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1.  The impact of depressive symptoms on patient–provider communication in HIV care 
AIDS care  2013;25(9):1185-1192.
Persons with HIV who develop depression have worse medical adherence and outcomes. Poor patient–provider communication may play a role in these outcomes. This cross-sectional study evaluated the influence of patient depression on the quality of patient–provider communication. Patient–provider visits (n = 406) at four HIV care sites were audio-recorded and coded with the Roter Interaction Analysis System (RIAS). Negative binomial and linear regressions using generalized estimating equations tested the association of depressive symptoms, as measured by the Center for Epidemiology Studies Depression scale (CES-D), with RIAS measures and postvisit patient-rated quality of care and provider-reported regard for his or her patient. The patients, averaged 45 years of age (range = 20–77), were predominately male (n = 286, 68.5%), of black race (n = 250, 60%), and on antiretroviral medications (n = 334, 80%). Women had greater mean CES-D depression scores (12.0) than men (10.6; p = 0.03). There were no age, race, or education differences in depression scores. Visits with patients reporting severe depressive symptoms compared to those reporting none/mild depressive symptoms were longer and speech speed was slower. Patients with severe depressive symptoms did more emotional rapport building but less social rapport building, and their providers did more data gathering/counseling (ps < 0.05). In postvisit questionnaires, providers reported lower levels of positive regard for, and rated more negatively patients reporting more depressive symptoms (p < 0.01). In turn, patients reporting more depressive symptoms felt less respected and were less likely to report that their provider knows them as a person than none/mild depressive symptoms patients (ps < 0.05). Greater psychosocial needs of patients presenting with depressive symptoms and limited time/resources to address these needs may partially contribute to providers’ negative attitudes regarding their patients with depressive symptoms. These negative attitudes may ultimately serve to adversely impact patient–provider communication and quality of HIV care.
doi:10.1080/09540121.2012.752788
PMCID: PMC4090599  PMID: 23320529
depression; communication; quality of health care; patient satisfaction; HIV
2.  The serotonin transporter gene polymorphism (5HTTLPR) moderates the effect of adolescent environmental conditions on self-esteem in young adulthood: A structural equation modeling approach 
Biological psychology  2012;91(1):111-119.
Here we examine the effects of both self-reported and independent observer-reported environmental risk indices, the serotonin transporter gene promoter (5HTTLPR) polymorphism, and their interaction on self-esteem. This trait was assessed during early and mid adolescence (mean age = 14 and 16.5, respectively) and young adulthood (mean age = 21.8) in a prospective cohort of 1214 unrelated participants in the Longitudinal Study of Adolescent Health (Add Health). Using structural equation modeling we identified a gene–environment (G × E) interaction using observer-report but not self-report measures of environmental stress exposure during adolescence: 5HTTLPR genotype and observer-reports of home and neighborhood quality (HNQ) during adolescence interacted to predict self-esteem levels in young adulthood (p < .004). Carriers of the s allele who lived in poor HNQ conditions during adolescence reported lower self-esteem in young adulthood than those with a good HNQ during adolescence. In contrast, among individuals with the l/l genotype, adolescent HNQ did not predict adulthood self-esteem. Genes may moderate the effect of adolescent environmental conditions on adulthood self-esteem.
doi:10.1016/j.biopsycho.2012.05.004
PMCID: PMC3574633  PMID: 22659377
Adolescents; Genetic polymorphism; Socioeconomic status; Serotonin; Self-esteem
3.  The Association of Optimism and Perceived Discrimination With Health Care Utilization in Adults With Sickle Cell Disease 
Objective
We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD).
Methods
Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year.
Results
A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization.
Conclusions
African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.
PMCID: PMC3663072  PMID: 21141295
sickle cell anemia; discrimination; health care
4.  Low Life Course Socioeconomic Status (SES) is Associated with Negative NEO PI-R Personality Patterns 
Background
Low socioeconomic status (SES) is associated with poor health. One potential pathway accounting for this relationship may be an association between low SES and personality characteristics that affect health.
Methods
Associations among parent's education, current SES (education and income), and personality were examined among 233 African Americans and Caucasian, male and female community volunteers.
