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The Clinical and Translational Science Award (CTSA) Program recognizes that advancing diversity, equity, inclusion, and accessibility (DEIA) requires moving beyond statements of commitment to transformative actions. In 2021, the CTSA Program created a Task Force (TF) to initiate work in support of structural and transformational initiatives that advance DEIA for the consortium and its individual hubs. We describe the process of forming the expertise-driven (DEIA) TF and our activities to date. We 1) developed and adopted the DEIA Learning Systems Framework to guide our approach; 2) defined a set of recommendations across four focus areas (Institutional; Programmatic; Community-Centered; and Social, Cultural, Environmental); and 3) designed and disseminated a survey to capture the CTSA Program's baseline demographic, community, infrastructural, and leadership diversity. The CTSA Consortium also elevated the TF to a standing Committee to extend our understanding, development, and implementation of DEIA approaches to translational and clinical science. These initial steps provide a foundation for collectively fostering environment that support DEIA across the research continuum.

The authors present findings from formative research to assess the need and receptivity for a Web-based, integrated healthy sexual and dating relationships intervention among community college students in South Central Texas. Texas ranks third highest among U.S. states in its overall teen birth rate; 69% of those births are among females 18 to 19 years of age. Texas also ranks No. 1 among U.S. states in its repeat teen pregnancy rate, reflecting the need for effective pregnancy and dating violence prevention among young adults. The goals of this study were the following: (1) examine patterns of sexual behaviors, dating violence, and related psychosocial factors among students attending community colleges in South Central Texas; (2) examine differences in patterns of specific types of dating violence perpetration and victimization by gender, race/ethnicity, and sexual identity; (3) examine associations between psychosocial factors and dating violence perpetration and victimization; and (4) assess the usability and short-term psychosocial outcomes of activities from a Web-based healthy sexual and dating relationships intervention. Collectively, these findings will inform the development of an integrated Web-based healthy sexual and dating relationship intervention that is acceptable and engaging, and potentially scalable for use in community college settings.

Summary: Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well‐being within low‐ or middle‐income countries. This study utilised longitudinal cohort data from a community‐based empowerment programme in Meru County, Kenya to assess cross‐lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18–86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within‐time correlations across measures, within‐measure correlations across time, and sociodemographic background characteristics. The findings are consistent with research across high‐income countries, underscoring the need for more contextualised research into sleep behaviours across low‐ and middle‐income countries. The findings may inform interventions to increase mental and social well‐being within Kenya. [ABSTRACT FROM AUTHOR]

Background: Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Methods: Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1 year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results: A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P = 0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07–1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53–0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P = 0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P = 0.04). No differences in attendance by race or HIV status were observed in the home arm. Conclusions: HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm. Anal cancer disproportionately affects men who have sex with men living with HIV. We examined whether anal HPV sampling at home versus in a clinic impacts uptake of high-resolution anoscopy (HRA), an in-clinic procedure. Anal cytology history and insertive anal sex position were associated with higher HRA uptake, and attendance differed by race and HIV status in the clinic arm. Given that people living with HIV and Black men who have sex with men are disproportionately affected by anal cancer, interventions are needed to support their clinic attendance. [ABSTRACT FROM AUTHOR]

Because housing is central to the recovery of individuals with experiences of homelessness and incarceration, it is important to consider how U.S. policies denying housing to residents with criminal histories can adversely affect racial and ethnic minorities and individuals with a history of homelessness. The state of Texas passed a rule specifying certain criteria that Low-Income Housing Tax Credit (LIHTC) supportive housing providers must use to screen tenants using criminal history. A retrospective cohort of 600 LIHTC supportive housing residents was used to estimate the potential impact of the rule. Based on this sample, the rule would have resulted in significantly higher proportions of Black and chronically homeless individuals being denied housing compared to the proportions of White and low-income individuals, respectively, who would have been denied housing. With the exception of drug convictions, there was no significant difference in recidivism between residents who would have been affected by the rule and unaffected residents who also had criminal justice involvement within a comparable time frame before move-in. [ABSTRACT FROM AUTHOR]

This study examined spending behaviors of U.S. tenants who reported delaying rent payments during federal eviction moratoria in 2020-2021, enacted in response to the Coronavirus Disease-2019 (COVID-19) pandemic. A national sample of 772 middle and low-income tenants who reported delaying rent payments because of the eviction moratoria were assessed from May 2020 to October 2020. Among tenants who delayed paying rent, most rent money was spent on groceries (11-19%), utilities (9-14%), substance use (8-10%), and debt (7%) across two time periods; the remaining rent money was spent on other expenses including recreation and medical care. Sociodemographic and psychiatric characteristics together only explained 2-3% of the variance in spending in major expense categories suggesting the broad impact of the COVID-19 pandemic. Together, these findings provide insight into spending behaviors of tenants during a time of great financial and psychological distress. [ABSTRACT FROM AUTHOR]

Research increasingly shows that genital attitudes have an impact on sexual well-being and health-seeking behaviours. This study explored what women and men like and dislike about women's genitals. Data are from open-ended items, part of a cross-sectional internet-based survey anonymously completed by 496 women and 198 men. Overall, both women and men had positive attitudes towards women's genitals, although there was overlap between likes and dislikes. Some of the most common likes for women were related to aesthetics and for men were related to tactile and sexual aspects. Men listed more likes than dislikes. The emphasis on both positive and negative messages provides a more complete image of the complex ways people interact with their own and others' bodies and can help tailor clinical and educational messages.

Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self‐collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home‐based self‐collection swabbing kit or attend a clinic‐based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home‐arm and clinic‐arm individuals returned the swab, respectively (P =.003), difference between groups, 15.0% (95% CI 5.4%‐24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P =.006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P <.001). Self‐collected swabs and clinician‐collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self‐collect swabs at home rather than attend a clinic. [ABSTRACT FROM AUTHOR]