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IntroductionThe United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.-Mexico border region-they demonstrate the highest rates of STIs and unintended pregnancy among adolescents.MethodsQualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.-Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15-18 (n = 20).ResultsProviders and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent's knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH.ConclusionsAdolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region.

BackgroundOver the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation.Methods/designThis paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671).DiscussionThe NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.

OBJECTIVE: To understand the comparative concerns and perceptions of veterinary and medical health professionals regarding antimicrobial resistance (AMR) and its effects on their clinical practices. SAMPLE: 17 Doctors of medicine and veterinary medicine and 1 nurse practitioner were interviewed to collect qualitative-based data regarding their clinical experience with AMR. METHODS: The interviews from the health professionals were transcribed and thematically coded to reveal 3 overarching themes and 7 corresponding subthemes. RESULTS: Both veterinary and human medical health professionals share concerns about antimicrobial resistance, specifically regarding the development of "superbugs" and increased difficulty in treating disease. However, there were some unique differences in the clinical effects of AMR between the professions in relation to client demand and satisfaction, ability to track/test trends, and approaches to therapy. Both professions also discussed the possible one-health implications of AMR and its transmission. CLINICAL RELEVANCE: There are several barriers to veterinarians that prevent them from using best-practice methods with antimicrobials that were not shared with human medical personnel, who can use antibiotic stewardship principles and readily access necessary testing. However, many veterinarians possessed a unique one-health-based understanding of how antimicrobial resistance can affect the wider community across species and globally that many human medical professionals had not previously considered. This demonstrates an increased need for one-health understanding within human medical professionals and a need for veterinarians to have access to necessary tools to comply with stewardship guidelines, such as culture and sensitivity testing and antibiograms, to have the ability to limit their contribution to antibiotic resistance. [ABSTRACT FROM AUTHOR]