Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care

We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018–2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09–1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11–1.96), 1.07 (0.74–1.54), and 1.10 (0.85–1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors

Determinants of Bicycle-On-Bus Boardings: A Case Study of the Greater Cleveland RTA

Transit agencies around the country have made significant investments since the late 1990s to provide improved service to cyclist-transit users (CTUs), that is, transit riders who bring bicycles with them by using bicycle racks installed on buses. Use of these bus bicycle racks appears to vary significantly from transit system to transit system. It is unclear, however, what specific factors contribute most to bicycle-onbus boardings (BoBBs). Using multi-variate regression analysis and a detailed data set of 2008–2011 BoBBs for Northeast Ohio’s Greater Cleveland Regional Transit Authority (GCRTA), this study compared daily BoBBs to general ridership (measured by unlinked passenger trips) in light of key weather, transit service, and travel cost variables. Rates of BoBBs rose during the study’s time period and were strongly associated with weather conditions, though even in wet and cold weather, dozens of transit users traveled with their bicycles. To a lesser extent, BoBBs are also associated with transit service levels and travel costs

Public Transit Catchment Areas The Curious Case of Cycle-Transit Users

The coordination of bicycle and transit modes has received close attention from public transit planners and researchers in recent years as transit agencies around the world have installed bicycle racks on transit vehicles, implemented bicycles-on-trains policies, and made other efforts to facilitate bicycle-transit integration. Many planners presume that the catchment area for transit is enlarged by these efforts, but geographic changes in the size of catchment areas have not been documented effectively. The research project reported in this paper assessed the distances traveled on bicycle by cycle-transit users (CTUs) and included (a) those who used bicycles as a means of access to transit stops and stations and (b) those who bicycled to and traveled on transit with their bicycles. A mixed-methods approach was employed, with a literature review; a survey of CTUs in Philadelphia, Pennsylvania, and San Francisco, California; and telephone interviews with a subset of survey respondents. Responses in the two cities made it possible to define CTU characteristics and behavior in detail. The responses highlighted two intriguing findings. First, transit catchment areas could be much larger for CTUs than for traditional transit users who accessed transit buses and rail on foot. Second, the concept of a cycle-transit catchment area was seen to be complex because of the variety of travel opportunities that cycle-transit coordination policies presented to transit riders. CTUs took advantage of larger catchment areas to reduce their travel costs, and they used those catchment areas in curious and less predictable ways

Changes in access to public transportation for cycle–transit users in response to service reductions

North American transit agencies have made large investments since the late 1990s in the coordination of bicycling and public transit services. A key goal in doing so has been to increase transit ridership by extending the geographic area from which riders can easily and quickly reach transit stops and stations. While it is widely hypothesized that being able to travel on transit vehicles with bicycles allows riders to access transit stops and stations from a larger geographic area, the empirical evidence of this is scanty. Information available for Northeast Ohio, where the Greater Cleveland Regional Transit Authority (GCRTA) operates rail, bus and demand response transit, presents an opportunity to address an important aspect of this issue. The availability of detailed long-term bicycle-on-bus boardings (BoBBs) data and the implementation of a series of service reductions in 2008, 2009 and 2010 offer an opportunity to ask the question: Do significant changes in geographic access to transit services result in significant changes to the numbers of cycle–transit users accessing transit buses? The evidence from GCRTA׳s service area provides some support for this conclusion, with the rates of utilization of bus bicycle racks increasing significantly over time and in slightly higher numbers for routes that saw the largest reductions in bus transit service

Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial.

BackgroundSubstance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care.MethodsThe Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators.DiscussionThe study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services.Trial registrationNCT03217058