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Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397–407. https://doi.org/10.2105/AJPH.2022.307199 )

Complete COVID-19 data for American Indian/Alaska Native (AI/AN) populations are critical to equitable pandemic response.We used the COVID-19 U.S. State Policy database to document gaps in COVID-19 data reporting for AI/AN people.Sixty-four percent of states do not report AI/AN data for at least one COVID-19 health metric: cases, hospitalizations, deaths, or vaccinations.The lack of AI/AN-specific data masks the disproportionate burden of COVID-19 and presents challenges to COVID-19 prevention, policy implementation, and health equity.Public-facing data disaggregated by race may facilitate rapid response COVID-19 research and policymaking to support AI/AN communities.

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool. Long-acting injectable PrEP (LAI-PrEP) offers another opportunity to reduce HIV. However, how at-risk individuals will consider LAI-PrEP over other modes of administration is unclear. We conducted a discrete choice experiment on preferences for PrEP among a sample of N = 688 gay, bisexual, and other men who have sex with men (GBMSM). We analyzed preferences for mode of administration, side-effects, monetary cost, and time cost using a conditional logit model and predicted preference for PrEP options. LAI-PrEP was preferred, despite mode of administration being the least important PrEP attribute. Side-effects were the most important attribute influencing preferences for PrEP (44% of decision); costs were second-most-important (35% of decision). PrEP with no side-effects was the most important preference, followed by monthly out-of-pocket costs of $0. Practitioners and policymakers looking to increase PrEP uptake should keep costs low, communicate clearly about PrEP side-effects, and allow the use of patient-preferred modes of PrEP administration, including LAI-PrEP.

Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.

State-level structural stigma and its consequences in healthcare settings shape access to pre-exposure prophylaxis (PrEP) for HIV prevention among gay, bisexual, and other men who have sex with men (GBMSM). Our objective was to assess the relationships between same-sex marriage laws, a measure of structural stigma at the state level, provider-patient communication about sex, and GBMSM awareness and use of PrEP. Using data from the Fenway Institute's MSM Internet Survey collected in 2013 (N = 3296), we conducted modified Poisson regression analyses to evaluate associations between same-sex marriage legality, measures of provider-patient communication, and PrEP awareness and use. Living in a state where same-sex marriage was legal was associated with PrEP awareness (aPR 1.27; 95% CI 1.14, 1.41), as were feeling comfortable discussing with primary care providers that they have had sex with a man (aPR 1.63; 95% CI 1.46, 1.82), discussing with their primary care provider having had condomless sex with a man (aPR 1.65; 95% CI 1.49, 1.82), and discussing with their primary care provider ways to prevent sexual transmission of HIV (aPR 1.39; 95% CI 1.26, 1.54). Each of these three measures of provider-patient communication were additionally associated with PrEP awareness and use. In sum, structural stigma was associated with reduced PrEP awareness and use. Policies that reduce stigma against GBMSM may help to promote PrEP and prevent HIV transmission.

Background Since COVID-19 first appeared in the United States (US) in January 2020, US states have pursued a wide range of policies to mitigate the spread of the virus and its economic ramifications. Without unified federal guidance, states have been the front lines of the policy response. Main text We created the COVID-19 US State Policy (CUSP) database (https://statepolicies.com/) to document the dates and components of economic relief and public health measures issued at the state level in response to the COVID-19 pandemic. Documented interventions included school and business closures, face mask mandates, directives on vaccine eligibility, eviction moratoria, and expanded unemployment insurance benefits. By providing continually updated information, CUSP was designed to inform rapid-response, policy-relevant research in the context of the COVID-19 pandemic and has been widely used to investigate the impact of state policies on population health and health equity. This paper introduces the CUSP database and highlights how it is already informing the COVID-19 pandemic response in the US. Conclusion CUSP is the most comprehensive publicly available policy database of health, social, and economic policies in response to the COVID-19 pandemic in the US. CUSP documents widespread variation in state policy decisions and implementation dates across the US and serves as a freely available and valuable resource to policymakers and researchers.

The US population faced stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation in the context of the pandemic may inform policies and programs to prevent suicidality and suicide. We compared suicidal ideation between two cross-sectional, nationally representative surveys of adults in the United States: the 2017–2018 National Health and Nutrition Examination Survey (NHANES) and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study (conducted March 31 to April 13). We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance to generate unadjusted and adjusted prevalence ratios (PR and aPR). Suicidal ideation increased from 3.4% in the 2017–2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. In the multivariable model, difficulty paying rent (aPR: 1.5, 95% CI: 1.2–2.1) and feeling alone (aPR: 1.9, 95% CI: 1.5–2.4) were associated with suicidal ideation but job loss was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Suicidal ideation increased by 12.9 percentage points and was almost 4.8 times higher during the COVID-19 pandemic. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.

