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INTRODUCTION: Implementing public health vending machines (PHVMs) is an evidence-based strategy for mitigating substance use-associated morbidity and mortality via the dispensation of essential supplies to people who use drugs, including overdose prevention resources. PHVMs have been implemented throughout the world; however, their implementation in the United States (US) is a recent phenomenon. In 2017, Trac-B Exchange (a syringe services program in Clark County, Nevada) installed three PHVMs. In 2019, naloxone dispensation was launched at PHVMs in Clark County. The purpose of this research is to examine the extent to which naloxone dispensation at PHVMs was associated with changes in opioid-involved overdose fatalities. METHODS: Monthly counts of opioid-involved overdose fatalities among Clark County residents that occurred from January 2015 to December 2020 were used to build an autoregressive integrated moving averages (ARIMA) model to measure the impact of naloxone dispensation at PHVMs. We forecasted the number of expected opioid-involved overdose fatalities had naloxone dispensation at PHVMs not occurred and compared to observed monthly counts. Interrupted time series analyses (ITSA) were used to evaluate the step (i.e. the immediate impact of naloxone dispensation at PHVMs on opioid-involved overdose fatalities) and slope change (i.e. changes in trend and directionality of monthly counts of opioid-involved overdose fatalities following naloxone dispensation at PHVMs). RESULTS: During the 12-months immediately following naloxone dispensation at PHVMs, our model forecasted 270 opioid-involved overdose fatalities, but death certificate data indicated only 229 occurred, suggesting an aversion of 41 deaths. ITSA identified a significant negative step change in opioid-involved overdose fatalities at the time naloxone dispensation at PHVMs was launched (B = -8.52, p = .0022) and a significant increasing slope change (B = 1.01, p<.0001). Forecasts that extended into the COVID-19 pandemic suggested worsening trends in overdose fatalities. CONCLUSION: Naloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities. Key MessagesNaloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities.Communities should consider implementing public health vending machines in efforts to prevent opioid-involved overdose fatalities.The COVID-19 pandemic worsened the overdose crisis.

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Genetic differences between SARS-CoV-2 variants raise concerns about reinfection. Public health authorities monitored the incidence of suspected reinfection in Clark County, Nevada, USA, during March 2020-March 2022. Suspected reinfections, defined as a second positive PCR test collected >90 days after an initial positive test, were monitored through an electronic disease surveillance system. We calculated the proportion of all new cases per week that were suspected reinfections and rates per 1,000 previously infected persons by demographic groups. The rate of suspected reinfection remained <2.7% until December 2021, then increased to ≈11%, corresponding with local Omicron variant detection. Reinfection rates were higher among adults 18-50 years of age, women, and minority groups, especially persons identifying as American Indian/Alaska Native. Suspected reinfection became more common in Clark County after introduction of the Omicron variant, and some demographic groups are disproportionately affected. Public health surveillance could clarify the SARS-CoV-2 reinfection burden in communities.

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OBJECTIVES: The purpose of this exploratory study was to improve understanding of the sociodemographic correlates of human papillomavirus (HPV) awareness, knowledge, and vaccination attitudes in a convenience sample of church-going, African-American women and how knowledge about HPV-related cancers relates to vaccination attitudes for girls and boys. METHODS: Participants (N = 308) answered survey questions about HPV awareness, knowledge, and vaccination attitudes. Associations between variables were assessed using Bonferroni-adjusted chi-square tests and regression analyses. RESULTS: Younger age was associated with having heard of HPV and willingness to vaccinate a daughter or son in covariate-adjusted analyses. Younger age and greater education were associated with knowledge that HPV causes cervical cancer. A positive association existed between willingness to vaccinate a daughter or son based on knowledge of the number of cancers associated with HPV. Knowledge that HPV was related to non-cervical cancers was significantly associated with greater willingness to vaccinate sons. CONCLUSIONS: Knowledge that HPV causes multiple cancers is important to willingness to vaccinate a child. Education campaigns should emphasize that HPV is also related to non-cervical cancers. African-American women of older age and less education might benefit from church-based HPV educational campaigns.

