Background: Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample. Methods: Using data on 67,354 adults (ages 18–49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18–25, 26–34, and 35–49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics. Results: Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18–25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35–49 for marijuana use and alcohol/substance use disorder. Conclusions: We find notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.

Background: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. Methods: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. Results: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. Conclusions: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

Highlights Health professional students can effectively implement a contact tracing initiative A replicable workflow and onboarding system aids in efficient contact tracing Testing capacity, community buy-in, and sparse resources can impact contact tracing

Background.-Sexual minorities (experience significant health disparities across a variety of mental, behavioral, and physical health indicators. Yet, an understanding of the etiology and progression of sexual minority health disparities across the lifespan is limited. Methods.-We used the US National Epidemiologic Survey of Alcohol and Related Conditions III to evaluate the association between sexual minority status and seven past-year health outcomes (alcohol use disorder, tobacco use disorder, drug use disorder, major depressive episode, generalized anxiety disorder, sexually transmitted infection, and cardiovascular conditions). To do this, we used unadjusted and adjusted logistic regression among our study sample (n=30,999; aged 18-65) and time-varying effect models to evaluate how sexual orientation differences in these outcomes vary across adulthood. Results.-Relative to heterosexuals, sexual minorities had elevated odds of past-year alcohol use disorder and drug use disorder across all ages (18 to 65 years), though the magnitude of the

The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).

Aim Unprotected anal intercourse is often used as a single indicator of risky behavior among men who have sex with men (MSM), yet MSM engage in a variety of behaviors which have unknown associations with sexually transmitted infection (STI) and HIV. We assessed the prevalence of a wide range of sexual behaviors as well as their associations with prevalent STI and HIV. Methods We used a standardized, self-administered survey to collect behavioral data for this cross-sectional study of 235 MSM seeking care in a public STD clinic. Using modified Poisson regression, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize associations between recent participation in each behavior and prevalent STI and HIV. Results Participants’ median age was 26 years. One-third (35%) were STI-positive. STI prevalence was significantly associated with using sex slings (adjusted prevalence ratio (aPR): 2.35), felching (aPR: 2.22), group sex (aPR: 1.86), fisting (aPR: 1.78), anonymous sex (aPR: 1.51), and sex toys (aPR: 1.46). HIV prevalence was 17% and was significantly associated with fisting (aPR: 4.75), felching (aPR: 4.22), enemas (aPR: 3.65), and group sex (aPR: 1.92). Conclusions Multiple behaviors were significantly associated with prevalent STI and HIV in adjusted analyses. To provide a more comprehensive understanding of sexual risk among MSM, prospective studies are needed to examine whether these behaviors are causally associated with HIV/STI acquisition.

Purpose To examine how age of onset of sexual intercourse is associated with past-year and lifetime sexually transmitted infections (STIs) and depression in young adulthood. Methods We examined how occurrence of a lifetime and past-year STI, lifetime diagnosis of depression, and past-week depressive symptoms differed as a function of age of onset of sexual intercourse using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 8,938 individuals). Time-varying effect models (TVEMs) were used to examine how age of onset, measured as continuous age, was associated with these outcomes in young adulthood, with all analyses stratified to examine gender differences. Results Individuals who engaged in first intercourse prior to age 16 reported higher than average rates of all outcomes studied; for example, an estimated 35% of women and 12% of men who initiated at age 14 reported a lifetime STI, compared to about 5% of those who initiated at age 24. Timing of first intercourse past the mid-twenties was associated with lower than average rates of STIs and lifetime depression diagnoses, but was associated with a somewhat higher level of past-year depressive symptoms. Patterns were similar by gender, although there was little difference in men's depression diagnoses by age of onset. Discussion Results suggest that sexual intercourse prior to age 16 may be associated with higher rates of STIs and depression. Findings provide support for comprehensive programs that both promote delay of first intercourse and provide safe-sex and psychological support for those who initiate early.

Purpose Contact tracing has proven successful at controlling COVID-19 globally and the Center for Health Security has recommended that the United States add 100,000 contact tracers to the current workforce. Methods To address gaps in local contact tracing, health professional students partnered with their academic institution to conduct contact tracing for all COVID-19 cases diagnosed on site, which included identifying and reaching their contacts, educating participants and providing social resources to support effective quarantine and isolation. Results From March 24 th to May 28 th , 536 laboratory-confirmed COVID-19 cases were contacted and reported an average of 2.6 contacts. Contacts were informed of their exposure, asked to quarantine and monitored for the onset of symptoms. Callers reached 94% of cases and 84% of contacts. 74% of cases reported at least 1 contact. Household members had higher rates of reporting symptoms (OR 1.65, 95% CI 1.19:2.28). The average test turnaround time decreased from 21.8 days for the first patients of this program to 2.3 days on the eleventh week. Conclusions This provides evidence for the untapped potential of community contact tracing to respond to regional needs, confront barriers to effective quarantine and mitigate the spread of COVID-19.