This study examines current minor consent laws for sexually transmitted infection/HIV services and related confidentiality protections in all 50 states and the District of Columbia.

IntroductionPeople in low-income households face a disproportionate burden of health and economic consequences brought on by the COVID-19 pandemic, including COVID-19 and food insufficiency. State minimum wage and paid sick leave policies may affect whether people are vulnerable to employment and health shocks to income and affect food insufficiency.MethodsWe evaluated the relationship between state minimum wage policies and the outcome of household food insufficiency among participants younger than 65 during the COVID-19 pandemic. We used data from biweekly, state representative Census Pulse surveys conducted between August 19 and December 21, 2020. We conducted analyses in the full population under age 65 years, who are most likely to work, and in households with children. The primary exposure was state minimum wage policies in four categories: less than $8.00, $8.00 to $9.99, $10.00 to $11.99, and $12.00 or more. A secondary exposure was missing work due to COVID-19, interacted with whether participants reported not having paid sick leave. Food insufficiency was defined as sometimes or often not having enough to eat in the past seven days. Very low child food sufficiency was defined as children sometimes or often not eating enough in the past seven days because of inability to afford food. We conducted a multivariable modified Poisson regression analysis to estimate adjusted prevalence ratios and marginal effects. We clustered standard errors by state. To adjust for state health and social programs, we adjusted for health insurance and receipt of supplemental nutrition assistance program benefits, unemployment insurance, and stimulus payments as well as for population demographic characteristics associated with food insufficiency. We conducted subgroup analyses among populations most likely to be affected by minimum wage policies: Participants who reported any work in the past seven days, who reported $75,000 in 2019 household income.ResultsIn states with a minimum wage of less than $8.00, 14.3% of participants under age 65 and 16.6% of participants in households with children reported household food insufficiency, while 10.3% of participants reported very low child food sufficiency. A state minimum wage of $12 or more per hour was associated with a 1.83 percentage point reduction in the proportion of households reporting food insufficiency relative to a minimum wage of less than $8.00 per hour (95% CI: −2.67 to −0.99 percentage points). In households with children, a state minimum wage of $12 or more per hour was associated with a 2.13 percentage point reduction in household food insufficiency (95% CI: −3.25 to −1.00 percentage points) and in very low child food sufficiency (−1.16 percentage points, 95% CI: −1.69 to −0.63 percentage points) relative to a state minimum wage of less than $8.00 per hour. Minimum wages of $8.00 to $9.99 and $10.00 to $11.99 were not associated with changes in child food insufficiency or very low child food sufficiency relative to less than $8.00 per hour. Subgroup analyses and sensitivity analyses were consistent with the main results. Estimates were of a lesser magnitude (DiscussionFood insufficiency is high in all households and even more so in households with children during the COVID-19 pandemic. Living in a state with at least a $12 minimum wage was associated with a decrease in the proportion of people reporting food insufficiency during the COVID-19 pandemic. Not having paid leave was associated with increases in food insufficiency among people who reported missing work due to COVID-19 illness. Policymakers may wish to consider raising the minimum wage and paid sick leave as approaches to reducing food insufficiency during and after the COVID-19 pandemic.

Background Respiratory tract infections (RTIs) are often inappropriately treated with antibiotics. Rapid diagnostic tests (RDTs) have been developed with the aim of improving antibiotic prescribing but uptake remains low. The aim of this study was to examine provider knowledge, attitudes and behaviors regarding RDT use and their relationship to antibiotic prescribing decisions across multiple clinical departments in an urban safety-net hospital. Methods We conducted a mixed methods sequential explanatory study. Providers with prescribing authority (attending physicians, nurse practitioners and physician assistants) who had at least 20 RTI encounters from January 1, 2016 to December 31, 2018. Eighty-five providers completed surveys and 16 participated in interviews. We conducted electronic surveys via RedCap from April to July 2019, followed by semi-structured individual interviews from October to December 2019, to ascertain knowledge, attitudes and behaviors related to RDT use and antibiotic prescribing. Results Survey findings indicated that providers felt knowledgeable about antibiotic prescribing guidelines. They reported high familiarity with the rapid streptococcus and rapid influenza tests. Familiarity with comprehensive respiratory panel PCR (RPP-respiratory panel PCR) and procalcitonin differed by clinical department. Qualitative interviews identified four main themes: providers trust their clinical judgment more than rapid test results; patient-provider relationships play an important role in prescribing decisions; there is patient demand for antibiotics and providers employ different strategies to address the demand and providers do not believe RDTs are implemented with sufficient education or evidence for clinical practice. Conclusion Prescribers are knowledgeable about prescribing guidelines but often rely on clinical judgement to make final decisions. The utility of RDTs is specific to the type of RDT and the clinical department. Given the low familiarity and clinical utility of RPP and procalcitonin, providers may require additional education and these tests may need to be implemented differently based on clinical department.

