poverty rate, poor housing, etc.) is associated with greater dementia risk and possibly greater postmortem Alzheimer’s pathology. It remains unknown if neighborhood disadvantage is associated with in vivo beta‐amyloid positron emission tomography (PET) for Alzheimer’s. We examined this using data from the Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study. Methods IDEAS captured >18,000 PET scans among cognitively impaired Medicare beneficiaries from 595 US dementia clinics between 2016‐2018. We defined neighborhood disadvantage using Area Deprivation Index (ADI), a validated composite of 17 social determinants measures captured in American Community Survey and US Census data. IDEAS participant zip code data was linked to census block group for ADI value calculation through geocoding. Association between visual interpretation of PET in IDEAS (positive/negative) and state‐level ADI (1‐10; 10 being greatest disadvantage) was examined via logistic regression controlling for covariates (age, sex, education, level of impairment (MCI vs dementia), race/ethnicity, comorbid conditions) with cluster adjusted standard errors by practice location. Results Among 13,961 cognitively impaired participants, 61.6% were amyloid positive, 56.5% had MCI, and 50.4% were female (Table 1). The majority (90.2%) were non‐Latino White with 4.7% Latino, 3.2% Black, and 1.9% Asian representation (Table 1). Participants were highly educated (68.1% beyond high school) and 31.0% (4,333/13,961) resided in neighborhoods of greater disadvantage (ADI > 6) (Figure 1). Greater ADI was associated with lower odds of amyloid positivity (aOR 0.61, 95% CI 0.51‐0.73, p<.001 for ADI 10 vs ADI 2 and aOR 0.87, 0.76‐1.00, p .051 for ADI 2 vs. ADI 1(ref)). Latino (aOR 0.62, 0.48‐0.80, p<.001), Black (aOR 0.58, 0.48‐0.72, p<.001), and Asian (aOR 0.42, 0.31‐0.58, p<.001) identity was associated with lower odds of amyloid positivity along with multiple comorbidities (Table 2). Conclusion We observed a relationship between residence in a more disadvantaged neighborhood (higher ADI) and lower rates of amyloid positivity. Given this finding and known association between neighborhood disadvantage and postmortem AD pathology, it is possible non‐amyloid pathology also contributes towards cognitive impairment among individuals from disadvantaged neighborhoods and among diverse groups. This has implications for clinical use of novel amyloid lowering therapies.

Posttraumatic stress symptoms are very high among sexual and/or gender minority (SGM) people. Development and testing of trauma interventions with SGM people is needed, but first, we need to understand who among SGM people are at greatest risk of posttraumatic stress symptoms, how minority stress may contribute, and the frequency of substance use comorbidity with significant posttraumatic stress symptoms among SGM people. General linear models and logistic regressions were used to examine demographic differences, minority stress, and substance use related to posttraumatic stress symptoms among a national sample of SGM people (N = 4,589, Mage = 32.1, 55% cisgender). All gender groups had greater posttraumatic stress symptoms than the reference group of cisgender men. All sexual orientation groups, except for straight/heterosexual SGM people, had greater posttraumatic stress symptoms than participants in the reference gay/lesbian group. Younger age or identifying as American Indian or Alaska Native, or Hispanic, Latino, or Spanish was associated with more posttraumatic stress symptoms. Nonspecific and SGM-specific minority stress were each related to greater odds of significant posttraumatic stress symptoms, even after accounting for Criterion A events. Among participants with significant posttraumatic stress symptoms, 13.6% were at risk for alcohol use disorder, and 56.4% were at risk for other substance use disorder. Marginalized SGM subgroups have more posttraumatic stress symptoms. Interventions for SGM people should consider minority stress coping strategies and substance use comorbidities.

Although research has shown that social support generally is beneficial to mental health among trans and nonbinary (TNB) adults, less is known regarding what forms of support and the degree to which they mitigate the harms of minority stress on mental health over time. This study investigated differences in types of social support and their association with mental health over time in a sample of 2,411 TNB adults, predominantly younger in age (53% 18–30 years old), diverse in sexual orientation (97.5%, LGBQA+, 2.5% straight/heterosexual), gender identity (53.3% nonbinary, 26% trans man, 12.4% trans woman), and similar in race and ethnicity to the U.S. national population. We conducted a latent profile analysis (LPA) to identify social support typologies. A three-profile solution classified participants into a low- (39.6%), moderate- (40.7%), or high-support profile (19.7%). Significant variability in gender-related support experiences was noted for those in the moderate- and high-support profiles, while those in the low-support profile had almost uniformly little to no support from family. Mental health outcomes differed between the profiles; low-support participants reported significantly worse depression and posttraumatic stress disorder symptoms; demographically, the greatest proportion of participants with marginalized identities clustered in the low-support profile. Finally, we tested profile membership as a moderating variable in the association of minority stressors with mental health over time. Few significant differences emerged between groups, suggesting that being in a higher support profile may not necessarily buffer the harms of minority stress on mental health over time. Intervention implications are discussed.

