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Consistent antiretroviral therapy (ART) adherence is necessary for HIV viral suppression. However, adherence may fluctuate around daily routines and life events, warranting intervention support. We examined reasons for ART adherence interruptions, using in-depth, semi-structured qualitative interviews, among young (18-34-year-old) Latino men who have sex with men (YLMSM) with HIV. Interviews (n = 24) were guided by the Theory of Planned Behavior, the Information-Motivation-Behavioral Skills Theory, and the Socio-Ecological Model. Two coders independently coded transcripts using NVivo 12 software and synthesized codes into themes using Thematic Content Analysis. Results suggested 4 primary influences on ART adherence interruptions: (1) HIV diagnosis denial, (2) breaks in daily routine, (3) substance use, and (4) HIV status disclosure. Participant quotes highlighted routinization of pill-taking and planning ahead for breaks in routine as critically important. The narrative suggested modification of pill-taking routines during alcohol use, and that periods most vulnerable for long-term interruptions in ART adherence were following an HIV diagnosis and during periods of drug use. Support at the time of HIV diagnosis, including a plan for routinization of pill taking, and adaptive interventions incorporating real-time support during breaks in routines and substance use episodes may be one way to help YLMSM adhere to ARTs.

Demographic and income disparities may impact food accessibility. Research has not yet well documented the precise location of healthy and unhealthy food resources around children's homes and schools. The objective of this study was to examine the food environment around homes and schools for all public school children, stratified by race/ethnicity and poverty status. This cross-sectional study linked data on the exact home and school addresses of a population-based sample of public school children in New York City from 2013 to all corner stores, supermarkets, fast-food restaurants, and wait-service restaurants. Two measures were created around these addresses for all children: 1) distance to the nearest outlet, and 2) count of outlets within 0.25 miles. The total analytic sample included 789,520 K-12 graders. The average age was 11.78 years (SD ± 4.0 years). Black, Hispanic, and Asian students live and attend schools closer to nearly all food outlet types than White students, regardless of poverty status. Among not low-income students, Black, Hispanic, and Asian students were closer from home and school to corner stores and supermarkets, and had more supermarkets around school than White students. The context in which children live matters, and more nuanced data is important for development of appropriate solutions for childhood obesity. Future research should examine disparities in the food environment in other geographies and by other demographic characteristics, and then link these differences to health outcomes like body mass index. These findings can be used to better understand disparities in food access and to help design policies intended to promote healthy eating among children.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

BackgroundPolicymakers need accurate data to develop efficient interventions to promote transport physical activity. Given the imprecise assessment of physical activity in trips, our aim was to illustrate novel advances in the measurement of walking in trips, including in trips incorporating non-walking modes.MethodsWe used data of 285 participants (RECORD MultiSensor Study, 2013-2015, Paris region) who carried GPS receivers and accelerometers over 7 days and underwent a phone-administered web mobility survey on the basis of algorithm-processed GPS data. With this mobility survey, we decomposed trips into unimodal trip stages with their start/end times, validated information on travel modes, and manually complemented and cleaned GPS tracks. This strategy enabled to quantify walking in trips with different modes with two alternative metrics: distance walked and accelerometry-derived number of steps taken.ResultsCompared with GPS-based mobility survey data, algorithm-only processed GPS data indicated that the median distance covered by participants per day was 25.3 km (rather than 23.4 km); correctly identified transport time vs. time at visited places in 72.7% of time; and correctly identified the transport mode in 67% of time (and only in 55% of time for public transport). The 285 participants provided data for 8983 trips (21,163 segments of observation). Participants spent a median of 7.0% of their total time in trips. The median distance walked per trip was 0.40 km for entirely walked trips and 0.85 km for public transport trips (the median number of accelerometer steps were 425 and 1352 in the corresponding trips). Overall, 33.8% of the total distance walked in trips and 37.3% of the accelerometer steps in trips were accumulated during public transport trips. Residents of the far suburbs cumulated a 1.7 times lower distance walked per day and a 1.6 times lower number of steps during trips per 8 h of wear time than residents of the Paris core city.ConclusionsOur approach complementing GPS and accelerometer tracking with a GPS-based mobility survey substantially improved transport mode detection. Our findings suggest that promoting public transport use should be one of the cornerstones of policies to promote physical activity.

