Dustin T Duncan

Dustin T Duncan

19-20 Adjunct Clinical Associate Professor

Publications

Publications

Accessibility of HIV Services in Philadelphia: Location-Allocation Analysis

Association of city-level walkability, accessibility to biking and public transportation and socio-economic features with COVID-19 infection in Massachusetts, USA: An ecological study

Association of sleep duration with mental health: results from a Spanish general population survey

Braçe, O., Duncan, D. T., Correa-Fernández, J., & Garrido-Cumbrera, M. (n.d.).

Publication year

2022

Journal title

Sleep and Breathing

Volume

26

Issue

1

Page(s)

389-396
Abstract
Abstract
Purpose: The purpose of the present study was to evaluate the association of sleep duration and mental health among the general population. Methods: A cross-sectional study was carried out with an adult Spanish population sample between 16 and 64 years old. The information was obtained from data provided by a randomly selected representative sample of 505 adults stratified by age, sex, and geographic area. Participants were interviewed face-to-face in their respective households with questions including sociodemographic characteristics, lifestyle, sleep duration, and the 12-item General Health Questionnaire to screen risk for poor mental health. The duration of sleep hours were grouped into the following categories: < 6 h, 6-7 h, and, > 7 h. Regression analysis was used to assess associations between sleep duration and risk of poor mental health. Results: A percentage of respondents 13.1% reported sleeping less than 6 h. The analysis demonstrated a significant (p = 0.001) negative (B = − 0.512) relationship between hours of sleep and risk of poor mental health (GHQ-12), demonstrating that reduced sleep duration increases the risk of poor mental health. Conclusions: Sleep duration lower than 6 h is prevalent among the general population in Spain, especially among women and people who frequently use electronic devices. The results show that people who experience shorter sleep duration face a greater risk of poor mental health. These findings suggest that it is important to raise awareness of healthy sleeping habits, with emphasis on adequate sleep duration.

COVID-19 Conspiracy Beliefs are not Barriers to HIV Status Neutral Care Among Black Cisgender Sexual Minority Men and Black Transgender Women at the Initial Peak of the COVID-19 Pandemic in Chicago, USA

COVID-19 stressors and symptoms of depression and anxiety among Black cisgender sexual minority men and Black transgender women during the initial peak of the COVID-19 pandemic

Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA

Knox, J., Hwang, G., Carrico, A. W., Duncan, D. T., Watson, R. J., & Eaton, L. A. (n.d.).

Publication year

2022

Journal title

AIDS and Behavior

Volume

26

Issue

8

Page(s)

2503-2515
Abstract
Abstract
We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11–8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.

Examining the associations of gender minority stressors with sleep health in gender minority individuals

Examining the Geospatial Distribution of Health and Support Services for Transgender, Gender Nonbinary, and Other Gender Diverse People in New York City

Factors Associated with Geographic Patterns of Poor Sustained Viral Suppression in Miami-Dade County Florida, 2017

Dawit, R., Trepka, M. J., Duncan, D. T., Gbadamosi, S. O., Li, T., Pires, S. F., Ladner, R. A., & Sheehan, D. M. (n.d.).

Publication year

2022

Journal title

Journal of Racial and Ethnic Health Disparities
Abstract
Abstract
Background: Identifying geographic locations most affected by the HIV epidemic is essential to addressing disparities that impact people living with HIV. This study sought to identify individual and neighborhood-level factors that are associated with residing in geographic hotspots of poor sustained HIV viral suppression. Methods: Using data from the Miami-Dade County Ryan White HIV/AIDS program, spatial autocorrelation of poor sustained viral suppression (at least 1 laboratory test ≥ 200 copies/ml in 2017) was investigated using Global Moran’s I followed by Local Moran’s I and Getis Ord Gi* statistics by ZIP code tabulation areas (ZCTAs). Subsequently, multivariable logistic regression analysis was conducted to identify factors associated with residing in geographic hotspots of poor sustained viral suppression. Results: Several ZCTAs in the northern part of the county, accounting for 1/3 of the Ryan White program clients, had significantly higher clustering of poor sustained viral suppression. Client-level sociodemographic characteristics such as race/ethnicity, age, and poverty, and neighborhood-level characteristics (socioeconomic disadvantage index, residential instability index, and racial/language homogeneity index) were significantly associated with living in a hotspot of poor sustained viral suppression. Conclusion: These findings highlight that spatial variation in sustained viral suppression exists within the county. Targeted strategies that address structural factors and the needs of people with HIV living in specified geographic areas may improve their HIV health outcomes and contribute towards local, regional, and national goals of ending the HIV epidemic.

Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV

Weinstein, E. R., Harkness, A., Ironson, G., Shrader, C. H., Duncan, D. T., & Safren, S. A. (n.d.).

Publication year

2022

Journal title

International Journal of Behavioral Medicine
Abstract
Abstract
Background: Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes—viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. Methods: Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. Results: Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = − 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = − 0.40, BSTP [− 0.87, − 0.09]). Conclusion: This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.

Mediating role of psychological distress in the associations between neighborhood social environments and sleep health

Kim, B., Troxel, W. M., Dubowitz, T., Hunter, G. P., Ghosh-Dastidar, B., Chaix, B., Rudolph, K. E., Morrison, C. N., Branas, C. C., & Duncan, D. T. (n.d.).

Publication year

2022

Journal title

Sleep

Volume

45

Issue

8
Abstract
Abstract
Study Objectives: The characteristics of neighborhood social environments, such as safety and social cohesion, have been examined as determinants of poor sleep. The current study investigates associations between neighborhood social characteristics and sleep health, as well as the mediating role of psychological distress on these possible associations. Methods: Three waves of PHRESH Zzz (n = 2699), a longitudinal study conducted in two low-income, predominately Black neighborhoods, were utilized for this analysis. The characteristics of neighborhood social environments were measured using crime rates, a neighborhood social disorder index, and self-reported social cohesion. Sleep health was measured via 7 days of wrist-worn actigraphy as insufficient sleep, sleep duration, wake after sleep onset (WASO), and sleep efficiency. G-estimations based on structural nested mean models and mediation analyses were performed to estimate the effects of neighborhood social environments on sleep as well as direct/indirect effects through psychological distress. Results: Crime rate around residential addresses was associated with increased risk of insufficient sleep (risk ratio: 1.05 [1.02, 1.12]), increased WASO (?: 3.73 [0.26, 6.04]), and decreased sleep efficiency (?:-0.54 [-0.91,-0.09]). Perceived social cohesion was associated with decreased risk of insufficient sleep (OR: 0.93 [0.88, 0.97]). Psychological distress mediated part of the associations of crime and social cohesion with insufficient sleep. Conclusions: Neighborhood social environments may contribute to poor sleep health in low-income, predominantly Black neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health.

MobiliSense cohort study protocol: do air pollution and noise exposure related to transport behaviour have short-term and longer-term health effects in Paris, France?

Neighborhoods and sleep health among adults: A systematic review

Kim, B., Branas, C. C., Rudolph, K. E., Morrison, C. N., Chaix, B., Troxel, W. M., & Duncan, D. T. (n.d.).

Publication year

2022

Journal title

Sleep Health

Volume

8

Issue

3

Page(s)

322-333
Abstract
Abstract
Objective: Sleep is an important determinant of various health outcomes, and insufficient sleep and sleep disorders are a public health crisis in the United States. The objective of this review is to provide an update on scientific contributions to our understanding of the social/built environmental determinants of sleep health. In particular, this review focuses on the diverse measurements of neighborhood characteristics and sleep outcomes, as well as analytic approaches for quantifying the effect of neighborhood on sleep health. Methods: Two major electronic databases were searched and reviewed for relevant articles that examined the associations of social/built environments with sleep health. Inclusion criteria included peer-reviewed empirical studies on neighborhood-level characteristics and sleep health among adult populations. Results: Systematic searches in MEDLINE/PubMed and SCOPUS identified 52 eligible articles (out of 11,084). Various social/built environmental characteristics of neighborhoods were identified as potential determinants of sleep health, and the majority of studies examined neighborhood social capital, safety, and environmental stressors. However, 88% of included articles employed cross-sectional study designs, limiting causal identification. We found substantial differences in neighborhood measures, variations in sleep health measurements with the majority employing self-reported methods, and inconsistent model specifications. While the majority of articles (48%) utilized perceived neighborhood conditions as the main exposure, more recent studies (23%) employed geographic information systems to measure neighborhood characteristics. Conclusions: To establish the causal relationships between social/physical neighborhood characteristics and sleep health, more studies should be conducted with longitudinal, quasi-experimental, and randomized trial designs coupled with objectively measured neighborhood and sleep health parameters.