Background To build research capacity for early-career faculty conducting HIV/STI research with minoritized communities and to enhance diversity in the scientific workforce, the University of California, San Francisco (UCSF) Center for AIDS Prevention (CAPS) conducts a training program for visiting professors (VPs), begun in 1996. VPs are in residence at CAPS for three summers, complete a pilot research project, and prepare National Institutes of Health (NIH) grant proposals. Best practices and key elements for successfully training scholars of color, and others who work with minoritized communities, are identified. Methods This paper draws on qualitative interviews with 31 VPs and 10 program mentors (VPMs) who participated in the program between 1996 and 2016. All VPs were also invited to participate in an anonymous survey to assess potential differences between study participants and non-participants. Interviews took place between September 2017 and March 2018 and were audio-recorded, transcribed, and thematically coded. Results VPs and VPMs described key elements relevant to both human and social capital that contributed to Program success. Paramount among these were the importance of establishing trusting mentorship relationships; sustained collegial engagement over time; and fostering a training environment based on multidisciplinarity, skills-building, scholarly networking, and peer reviews. Conclusions Participant voices from this objectively successful training program provide directions for future initiatives to support scholars of color and those working with minoritized groups. An indispensable value of such programs is to intentionally foster trusted scholarly communities to counterbalance systemic inequities in the academy.

Introduction: Uncontrolled hypertension substantially increases the risk for cardiovascular disease and is a major cause of mortality among people living with HIV in many countries in sub-Saharan Africa, including Malawi. Despite previous studies showing low rates of blood pressure (BP) control among individuals with comorbid HIV and hypertension in these settings, few have focused on identifying potentially modifiable factors for improving BP control. This study examined contextual and self-management behaviors associated with BP control. Methods: This is a cross-sectional analysis of baseline data from participants in Healthy Hearts, a cohort study of persons with HIV and cardiometabolic conditions in Malawi. Participants were adults aged ≥18 years with HIV and hypertension (n=202), recruited from HIV care clinics at 3 hospitals. Multiple logistic regression was used to examine factors associated with BP control, defined as mean systolic BP <140mmHg and diastolic BP <90mmHg based on the 2020 International Society of Hypertension guidelines. Independent variables included age, gender, education level, access to healthcare, presence of comorbid conditions, body mass index, multimorbidity illness perceptions, hypertension-related knowledge, and self-management behaviors (self-reported physical activity, salt intake, fruit and vegetable intake, and antihypertensive medication adherence). Results: All participants were on antiretroviral therapy, 83.1% were on antihypertensive medication, and only 37.3% had controlled BP. Having a higher score in hypertension-related knowledge was positively associated with BP control (odds ratio [OR], 2.44; 95% CI 1.14–5.23). Factors negatively associated with BP control included increasing age (OR, 0.92; 95% CI 0.89–0.96), low antihypertensive medication adherence (OR, 0.32; 95% CI 0.11–0.89) or not being on antihypertensives (OR, 0.30; 95% CI 0.11–0.82), and perceiving multimorbidity as having greater negative impact on health (OR, 0.54; 95% CI 0.30–0.98). Conclusions: Age and potentially modifiable factors such as hypertension-related health literacy, medication adherence, and multimorbidity illness perceptions were independently associated with BP control at baseline in a cohort of Malawian adults with comorbid HIV and hypertension. These insights can help guide the development of tailored interventions for promoting BP control in persons with HIV at high risk for cardiovascular disease living in low-income countries.

Background In the United States (US), transgender women of color experience cyclical, interlocking systems of structural and institutional oppression rooted in racism and transphobia, which fuel economic vulnerability. Together, cycles of intersecting racism, transphobia, and economic vulnerability create conditions that give rise to extreme HIV inequities among transgender women of color. Microeconomic interventions — designed to improve financial standing by increasing income generation and access to financial resources through entrepreneurship, cash transfers, and training — have the potential to address structural factors underlying HIV inequities. Over the past few years, several trans-led organizations, including the Trans Sistas of Color Project, have integrated microeconomic strategies, specifically emergency assistance, into their programming. The aim of the current study is to conduct a pilot randomized controlled trial (RCT) to evaluate the feasibility and acceptability of a definitive subsequent RCT and explore initial evidence of an enhanced microeconomic intervention to increase income generation and improve HIV prevention and care continua outcomes. Methods This is a two-arm waitlist randomized controlled trial in which transgender women of color will be randomly allocated to either usual care that includes the Trans Sistas of Color Project’s existing microeconomic interventions, which includes the following: (1) US $250 in emergency assistance and (2) peer support to obtain legal gender affirmation (i.e., legal name and gender markers on identification documents) or the enhanced microeconomic intervention that includes usual care and will be enhanced to include the following: (1) 12 weekly educational group sessions on economic empowerment (i.e., job acquisition, income generation through micro-business, and financial literacy) and HIV prevention and care, (2) employment-focused mentoring, and (3) an unconditional grant (US$1200) for use towards acquiring self-led or formal employment. Participants in each condition will complete a baseline survey prior to randomization, a follow-up survey immediately following intervention completion, and 3-month survey after intervention completion. Participants will also complete qualitative exit interviews within 1 month of intervention completion for both conditions. Discussion This study will be one of the first US-based pilot randomized clinical trials that builds upon existing community-led solutions to economic vulnerability to address HIV inequities. Findings will provide the necessary groundwork to examine intervention effectiveness in a future large-scale trial. Trials registration NCT06212544. Protocol version September 25, 2024, version 2.