BackgroundUnderstanding where and how young black men who have sex with men (YBMSM) in the southern United States meet their sexual partners is germane to understanding the underlying factors contributing to the ongoing HIV transmission in this community. Men who have sex with men (MSM) commonly use geosocial networking apps to meet sexual partners. However, there is a lack of literature exploring geosocial networking app use in this particular population. ObjectiveOur aim was to examine the characteristics, preferences, and behaviors of a geographically diverse sample of geosocial networking app-using YBMSM in the southern United States. MethodsData were collected from a sample of 75 YBMSM across three cities (Gulfport, Mississippi; Jackson, Mississippi; and New Orleans, Louisiana). Multiple aspects of geosocial networking app use were assessed, including overall app use, age of participant at first app use, specific apps used, reasons for app use, photos presented on apps, logon times and duration, number of messages sent and received, and characteristics of and behaviors with partners met on apps. Survey measures of app-met partner and sexual behavior characteristics assessed at midpoint (Day 7) and completion visits (Day 14) were compared using McNemar’s test or Wilcoxon signed-rank test. In addition, we assessed activity spaces derived from GPS devices that participants wore for 2 weeks. ResultsOf the 70 participants who responded to the overall app-use item, almost three-quarters (53/70, 76%) had ever used geosocial networking apps. Jack’d was the most commonly used geosocial networking app (37/53, 70%), followed by Adam4Adam (22/53, 42%), and Grindr (19/53, 36%). The mean and median number of apps used were 4.3 (SD 2.7) and 4.0 (range 0-13), respectively. Most app-using participants displayed their face on the profile picture (35/52, 67%), whereas fewer displayed their bare legs (2/52, 4%) or bare buttocks (or ass; 2/52, 4%). The mean age at the initiation of app use was 20.1 years (SD 2.78) ranging from 13-26 years. Two-thirds (35/53, 66%) of the sample reported using the apps to “kill time” when bored. A minority (9/53, 17%) reported using the apps to meet people to have sex/hook up with. The vast majority of participants reported meeting black partners for sex. Over two-thirds (36/53, 68%) reported that the HIV status of their app-met partners was negative, and 26% (14/53) reported that they did not know their partner’s HIV status. There was a significant difference in GPS activity spaces between app using YBMSM compared to nonapp using YBMSM (2719.54 km2 vs 1855.68 km2, P=.011). ConclusionsUse of geosocial networking apps to meet sexual partners among our sample of YBMSM in the southern United States was common, with a diverse range of app use behaviors being reported. Further research should characterize the association between geosocial networking app use and engagement in sexual behaviors that increase risk for HIV acquisition and transmission. In addition, geosocial networking apps present a promising platform for HIV prevention interventions targeting YBMSM who use these apps.

BackgroundMobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. ObjectiveThe objective of this study was to explore behaviors and perceptions about mobile phone–based apps for health among individuals with chronic conditions. MethodsData were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. ResultsAmong participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P

BackgroundMany men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. ObjectiveThe purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. MethodsBroadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. ResultsBroadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. ConclusionsMSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population.

BackgroundMobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Information is limited with regard to important metrics, including the percentage of the population that uses health apps, reasons for adoption/nonadoption, and reasons for noncontinuance of use. ObjectiveThe purpose of this study was to examine health app use among mobile phone owners in the United States. MethodsWe conducted a cross-sectional survey of 1604 mobile phone users throughout the United States. The 36-item survey assessed sociodemographic characteristics, history of and reasons for health app use/nonuse, perceived effectiveness of health apps, reasons for stopping use, and general health status. ResultsA little over half (934/1604, 58.23%) of mobile phone users had downloaded a health-related mobile app. Fitness and nutrition were the most common categories of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Individuals more likely to use health apps tended to be younger, have higher incomes, be more educated, be Latino/Hispanic, and have a body mass index (BMI) in the obese range (all P