Papers by Nikhil Prachand
Journal of Public Health Management and Practice, 2022
Context: As response rates to health surveys conducted by telephone continue to decline and costs... more Context: As response rates to health surveys conducted by telephone continue to decline and costs continue to increase, practitioners are increasingly considering a transition to self-administered mail contact modes. Objective: To compare empirical differences observed across adjacent administrations of the Healthy Chicago Survey (HCS) conducted by telephone versus self-administered via mail contact. Design: Data from the 2016, 2018, and 2020 administrations of the HCS are contrasted, and demographic distributions are benchmarked against the American Community Survey to investigate differences that may be linked to the HCS' transition from a telephone to self-administered mail mode between 2018 and 2020. Setting: All survey data were collected from adult residents of Chicago, Illinois, between 2016 and 2020. Main Outcome Measures: Costs, response rates, key health statistics, demographic distributions, and measures of precision generated from the HCS. Results: The mail mode led ...
LGBT Health, 2020
Purpose: We examined the relationship between family factors and HIV-related sexual risk behavior... more Purpose: We examined the relationship between family factors and HIV-related sexual risk behaviors among adolescent sexual minority males (ASMM) who are affected disproportionately by HIV. Methods: We analyzed results from the National HIV Behavioral Surveillance among Young Men Who Have Sex with Men. Adolescent males ages 13-18 who identified as gay or bisexual, or who reported attraction to or sex with males were interviewed in 2015 in Chicago, New York City, and Philadelphia. Separate log-linked Poisson regression models were used to estimate associations between family factors and sexual risk behaviors. Results: Of the 569 ASMM, 41% had condomless anal intercourse in the past 12 months, 38% had ≥4 male sex partners in the past 12 months, and 23% had vaginal or anal sex before age 13. ASMM who had ever been kicked out of their house or run away, those who were out to their mother, and those who were out to their father, were more likely to engage in sexual risk behaviors. ASMM who were currently living with parents or guardians and those who received a positive reaction to their outness by their mother were less likely to engage in sexual risk behaviors. Conclusion: Our findings highlight the important role of family factors in HIV risk reduction among ASMM. A better understanding of the complex dynamics of these families will help in developing family-based interventions.
The Journal of Infectious Diseases, 2020
BackgroundData on behavioral correlates of mental illness among young people who inject drugs (PW... more BackgroundData on behavioral correlates of mental illness among young people who inject drugs (PWID) are limited. We examine injection risks and healthcare use among young PWID with probable serious mental illness (PSMI).MethodsPeople who inject drugs were recruited and interviewed in 20 US cities for 2015 National HIV Behavioral Surveillance. Probable serious mental illness was assessed using the Kessler-6 screening scale. Bivariate analyses using log-linked Poisson regression with generalized estimating equations adjusted for design covariates were conducted to examine associations between PSMI and behaviors among PWID ages 18–29 years.ResultsOf 1769 young PWID, 45% had PSMI. Compared to those without PSMI, PWID with PSMI were more likely to report injecting more than once a day, receptive syringe sharing, sharing of other injection equipment, and unmet needs for medical care and substance use disorder (SUD) treatment. Those with PSMI were less likely to use syringe services progr...