Objective and Subjective Neighborhood Crime Associated with Poor Sleep among Young Sexual Minority Men: a GPS Study

Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak

Moody, R. L., Chen, Y. T., Schneider, J. A., Knox, J., Timmins, L., Hanson, H., Koli, K., Durrell, M., Dehlin, J., Eavou, R., Martins, S. S., & Duncan, D. T. (n.d.).

Publication year

2022

Journal title

Substance Abuse: Treatment, Prevention, and Policy

Volume

17

Issue

1
Abstract
Abstract
Background: In response to COVID-19, the city of Chicago issued stay-at-home orders, which began on March 20, 2020, and restrictions meant to “flatten the curve” remained in effect until June 2, 2020. On June 3, 2020, Chicago entered the reopening phase. This study compares rates of polysubstance use by COVID-19 lockdown phase and across sociodemographic characteristics in a Chicago-based sample of Black cisgender sexual minority men (SMM) and transgender women. Method: Data come from the Neighborhood and Networks (N2) cohort, an ongoing study of Black cisgender SMM and transgender women living in Chicago. Participants (N = 226) completed a survey between April 20, 2020, and July 30, 2020, during the initial peak of the COVID-19 pandemic in Chicago. We conducted chi-square tests of independence and modified Poisson regression models with robust error variance and estimated adjusted prevalence ratios. Results: Alcohol and marijuana were the most used substances, with 73.5% reporting at least one drinking day and 71.2% of the sample reporting marijuana use in the past 14 days. Tobacco was used by 41.6% of the sample, and illegal drug use, which does not include marijuana, was reported by 17.7% of the sample. Substance use was consistently associated with the use of other substances. As such, polysubstance use (i.e., using two or more substances) was common in this sample (63.7%). Few sociodemographic differences emerged, and substance use was not associated with lockdown phase. Conclusion: Substance use, including polysubstance use, was high in our sample of Black SMM and transgender women during the initial peak of the COVID-19 pandemic. Continued monitoring is needed given the duration of the COVID-19 pandemic and the negative health consequences associated with substance use in this population.

Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study

Pagkas-Bather, J., Duncan, D. T., Chen, Y. T., Cursio, J., Del Vecchio, N., Mayer, K. H., Knox, J., Hanson, H., Eavou, R., & Schneider, J. A. (n.d.).

Publication year

2022

Journal title

AIDS and Behavior

Volume

26

Issue

12

Page(s)

3827-3833
Abstract
Abstract
PrEP uptake and adherence among young Black sexual minority men (YBSMM), has been sub-optimal. Multiple studies identified sleep as an important determinant of medication adherence, although it has not been examined with regard to PrEP among YBSMM. This study utilized data collected from HIV-negative cisgender YBSMM in the Neighborhoods and Networks (N2) study in Chicago using PrEP (N = 70). Sleep quality was measured using the PHQ-9 and PrEP adherence questions were adapted from Reynolds et al., 2004. Bivariate and multivariable regression analyses were used to estimate associations between sleep and missing PrEP doses, controlling for relevant demographic and behavioral factors. YBSMM who reported sleep disturbance a moderate amount of time (aOR 7.59 [1.05 to 54.57]) were more likely to miss taking PrEP because they had too many pills to take. Sleep quality is an overlooked determinant of medication adherence, and may negatively impact YBSMM’s ability to consistently take PrEP.

Spatial analysis of HIV infection and the associated correlates among transgender persons in the United States

Staying Physically Active Is Associated with Better Mental Health and Sleep Health Outcomes during the Initial Period of COVID-19 Induced Nation-Wide Lockdown in Jordan

A qualitative study of antiretroviral therapy adherence interruptions among young Latino men who have sex with men with HIV: Project D.A.I.L.Y.