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BACKGROUND: After reaching an all-time low in 2000, syphilis incidence in the United States has increased as the burden shifted from heterosexuals to men who have sex with men (MSM). Houston, Texas, experienced 2 outbreaks of syphilis during this transformation in trends. Further evaluation is necessary to determine if these outbreaks occurred among the same subpopulations. METHODS: Surveillance data collected on all reported infectious syphilis cases in Houston from 1971 to 2013 were analyzed. Trends in incidence among MSM and human immunodeficiency virus-positive Houston residents were examined. Peak syphilis years subsequent to 1999, years 2007 and 2012, were compared to determine if outbreaks arose in distinctive subpopulations. Categorical variables between these years were compared using chi-square and Fisher's exact tests, whereas further associations between the years were evaluated using multivariable logistic regression. RESULTS: Incidence among MSM was 20.9 to 32.1 times higher than other men from 2005 to 2013. After adjusting for covariates, cases in 2012 were significantly more likely to be Hispanic (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [95% CI], 1.03-2.53), reported meeting partners via the Internet (AOR, 1.74; 95% CI, 1.18-2.58), and engaged in anonymous sex (AOR, 1.92; 95% CI, 1.40-2.63) in comparison to cases in 2007. CONCLUSIONS: We found marked disparities of syphilis by subpopulation in Houston. Herein, we present evidence that outbreaks have been distinct in a major southern city with a high burden of syphilis.

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As many as 40-50% of persons living with HIV (PLWH) who once were in HIV care are no longer in care. It is estimated that these individuals account for over 60% of HIV transmissions. So, preventing the leaving of care and re-engaging PLWH with care are crucial if the HIV epidemic is to be brought under control. Clinicians can improve retention by keeping in close contact with patients. Governmental public health agencies have great expertise in finding and engaging in care persons with sexually transmitted infections. This expertise can be used to re-engage PLWH with HIV care, but it can only be utilized if the agencies know that someone is out of care. Data on who has left care are in the hands of HIV providers. This requires a close working relationship between HIV providers and public health agencies.

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OBJECTIVE: To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women. METHODS: Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses. RESULTS: Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values <.038). Higher education was related to HPV knowledge (p = .006). CONCLUSIONS: African-American women of older age, less education, no family history of cancer, and/or higher spirituality might benefit from targeted church-based HPV educational campaigns.

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OBJECTIVES: To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults. METHODS: Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation. RESULTS: Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05). CONCLUSIONS: Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.

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INTRODUCTION: Residential tobacco retail outlet (TRO) density and proximity have been associated with smoking behaviors. More research is needed to understand the mechanisms underlying these relations and their potential relevance outside of the residential setting. This study integrates ecological momentary assessment (EMA) and geo-location tracking to explore real-time associations between exposure to TROs and smoking urges among 47 economically disadvantaged smokers in a cessation trial (59.6% female; 36.2% White). METHODS: EMA data were collected for 1 week postquit via smartphone, which recorded smoking urge strength ≤ 4 random times daily along with real-time participant location data. For each assessment, the participants' proximity to the closest TRO and the density of TROs surrounding the participant were calculated. Linear mixed model regressions examined associations between TRO variables and smoking urges and whether relations varied based on participants' distance from their home. Covariates included sociodemographics, prequit tobacco dependence, treatment group, and daily smoking status. RESULTS: Main effects were nonsignificant; however, the interaction between TRO proximity and distance from home was considered significant (p = .056). Specifically, closer proximity to TROs was associated with stronger smoking urges ≤ 1 mile of home (p = .001) but not >1 mile from home (p = .307). Significant associations were attributable to assessments completed at participants' home addresses. All density analyses were nonsignificant. CONCLUSIONS: Technological challenges encountered in this study resulted in a significant amount of missing data, highlighting the preliminary nature of these findings and limiting the inferences that can be drawn. However, results suggest that closer residential proximity to tobacco outlets may trigger stronger urges to smoke among economically disadvantaged smokers trying to quit, perhaps due to enhanced cigarette availability and accessibility. Therefore, limiting tobacco sales in close proximity to residential areas may complement existing tobacco control efforts and facilitate cessation.

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OBJECTIVES: To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans. METHODS: A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male). RESULTS: Greater discrimination was associated with poorer self-rated health (ß =-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05). CONCLUSIONS: Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.

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