A national prospective cohort study of SARS/COV2 pandemic outcomes in the U.S.: The CHASING COVID Cohort

Introduction: The Chasing COVID Cohort (C 3 ) study is a US-based, geographically and socio-demographically diverse sample of adults (18 and older) enrolled into a prospective cohort study during the upswing of the U.S. COVID-19 pandemic. Methods: We used internet-based strategies to enroll C 3 participants beginning March 28th, 2020. Following baseline questionnaire completion, study participants will be contacted monthly (for 6 months) to complete assessments of engagement in non-pharmaceutical interventions (e.g., use of cloth masks, avoiding large gatherings); COVID-19 symptoms; SARS/COV2 testing and diagnosis; hospitalizations; healthcare access; and uptake of health messaging. Dried blood spot (DBS) specimens will be collected at the first follow-up assessment (last week of April 2020) and at month 3 (last week of June 2020) and stored until a validated serologic test is available. Results: As of April 20, 2020, the number of people that completed the baseline survey and provided contact information for follow-up was 7,070. Participants resided in all 50 US states, the District of Columbia, Puerto Rico, and Guam. At least 24% of participants were frontline workers (healthcare and other essential workers). Twenty-three percent (23%) were 60+ years, 24% were Black or Hispanic, 52% were men, and 52% were currently employed. Nearly 20% reported recent COVID-like symptoms (cough, fever or shortness of breath) and a high proportion reported engaging in non-pharmaceutical interventions that reduce SARS/COV2 spread (93% avoided groups \u3e20, 58% wore masks; 73% quarantined). More than half (54%) had higher risk for severe COVID-19 illness should they become infected with SARS/COV2 based on age, underlying health conditions (e.g., chronic lung disease), or daily smoking. Discussion: A geographically and socio-demographically diverse group of participants was rapidly enrolled in the C3 during the upswing of the SARS/COV2 pandemic. Strengths of the C3 include the potential for direct observation of, and risk factors for, seroconversion and incident COVID disease (among those with or without antibodies to SARS/COV2) in areas of active transmission

Food Insecurity During the First Year of COVID-19: Employment and Sociodemographic Factors Among Participants in the CHASING COVID Cohort Study

Objective: While much has been reported about the impact of the COVID-19 pandemic on food insecurity, longitudinal data and the variability experienced by people working in various industries are limited. This study aims to further characterize people experiencing food insecurity during the pandemic in terms of employment, sociodemographic characteristics, and degree of food insecurity. Methods: The study sample consisted of people enrolled in the Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study from visit 1 (April–July 2020) through visit 7 (May–June 2021). We created weights to account for participants with incomplete or missing data. We used descriptive statistics and logistic regression models to determine employment and sociodemographic correlates of food insecurity. We also examined patterns of food insecurity and use of food support programs. Results: Of 6740 participants, 39.6% (n = 2670) were food insecure. Non-Hispanic Black and Hispanic (vs non-Hispanic White) participants, participants in households with children (vs no children), and participants with lower (vs higher) income and education levels had higher odds of food insecurity. By industry, people employed in construction, leisure and hospitality, and trade, transportation, and utilities industries had the highest prevalence of both food insecurity and income loss. Among participants reporting food insecurity, 42.0% (1122 of 2670) were persistently food insecure (≥4 consecutive visits) and 43.9% (1172 of 2670) did not use any food support programs. Conclusions: The pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in industries vulnerable to economic disruption and ensure those experiencing food insecurity can access food support programs for which they are eligible

Household factors and the risk of severe COVID-like illness early in the U.S. pandemic

Objective To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. Methods We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. Results In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7–19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2–6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0–6.1), and 0.8 (95% CI:0.15–4.1) among those living in single unit dwellings. Conclusion Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Evaluating Social Capital Effects On Adolescent Sexual Health Behaviors

Background: Adolescents continue to bear the burden of sexually transmitted diseases suggesting that innovative solutions to safe sexual health behaviors must be discovered to help reduce the rates of sexually transmitted diseases in this population. Research has suggested that adolescents are influenced by peer relationships, and the behaviors in which their peers participate. This study aims to examine the relationship between social capital and adolescent sexual initiation, condom use, and sexually transmitted infections. Methods: Secondary data analysis was conducted using nominated friendship data from Waves I and II of the National Longitudinal Study of Adolescent Health. Wave I data was used to create behavior proportions within the immediate and broader peer groups used to estimate bonding and bridging social capital. Outcomes for sexual initiation, condom use, and sexually transmitted diseases were assessed at Wave II. Logistic regression analyses were conducted for each outcome and predictor variable. Additional analyses for determining the association of the immediate peer group\u27s effects on adolescent sexual behaviors included a sensitivity analysis and simulation/extrapolation analysis to determine the effects of missingness on each estimate. Results: The findings suggest a positive association for the relationships between bonding social capital and adolescent sexual initiation, bridging social capital and adolescent sexual initiation, and bridging social capital and adolescent STI status. Other findings for the associations of bonding social capital and adolescent condom use, bridging social capital and condom use, and bonding social capital and adolescent STI status were non-significant. Conclusion: This study helps to illustrate the differential effects of bonding and bridging social capital on adolescent sexual behaviors, and indicate the potential for targeted interventions at these different sources to help reduce the burden of STIs among adolescents