MMWR. Morbidity and Mortality Weekly Report, 2019
National Latinx AIDS Awareness Day, October 15, is observed each year to focus on the continuing ... more National Latinx AIDS Awareness Day, October 15, is observed each year to focus on the continuing and disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on Hispanics/Latinos in the United States. In 2017, 26% of newly diagnosed HIV infections occurred in Hispanics/Latinos (1). Seventy-five percent of these newly diagnosed HIV infections in Hispanics/ Latinos were in men who have sex with men (MSM), and an additional 3% were in MSM who inject drugs (1). An analysis of the behaviors of Hispanic/Latino MSM included in CDC's National HIV Behavioral Surveillance system found that nearly 75% reported having had condomless anal sex during 2017 (2). However, because some of these MSM reported using preexposure prophylaxis (PrEP), fewer than 60% of those who were non-U.S.-born and fewer than 50% of those who were U.S.-born were having unprotected anal sex (2). National Latinx AIDS Awareness Day is an opportunity to encourage increased HIV prevention efforts among Hispanics/Latinos. CDC supports testing, linkage to and engagement in care and treatment, and other efforts to reduce the risk for acquiring or transmitting HIV infection. More information is available at
MMWR. Morbidity and Mortality Weekly Report, 2019
Annals of Epidemiology, 2016
Purpose-Investigate whether characteristics of geographic areas are associated with condomless se... more Purpose-Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States. Methods-PWID were recruited from 19 metropolitan statistical areas (MSAs) for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and MSAs where PWID lived. Multilevel models, stratified by racial/ethnic group, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment). Results-Among black PWID, living in the South (vs. Northeast) was associated with injectionrelated risk behavior [Adjusted Odds Ratio (AOR)=2.24, 95% Confidence Interval (CI)=1.37,4.34;p-value=0.011] and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex [AOR=1.
The International Journal of Tuberculosis and Lung Disease, 2015
* Statistical analysis consisted of a generalized estimating equation model, accounting for effec... more * Statistical analysis consisted of a generalized estimating equation model, accounting for effect of repeated measures using proc mianalyze. † Adjusted for all of the other variables included in the model. RR ¼ relative risk; CI ¼ confidence interval; aRR ¼ adjusted RR; HIV ¼ human immunodeficiency virus.
Journal of acquired immune deficiency syndromes (1999), Jul 1, 2017
HIV prevalence estimates among transgender women in the United States are high, particularly amon... more HIV prevalence estimates among transgender women in the United States are high, particularly among racial/ethnic minorities. Despite increased HIV risk and evidence of racial disparities in HIV prevalence among transgender women, few data are available to inform HIV prevention efforts. A transgender HIV-related behavioral survey conducted in 2009 in 3 US metropolitan areas (Chicago, Houston, and Los Angeles County), used respondent-driven sampling to recruit 227 black (n = 139) and Latina (n = 88) transgender women. We present descriptive statistics on sociodemographic, health care, and HIV-risk behaviors. Of 227 transgender women enrolled, most were economically and socially disadvantaged: 73% had an annual income of less than $15,000; 62% lacked health insurance; 61% were unemployed; and 46% reported being homeless in the past 12 months. Most (80%) had visited a health care provider and over half (58%) had tested for HIV in the past 12 months. Twenty-nine percent of those who repo...
Maternal and Child Health Journal
JAMA Network Open, 2020
IMPORTANCE Childhood lead poisoning causes irreversible neurobehavioral deficits, but current pra... more IMPORTANCE Childhood lead poisoning causes irreversible neurobehavioral deficits, but current practice is secondary prevention. OBJECTIVE To validate a machine learning (random forest) prediction model of elevated blood lead levels (EBLLs) by comparison with a parsimonious logistic regression. DESIGN, SETTING, AND PARTICIPANTS This prognostic study for temporal validation of multivariable prediction models used data from the Women, Infants, and Children (WIC) program of the Chicago Department of Public Health. Participants included a development cohort of children
Journal of Ethnicity in Substance Abuse, 2020
Compared to national findings, Chicago has both a higher rate of opioid-related overdose death an... more Compared to national findings, Chicago has both a higher rate of opioid-related overdose death and a markedly different distribution by demographics. The Chicago Department of Public Health analyzed fatal overdoses by level of neighborhood economic hardship. The highest rate of opioid-related deaths occurred in neighborhoods with high economic hardship (36.9 per 100,000 population) compared to medium-(20.5) and low-(12.3) hardship neighborhoods. However, these patterns were not consistent across racial/Hispanic ethnicity subgroups. These data support the need to consider the role of racism and other structural, social, and economic factors when designing interventions to reduce opioid-related overdose deaths.
Annals of Allergy, Asthma & Immunology, 2019
Disparities persist in asthma-related emergency department visits among Chicago children Disparit... more Disparities persist in asthma-related emergency department visits among Chicago children Disparities in pediatric asthma are well described, with prevalence and morbidity more than 2 times higher among Hispanic and black children as compared with white peers. 1 Increased national attention has been focused on racial/ethnic disparities in asthma, with the goal of improving access and quality of care while reducing morbidity, such as emergency department (ED) visits. 2 This study examines trends in asthma-related ED visits among Chicago children since 2009, with a particular focus on assessing racial and ethnic disparities, which previous work indicates may be substantial. 3 This retrospective observational study was conducted using Comparative Health Care and Hospital Data Reporting Services (COMPdata), which provides clinical information for all Illinois hospitals and health systems. All cases of asthma-related ED visits from 2009 to 2015 were extracted by principal diagnosis (ICD-9 ¼ 493.00-493.92) for children 0 to 18 years of age in Chicago zip codes. Racial/ethnic groups identified were non-Hispanic whites (NHW), non-Hispanic blacks (NHB), non-Hispanic Asian or Pacific Islander (AP), and Hispanic/Latino (HL). Age-standardized rates per 10,000 children were calculated, adjusting to the 2000 United States standard population. Personyears were obtained from the US Census Bureau and restricted to age younger than 19 years. Trends and annual percentage changes with 95% confidence intervals (CI) were assessed over the 7 years. Rate ratios with 95% CI were also calculated. Analyses were performed using STATA (StataCorp, version 15) and Joinpoint regression program (National Cancer Institute, version 4.6). From 2009 to 2015, the number of asthma-related ED visits among Chicago children decreased from 9,702 to 8,848dan overall decrease of 8.8% (95% CI: 8.77, 8.83). Over this 7-year period, the rates of asthma-related ED visits showed a statistically significant decrease by 1.03% annually (95% CI: À1.8, À0.2), from 150.5 to 141.2 per 10,000 person-years (Fig 1). Examining asthma-related ED visits by race/ethnicity, NHB children accounted for more than 60% of all asthma-related ED visits (2009: 68.2%, n ¼ 6,619/9,702; 2015: 63.4%, n ¼ 5,614/ 8,848). Furthermore, NHB children had a significant decrease in the rate of ED visits by 2.40% annually (95% CI, À3.7, À1.1). Asian children had a significant increase of 6.92% annually (95% CI: 0.8, 13.4). In contrast, asthma-related ED visit rates remained stable for NHW and HL children (NHW: À0.14%, 95% CI: À2.8, 2.5; HL: À0.11%, 95% CI: À2.8, 3.1). Non-Hispanic Black and HL children were 5 to 6 and 1.5 to 2 times more likely to have an asthma-related ED visit, respectively, as compared with NHW youth (NHB: 2009 rate ratio [RR] ¼ 5.23, Figure 1. Age-standardized rates for asthma-related emergency department visits among children for 2009-2015, by ethnicity and year.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 5, 2018
Much has been written about the impact of human immunodeficiency virus (HIV) among young (13-24) ... more Much has been written about the impact of human immunodeficiency virus (HIV) among young (13-24) sexual minority men (SMM). Evidence for concern is substantial for emerging adult (18-24 years) SMM. Data documenting the burden and associated risk factors of HIV among adolescent SMM (<18 years) remain limited. Adolescent SMM aged 13-18 years were recruited in 3 cities (Chicago, New York City, and Philadelphia) for interview and HIV testing. We used χ2 tests for percentages of binary variables and 1-way analysis of variance for means of continuous variables to assess differences by race/ethnicity in behaviors. We calculated estimated annual HIV incidence density (number of HIV infections per 100 person-years [PY] at risk). We computed Fisher's exact tests to determine differences in HIV prevalence by selected characteristics. Of 415 sexually active adolescent SMM with a valid HIV test result, 25 (6%) had a positive test. Estimated annual HIV incidence density was 3.4/100 PY; inc...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2017
for the NHBS Study Group Background: Monitoring the effects of HIV prevention efforts on risk beh... more for the NHBS Study Group Background: Monitoring the effects of HIV prevention efforts on risk behaviors among persons who inject drugs is a key to inform prevention programs and policy. Methods: Using data from the 2012 National HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities (n = 10,171), we conducted latent class analysis to identify injection risk classes and assess the relationship between engagement in prevention services and injection-related risk behavior. We conducted stratified analyses to examine the consistency of these associations across different geographical regions. Results: The latent class analysis identified 6 distinct classes of injection-related risk behavior. The class structure was consistent across regions of the United States, but the distribution of risk classes varied significantly across regions. With covariate adjustment, the South had the most high-risk behavior (21%) and the Midwest had the least (6%). Participation in syringe access services and other prevention services was the lowest in the South. Syringe access was associated with a significantly lower likelihood of membership in the highest risk class in all regions except the Midwest. Participation in individual or group intervention with a practical skills component was associated with less risky injection behavior in all regions except the Northeast. Interventions that featured only safer injection information and discussion had no relationship with risk class. Conclusions: Our findings support evidence of the effectiveness of syringe service programs and safer injection skills training in reducing high-risk injection behavior and underscore the need to improve access to these prevention interventions in the South of the United States.
Journal of urban health : bulletin of the New York Academy of Medicine, Jan 19, 2017
Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasi... more Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasingly, in addition to behavioral factors, biomedical interventions have been found to play important roles in HIV prevention. In this analysis, we used four waves of cross-sectional data (2004, 2008, 2011, and 2014) from the National HIV Behavioral Surveillance System (NHBS) to examine trends in key behaviors and biomedical interventions among MSM in Chicago (N = 3298). Logistic regression was used to determine changes in behaviors and use of biomedical interventions. Condomless sex increased significantly in waves 3 and 4, compared to wave 1: wave 3 (AOR = 2.07; 95% CI 1.53, 2.78) and wave 4 (AOR = 2.19; 95% CI 1.62, 2.96). Compared to those aged 18-24, older participants were significantly less likely to be routinely tested for HIV: 30-39 (AOR = 0.63; 95% CI 0.48, 0.83), 40-49 (AOR = 0.40; 95% CI 0.29, 0.55), and >50 (AOR = 0.28; 95% CI 0.18, 0.43). Awareness of both post-exposure pr...
Open Forum Infectious Diseases, 2014
PLOS ONE, 2015
People who inject drugs (PWID) are at high risk for blood-borne pathogens transmitted during the ... more People who inject drugs (PWID) are at high risk for blood-borne pathogens transmitted during the sharing of contaminated injection equipment, particularly hepatitis C virus (HCV). HCV prevalence is influenced by a complex interplay of drug-use behaviors, social networks, and geography, as well as the availability of interventions, such as needle exchange programs. To adequately address this complexity in HCV epidemic forecasting, we have developed a computational model, the Agent-based Pathogen Kinetics model (APK). APK simulates the PWID population in metropolitan Chicago, including the social interactions that result in HCV infection. We used multiple empirical data sources on Chicago PWID to build a spatial distribution of an in silico PWID population and modeled networks among the PWID by considering the geography of the city and its suburbs. APK was validated against 2012 empirical data (the latest available) and shown to agree with network and epidemiological surveys to within 1%. For the period 2010-2020, APK forecasts a decline in HCV prevalence of 0.8% per year from 44(±2)% to 36(±5)%, although some sub-populations would continue to have relatively high prevalence, including Non-Hispanic Blacks, 48(±5)%. The rate of decline will be lowest in Non-Hispanic Whites and we find, in a reversal of historical trends, that incidence among non-Hispanic Whites would exceed incidence among Non-Hispanic Blacks (0.66 per 100 per years vs 0.17 per 100 person years). APK also forecasts an increase in PWID mean age from 35(±1) to 40(±2) with a corresponding increase from 59 (±2)% to 80(±6)% in the proportion of the population >30 years old. Our studies highlight the importance of analyzing subpopulations in disease predictions, the utility of computer PLOS ONE |
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Papers by Nikhil Prachand