Associations between Parent-Child Communication on Sexual Health and Drug Use and Use of Drugs during Sex among Urban Black Youth

Boyd, D. T., Opara, I., Quinn, C. R., Waller, B., Ramos, S. R., & Duncan, D. T. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

10
Abstract
Abstract
Black youth and their families living in urban settings may experience unique stressors that contribute to underlying issues due to the environmental context. Such factors may exacerbate and promote drug use and engagement in risky sexual behaviors, unknowingly. Little is known about how family factors, peer pressure, condom use, and other related factors are associated with substance use and engaging in sexual behaviors while on drugs among urban African American youth aged 12–22 (N = 638). We used regression models to examine associations between parental bonding, parent–adolescent sexual health communication, condom use, peer pressure on substance use, and having sex while on drugs. Multivariate results indicated that parental bonding was statistically significant and associated with drug use (OR: 1.36, 95%CI: 1.36). Our study highlights that parental bonding plays a critical role in youth using drugs while living in urban environments.

Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans &amp; Gender Diverse Sexual Health Survey

Rosenberg, S., Callander, D., Holt, M., Duck-Chong, L., Pony, M., Cornelisse, V., Baradaran, A., Duncan, D. T., & Cook, T. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

7
Abstract
Abstract
Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of 'gender insensitivity', which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community- based services (M = 1.3, SD = 1.4; p<0.001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p<0.001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,- 0.03, p = 0.007). Given the high rates of HIV and other STIs among trans and gender diverse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.

COVID-19 testing, case, and death rates and spatial socio-demographics in New York City: An ecological analysis as of June 2020

Kim, B., Rundle, A. G., Goodwin, A. T., Morrison, C. N., Branas, C. C., El-Sadr, W., & Duncan, D. T. (n.d.).

Publication year

2021

Journal title

Health and Place

Volume

68
Abstract
Abstract
We assessed the geographic variation in socio-demographics, mobility, and built environmental factors in relation to COVID-19 testing, case, and death rates in New York City (NYC). COVID-19 rates (as of June 10, 2020), relevant socio-demographic information, and built environment characteristics were aggregated by ZIP Code Tabulation Area (ZCTA). Spatially adjusted multivariable regression models were fitted to account for spatial autocorrelation. The results show that different sets of neighborhood characteristics were independently associated with COVID-19 testing, case, and death rates. For example, the proportions of Blacks and Hispanics in a ZCTA were positively associated with COVID-19 case rate. Contrary to the conventional hypothesis, neighborhoods with low-density housing experienced higher COVID-19 case rates. In addition, demographic changes (e.g. out-migration) during the pandemic may bias the estimates of COVID-19 rates. Future research should further investigate these neighborhood-level factors and their interactions over time to better understand the mechanisms by which they affect COVID-19.

COVID-19-Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA

Chen, Y. T., Duncan, D. T., Del Vecchio, N., Timmins, L., Pagkas-Bather, J., Lacap, S., Hotton, A., Knox, J., Hanson, H., Koli, K., Durrell, M., Dehlin, J., & Schneider, J. A. (n.d.).

Publication year

2021

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

88

Issue

3

Page(s)

261-271
Abstract
Abstract
Background:COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW.Methods:As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access.Results:Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3).Conclusions:Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.

Geographic Density and Uptake of Pre-exposure Prophylaxis (PrEP) Among Young Gay, Bisexual and Other Sexual Minority Men: A Global Positioning System (GPS) Study

Kim, B., Chaix, B., Chen, Y. T., Callander, D., Regan, S. D., & Duncan, D. T. (n.d.).

Publication year

2021

Journal title

AIDS and Behavior

Volume

25

Page(s)

155-164
Abstract
Abstract
The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017–January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.

Higher rates of low socioeconomic status, marginalization, and stress in black transgender women compared to black cisgender msm in the mari study

Russell, J. S., Hickson, D. A., Timmins, L., & Duncan, D. T. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

4

Page(s)

1-6
Abstract
Abstract
Most HIV research combines transgender women who have sex with men (TWSM) with cisgender men who have sex with men (MSM), despite emerging evidence of important differences. Using data from The MARI Study, we compared Black TWSM and Black cisgender MSM on personal and ecological factors. Black TWSM reported more unemployment (71.4% versus 51.4%, p = 0.015), incarceration (52.4% versus 36.0%, p = 0.046), stressful life experiences (median score 135.5 versus 90, p = 0.033), and HIV positivity (66.7% versus 22.9%, p = 0.008). Further research into the causes and consequences of these differences, and regarding TWSM specifically, is needed.

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New York, NY