RISKY BUSINESS: Sexual health behaviors, butt stuff, and whether people will talk about it

STDs present a preventable and continuing public health issue. Certain behaviors can increase the risk of STDs among young people. Additionally, much of the data used depends on potentially unreliable self-reported information. This dissertation (1) examined life-time risk factors and trajectories for STDs, (2) illuminated sexual health behaviors associated with HAI, and (3) investigated the validity of using a popular SDS in a young, urban population.The first study investigated the longitudinal effects of broader, individual, and partnership factors on number of sex partners and concurrent sexual relationships. Broader influences such as lesser degrees of parental support and being a native English speaker or having higher levels of acculturation suggest increases in both number of sexual partners and the occurrence of concurrent sexual relationships. We also found that substance use, including alcohol use, was associated with higher numbers of sexual partners and likelihood of concurrent sexual relationships. Finally, we found that the trajectories of sexual partners were not only explained by time, but by demographic characteristics.The second study used individual- and partner-level analyses to assess the association of demographic and behavioral characteristics with HAI. Demographic factors, such as identifying as Black/African American, or behaviors, such as alcohol consumption and having a sexual partner who was recently incarcerated, were associated with more reporting of HAI. Additionally, HAI was more likely to occur in main, longer, and more committed partnerships, as well as relationships where IPV was present. The third study evaluated the validity of using an older, popular SDS in a young, urban population. Factor analyses identified 15 questions from the MC-SDS that worked well in our population and differ from other short form versions. Of these 15 items, 20% were determined to be harder to answer based on underlying SD and about half were better able to differentiate between question scores for average SD. Finally, older age groups provided more socially desirable answers.The findings from this dissertation help highlight characteristics and behaviors that can be incorporated into sexual health interventions to reduce STDs, and to improve how we collect and analyze data related to reported sexual health behaviors

RISKY BUSINESS: Sexual health behaviors, butt stuff, and whether people will talk about it

STDs present a preventable and continuing public health issue. Certain behaviors can increase the risk of STDs among young people. Additionally, much of the data used depends on potentially unreliable self-reported information. This dissertation (1) examined life-time risk factors and trajectories for STDs, (2) illuminated sexual health behaviors associated with HAI, and (3) investigated the validity of using a popular SDS in a young, urban population.The first study investigated the longitudinal effects of broader, individual, and partnership factors on number of sex partners and concurrent sexual relationships. Broader influences such as lesser degrees of parental support and being a native English speaker or having higher levels of acculturation suggest increases in both number of sexual partners and the occurrence of concurrent sexual relationships. We also found that substance use, including alcohol use, was associated with higher numbers of sexual partners and likelihood of concurrent sexual relationships. Finally, we found that the trajectories of sexual partners were not only explained by time, but by demographic characteristics.The second study used individual- and partner-level analyses to assess the association of demographic and behavioral characteristics with HAI. Demographic factors, such as identifying as Black/African American, or behaviors, such as alcohol consumption and having a sexual partner who was recently incarcerated, were associated with more reporting of HAI. Additionally, HAI was more likely to occur in main, longer, and more committed partnerships, as well as relationships where IPV was present. The third study evaluated the validity of using an older, popular SDS in a young, urban population. Factor analyses identified 15 questions from the MC-SDS that worked well in our population and differ from other short form versions. Of these 15 items, 20% were determined to be harder to answer based on underlying SD and about half were better able to differentiate between question scores for average SD. Finally, older age groups provided more socially desirable answers.The findings from this dissertation help highlight characteristics and behaviors that can be incorporated into sexual health interventions to reduce STDs, and to improve how we collect and analyze data related to reported sexual health behaviors

Factors Associated With Pharyngeal Gonorrhea in Young People

BackgroundThe objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public sexually transmitted disease (STD) clinics.MethodsWe conducted a case-control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they (1) were 15 to 29 years of age, (2) reported giving oral sex to a partner of the opposite sex in the past 90 days, and (3) attended 1 of 12 public STD clinics in Los Angeles County. Computer-assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea.ResultsMost participants were younger than 25 years (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea, of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 to 64 cases. After adjusting for age, sex, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were 3 times as likely to have pharyngeal gonorrhea as compared with those without this exposure (adjusted odds ratio, 3.1; 95% confidence interval, 1.3-7.5).ConclusionsA large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids