Schnall Awarded $15.1 Million to Examine Women’s HIV Risk

Rebecca Schnall, PhD ’09, the Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion, with co-principal investigators Mirjam-Colette Kempf, PhD, at the University of Alabama and Amy Johnson, PhD, at Lurie Children’s Hospital, has received a $15,149,718 R01 award from the National Institute of Allergy and Infectious Diseases, the National Institute on Alcohol Abuse and Alcoholism, the Office of the Director, and the National Institute of Child Health and Human Development for a project titled “Examining Social Ecological and Network Factors to Assess Epidemio- logical Risk in a Large National Cohort of Cisgender Women.”

The five-year study will enroll a national digital cohort of 1,800 HIV-negative women and look at how multiple factors influence their risk of acquiring HIV and other sexually transmitted infections. The award is Columbia Nursing’s largest research grant to date.

“Cisgender women account for approximately 20 percent of annual HIV diagnoses in the United States, yet there is limited information on the combination of factors that contribute to HIV incidence in these women,” explains Schnall, who is also associate dean of faculty development at the school.

“In response, our study team proposes to develop a knowledge base of integrated data, including biomarker data, network data, and big data from disease surveillance and social determinants of health databases,” she adds. “At the conclusion of our study, we hope to identify the individual, social network, geospatial, and public policy factors that increase a woman’s risk for HIV and/or sexually transmitted infection acquisition, providing intervention opportunities to reduce women’s vulnerabilities to HIV infection.”

Bisexual Women Face Increased Risk of Heart Disease

Bisexual women were half as likely as their heterosexual peers to have high scores on a scale measuring cardiovascular health, shows new research from Columbia Nursing.

“Our findings support previous evidence of the heightened risk of heart disease among bisexual individuals and provide important insights to improve heart disease prevention for these individuals,” says Billy Caceres, PhD, an assistant professor at the school and lead author of the study. Titled “Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults,” it was published online on February 22 in JAMA Cardiology

There is growing evidence that sexual minority (SM) adults have worse cardiovascular health than their heterosexual peers, Caceres and his colleagues note, likely in part due to stress they experience as members of a minoritized group. Health and behavioral factors contribute as well, they add. SM men and women are more likely to be current or past smokers, for example, while SM women are at higher risk of obesity, diabetes, and insufficient sleep.

To look at heart health comprehensively, Caceres and his colleagues used the cardiovascular health (CVH) scoring system established by the American Heart Association (AHA); it measures heart risks on a scale from 0 to 100, with a score of 100 indicating “ideal” heart health.

The score is based on the AHA’s recommendations for what they call “Life’s Essential Eight”—that is, the four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index [BMI], cholesterol level, blood sugar level, and blood pressure) that are associated with heart disease and mortality.

Caceres and his colleagues analyzed data from 2007 through 2016 gathered by the National Health and Nutrition Examination Survey

(NHANES) to calculate CVH scores combining all eight risk factors. The study was based on data from 12,180 adults aged 18 to 59; about half were female, and two-thirds were non-Hispanic white.

Bisexual women were more likely to be obese than heterosexual women, while bisexual men were at higher risk than heterosexual men of having hypertension and using blood pressure medication, the researchers found. Bisexual and lesbian women had higher scores for nicotine exposure than heterosexual women, while bisexual women had less favorable BMI scores and lower heart health scores than heterosexual women.

Overall, the researchers found, bisexual women are about half as likely to have a CVH score in the high range (80 to 100) than the low range (0 to 49) compared to heterosexual women. Bisexual women are also the sexual identity group most likely to live in poverty, making them more likely to delay seeking health care due to financial challenges and/or to have difficulty finding a health care provider.

However, the differences between gay or bisexual men and their heterosexual peers were more mixed, Caceres and his colleagues found, with gay men on balance exhibiting better CVH than heterosexual men.

“There is a need for tailored interventions to improve the CVH of SM individuals, particularly bisexual women,” the researchers concluded in the paper reporting their findings. “Investigators should conduct longitudinal research that examines social determinants that may explain the sexual identity differences observed in this study.”

Other study authors from Columbia Nursing, all affiliated with the school’s Center for Sexual and Gender Minority Health Research, include PhD student Yashika Sharma MS ’20, research assistant Rohith Ravindranath, and research coordinator Danny Doan.