Results
Using multivariate analysis of variance (MANOVA) to model neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness simultaneously, participant's education, household income, and father's and mother's education each had significant main effects on personality. When examining the life course—the combination of both current and childhood SES—distinctive patterns emerged for each domain, depending upon whether mother's or father's education was used to index childhood SES. When using mother's education as a childhood SES index, a high life course SES (high participant's SES/high mother's education) was associated with high extraversion and openness. Using father's education as a childhood SES index, a low life course SES (low participant's SES/low father's education) was associated with disproportionately high neuroticism and low conscientiousness. These effects did not differ by race or sex.
Conclusion
The implications of these findings for the role of personality in the SES–health relationship are discussed.
doi:10.1007/s12529-009-9069-x
PMCID: PMC3634575  PMID: 20012811
Socioeconomic factors; Social class; Personality; Education
5.  Association of Candidate Genes with Phenotypic Traits Relevant to Anorexia Nervosa 
European Eating Disorders Review  2011;19(6):487-493.
This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein we investigate alternative phenotypes associated with AN. In 1762 females using regression analyses we examined: (1) lowest illness-related attained body mass index; (2) age at menarche; (3) drive for thinness; (4) body dissatisfaction; (5) trait anxiety; (6) concern over mistakes; and (7) the anticipatory worry and pessimism vs. uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes.
doi:10.1002/erv.1138
PMCID: PMC3261131  PMID: 21780254
covariates; eating disorders; association studies; personality; genetic
6.  Specific common variants of the obesity-associated FTO gene are not associated with psychological and behavioral eating disorder phenotypes 
Extensive population-based genome-wide association studies have identified an association between the FTO gene and BMI; however, the mechanism of action is still unknown. To determine whether FTO may influence weight regulation through psychological and behavioral factors, seven single nucleotide polymorphisms (SNPs) of the FTO gene were genotyped in 1085 individuals with anorexia nervosa (AN) and 677 healthy weight controls from the international Price Foundation Genetic Studies of Eating Disorders. Each SNP was tested in association with eating disorder phenotypes and measures that have previously been associated with eating behavior pathology: trait anxiety, harm-avoidance, novelty seeking, impulsivity, obsessionality, compulsivity, and concern over mistakes. After appropriate correction for multiple comparisons, no significant associations between individual FTO gene SNPs and eating disorder phenotypes or related eating behavior pathology were identified in cases or controls. Thus, this study found no evidence that FTO gene variants associated with weight regulation in the general population are associated with eating disorder phenotypes in AN participants or matched controls.
doi:10.1002/ajmg.b.31182
PMCID: PMC3249222  PMID: 21438147
7.  Socioeconomic status moderates the association between John Henryism and NEO PI-R personality domains 
Psychosomatic medicine  2010;72(2):141-147.
OBJECTIVE
The aim of this study was to investigate associations between John Henryism (JH) and NEO PI-R personality domains. JH—a strong behavioral predisposition to engage in high-effort coping with difficult psychosocial and economic stressors—has been associated with poor health, particularly among persons in lower socioeconomic (SES) groups. Unfavorable personality profiles have also been frequently linked to poor health; however, no studies have yet examined what global personality traits characterize JH.
METHODS
Hypotheses were examined using data from a sample of 233 community volunteers (mean age: 33 years; 61% black and 39% white) recruited specifically to represent the full range of the SES gradient. Personality (NEO PI-R) and active coping (12-item John Henryism scale) measures and covariates were derived from baseline interviews.
RESULTS
In a multiple regression analysis, independent of SES JH was positively associated with Conscientiousness (C; p<.001) and Extraversion (E; p<.001), while the combination of low JH and high SES was associated with Neuroticism (N; p=0.02) When examining associations between JH and combinations of NEO PI-R domains called “styles,” high JH was most strongly associated with a high E/high C “Go-Getters” style of activity while low JH was associated with the low E/high O “Introspectors” style. In facet level data, the most robust associations with JH were found for five C and five E facets.
CONCLUSIONS
High JH was associated with higher scores on C and E, but the combination of low JH and high SES was associated with higher scores on N.
doi:10.1097/PSY.0b013e3181cdc00e
PMCID: PMC2832746  PMID: 20100884
John Henryism; Personality; Coping; Conscientiousness; Extraversion; Neuroticism
8.  Personality and Inflammation: The Protective Effect of Openness to Experience 
Ethnicity & disease  2010;20(1):11-14.
Prior research found reduced mortality in coronary heart patients with higher scores on the Openness to Experience (O) domain and its facets. Decreased C-reactive protein level (CRP) levels may be one mechanism by which higher O leads to decreased mortality. Thus, the current study aimed to test the association between the O domain and its facets, as assessed by the NEO Personality Inventory-Revised, and CRP in a sample of 165 healthy black and white, male and female community volunteers.
Methods
Blood samples were taken before and after a 40-minute mental stress protocol. BMI and education were significant predictors of CRP and, in addition to age, were included as covariates in all analyses. Race and sex were tested as possible moderating variables.
Results
In a mixed effects model the main effect of Time (pre/post-stress), O and their interaction were not significant predictors of CRP. However, results showed a significant race x O effect on CRP (p =.03). In blacks, higher O domain (r = -.41, p<.01), Aesthetics facet (r = -.30, p=.01), Feelings facet (r = -.41, p<.01), and Ideas facet (r = -.38, p<.01) scores were associated with lower mean CRP levels. In contrast, among white participants, neither the O domain nor its related facets were associated with CRP.
Discussion
The O domain and its facets may be associated with markers of the inflammatory process among blacks but not whites.
PMCID: PMC2898189  PMID: 20178176
9.  Regional differences in awareness and attitudes regarding genetic testing for disease risk and ancestry 
Human Genetics  2010;128(3):249-260.
Little is known about the lay public’s awareness and attitudes concerning genetic testing and what factors influence their perspectives. The existing literature focuses mainly on ethnic and socioeconomic differences; however, here we focus on how awareness and attitudes regarding genetic testing differ by geographical regions in the US. We compared awareness and attitudes concerning genetic testing for disease risk and ancestry among 452 adults (41% Black and 67% female) in four major US cities, Norman, OK; Cincinnati, OH; Harlem, NY; and Washington, DC; prior to their participation in genetic ancestry testing. The OK participants reported more detail about their personal ancestries (p = 0.02) and valued ancestry testing over disease testing more than all other sites (p < 0.01). The NY participants were more likely than other sites to seek genetic testing for disease (p = 0.01) and to see benefit in finding out more about one’s ancestry (p = 0.02), while the DC participants reported reading and hearing more about genetic testing for African ancestry than all other sites (p < 0.01). These site differences were not better accounted for by sex, age, education, self-reported ethnicity, religion, or previous experience with genetic testing/counseling. Regional differences in awareness and attitudes transcend traditional demographic predictors, such as ethnicity, age and education. Local sociocultural factors, more than ethnicity and socioeconomic status, may influence the public’s awareness and belief systems, particularly with respect to genetics.
doi:10.1007/s00439-010-0845-0
PMCID: PMC2940428  PMID: 20549517
10.  Effects of Environmental Stress and Gender on Associations among Symptoms of Depression and the Serotonin Transporter Gene Linked Polymorphic Region (5-HTTLPR) 
Behavior genetics  2007;38(1):34-43.
The short (s) variant of the serotonin transporter (5-HTT) gene linked functional polymorphic region (5-HTTLPR) is associated with depression. Stressful life events, gender, and race have been shown to moderate this association. We examined the relationship between 5-HTTLPR genotype and symptoms of depression in two samples. Study 1 = 288 participants from a study of caregiver stress; and Study 2 = 142 participants from a study examining psychosocial stressors, genetics, and health. Main effects of 5-HTTLPR on symptoms of depression were examined, along with moderation by stress (care-giving status or low childhood socioeconomic status (SES), gender, and race. The 5-HTTLPR × stress group × gender interaction was significant in both samples (P < 0.003, and P < 0.008, respectively). For females, the s allele, combined with caregiving stress (Study 1) or low childhood SES (Study 2), was associated with higher depression scores as compared to participants in the non-stressor group and those with the long (l) allele; whereas, in males, the l allele, combined with a stressor, was associated with higher depression scores as compared to those in the non-stressor group and those with the s allele. Findings from two independent samples suggest that the association of 5-HTTLPR with depression varies according to gender and stressful life events.
doi:10.1007/s10519-007-9172-1
PMCID: PMC2777886  PMID: 17955359
5-HTTLPR; Depressive Symptoms; Caregiving; Socioeconomic Status; Race; Gender difference

Results 1-10 (10)