Aberrant mucin-type O-linked glycosylation is a common occurrence in cancer where the upregulation of sialyltransferases is often seen leading to the early termination of O-glycan chains. Mucin-type O-linked glycosylation is not limited to mucins and occurs on many cell surface glycoproteins including EGFR, where the number of sites can be limited. Upon EGF ligation, EGFR induces a signaling cascade and may also translocate to the nucleus where it directly regulates gene transcription, a process modulated by Galectin-3 and MUC1 in some cancers. Here, we show that upon EGF binding, breast cancer cells carrying different O-glycans respond by transcribing different gene expression signatures. MMP10, the principal gene upregulated when cells carrying sialylated core 1 glycans were stimulated with EGF, is also upregulated in ER-positive breast carcinoma reported to express high levels of ST3Gal1 and hence mainly core 1 sialylated O-glycans. In contrast, isogenic cells engineered to carry core 2 glycans upregulate CX3CL1 and FGFBP1 and these genes are upregulated in ER-negative breast carcinomas, also known to express longer core 2 O-glycans. Changes in O-glycosylation did not significantly alter signal transduction downstream of EGFR in core 1 or core 2 O-glycan expressing cells. However, striking changes were observed in the formation of an EGFR/galectin-3/MUC1/β-catenin complex at the cell surface that is present in cells carrying short core 1-based O-glycans but absent in core 2 carrying cells.

Cryptosporidium parvum is a waterborne pathogen, yet no suitable surrogate has been established for quantifying its filtration removal in porous media. Carboxyl polystyrene microspheres with size, density, and shape similar to C. parvum were coated with biotin (free and containing amine, NH(2)) and glycoprotein. These biomolecules have isoelectric points similar to C. parvum (pH ≈ 2), and glycoprotein is a major type of surface protein that oocysts possess. Zeta potential (ζ) and filtration removal of particles in sand of two different grain sizes were examined. Compared to unmodified microspheres, modified microspheres achieved a superior match to the oocysts in ζ, concentration, mass recovery, and collision coefficient. They showed the same log reduction in concentration as oocysts, whereas results from unmodified microspheres deviated by 1 order of magnitude. Of the three types of modified microspheres, glycoprotein-coated microspheres best resembled oocyst concentration, despite having ζ similar to NH(2)-biotin-coated microspheres, suggesting that surface protein also played an important role in particle attachment on solid surfaces. With further validation in environmental conditions, the surrogates developed here could be a cost-effective new tool for assessing oocyst filtration in porous media, for example, to evaluate the performance of sand filters in water and wastewater treatment, water recycling through riverbank filtration, and aquifer recharge.

Blue-eye trevalla (Hyperoglyphe antarctica), blue warehou (Seriolella brama) and silver warehou (Seriolella punctata) from the family Centrolophidae are three commercially important species in the Australian fishery. These species are currently managed as single stocks. We tested the hypothesis that patterns of phenotypic structuring in these species reflect underlying genetic stock structure using an analysis of mitochondrial DNA control region sequences. The analysis revealed high levels of haplotype diversity within populations. The most common haplotypes for the species occurred in all geographical locations sampled. For S. brama, although structuring was not significant after Bonferroni correction, differences between two sites were sufficient to warrant caution in the management of fishery zones for this species. There were also some indications of structuring when sites were grouped into common regions. Demographic analysis suggested that S. brama might have had a history of population bottlenecks followed by sudden population expansion, potentially contributing to genetic structuring in the fishery. No structuring was detected for H. antarctica and S. punctata. The present study highlights the need for, and the utility of, multiple sources of information, that is, genetic, phenotypic, behavioural and ecological, when managing marine fisheries and the need to take a cautionary approach to the interpretation of genetic data for fisheries management.