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Introduction: Hepatitis C virus (HCV) causes more morbidity and mortality in the US than any other bloodborne infectious disease, despite highly effective treatments. Significant challenges remain in identifying patients with HCV and linking them to care. IV drug use is widely recognized as the most important driver of current HCV transmission. However, other routes, such as sexual transmission, also occur but are comparatively understudied except in certain subpopulations such as men who have sex with men (MSM). It is unknown how gender and sexual orientation interact to modify the importance of sexual risk factors for HCV for the entire population. This research aimed to explore correlates to HCV seropositivity across patient subpopulations and investigate factors associated with linkage to care.Methods: For 14,718 patients tested for HCV between 2017-2020 at the Columbus, Ohio public health department, multivariate logistic regression was used to investigate how HCV seropositivity was associated with patient characteristics, health behaviors, and history of sexually transmitted infections (STI) including HIV, and how gender and sexual orientation modified these associations. A second analysis of correlates to linkage to care used logistic regression models to explore how patient characteristics and Medicaid policy changes were associated with linkage to care outcomes, using data from the Ohio Disease Reporting System (ODRS) for a cohort of HCV RNA-positive patients in urban central Ohio.Results: There were differences in how sexual risk behaviors were associated with HCV between strata of gender and sexual orientation in multivariate models. IV drug use was positively associated with HCV for all strata; however, number of sexual partners was associated with HCV for MSM (AOR 1.01; 95% CI 1.00-1.02) and WSM (AOR 1.02; 95% CI 1.00-1.03) but not MSW or WSW. Sex with an IV drug user was positively associated with HCV across all strata except MSM (AOR 6.72; 95% CI 4.38-10.32 for MSW; AOR 6.28; 95% CI 3.14-12.55 for WSM; AOR 9.40; 95% CI 3.19-27.68 for WSW). Linkage to care was associated with older age (AOR 1.03; 95% CI 1.02-1.04) and White race compared to Black race (AOR 1.50; 95% CI 1.12-2.01), and incarceration was associated with lower odds of linkage to care (AOR 0.10; 95% CI 0.02-0.41). Diagnosis before Medicaid coverage was expanded was associated with lower odds of linkage to care (AOR 0.41; 95% CI 0.22-0.80).Conclusions: This work identified differences in HCV risk factors across gender and sexual orientation. The observed stronger association between HCV and sexual risk factors for women could be suggestive of either higher risk of HCV sexual transmission, social factors related to unmeasured IV drug use, or a combination of these factors. While Ohio Medicaid rules expanding treatment coverage was associated with overall greater linkage to care, disparities in care access remained, most strikingly for people who were incarcerated. This illustrates that improving equity in care access is a human rights issue, as well as an important strategy in the fight to end HCV as a public health problem through treatment as prevention.

This study examined the outcomes a multifaceted home-based urban asthma program implemented through a city health department in a large Midwestern city. The purpose of the program was to improve asthma outcomes and reduce unintentional injury by mediating indoor asthma triggers and safety hazards in the home environment. Participants received home based education, cleaning and other supplies as well as physical home interventions such as mold abatement and pest control. A total of 310 low-income caregivers of children with asthma received services through the program. Outcomes were evaluated using survey data collected at baseline and 6 months following the intervention. A total of 115 participants for whom baseline and follow-up data were available were included in this analysis. Results showed statistically significant reduction in the following outcomes following the intervention: asthma symptom days, nighttime awakenings, days with activity limitation, and albuterol use. Emergency room visits, missed school days, and caregiver missed work days also were reduced significantly. There was no statistically significant reduction in hospitalizations. Caregiver quality of life showed significant improvement following the intervention, and caregivers were significantly more likely to report engaging in asthma trigger reducing household activities. Overall the program was found to have been successful in improving short- and long-term asthma outcomes and in improving caregiver quality of life. Program outcomes were similar to outcomes of comparable multifaceted home based interventions that have been described in the literature.

Young adults entering their first year of academic study beyond high school face seemingly limitless opportunities. For the first time, they’re on their own: deciding everything from when to eat to where to study and what to do in their free time. Campuses are rich with possibilities. From official student organizations and clubs, to impromptu pizza parties and dorm floor trivia contests, daily decisions create the experiences that shape the life to come. On many large campuses, alongside academic buildings are art galleries and performance spaces. Research shows that early exposures to the arts lead to increased engagement during student time on campus, and most important, beyond their degree-seeking years. Students at major universities are easily able to opt in for arts experiences without leaving their primary geography. For students on smaller campuses, however, this is often not the case. An undeniable barrier to critical early college career performing arts experiences in the city itself is the distance of travel to the venue. Between coordinating transportation, parking, and the associated costs—many find it easier to opt instead for a campus movie or night in front of the television. This research examines the barriers to attending performing arts events for first year college students, and methods for communicating benefits and incentives to this critical target audience. Adviser: Stacy James