Gender-based violence is a well-recognized risk factor for HIV infection among women. Alcohol use is associated with both gender-based violence and sexual risk behavior, but has not been examined as a correlate of both in a context of both high HIV risk and hazardous drinking. The purpose of this paper is to examine the association between recent abuse by a sex partner with alcohol and sexual risk behavior among female patrons of alcohol serving venues in South Africa. Specifically, the aim of this study is to determine whether sexual risk behaviors are associated with gender-based violence after controlling for levels of alcohol use. We surveyed 1,388 women attending informal drinking establishments in Cape Town, South Africa to assess recent history of gender-based violence, drinking, and sexual risk behaviors. Gender-based violence was associated with both drinking and sexual risk behaviors after controlling for demographics among the women. A hierarchical logistic regression analysis showed that after controlling for alcohol use sexual risk behavior remained significantly associated with gender-based violence, particularly with meeting a new sex partner at the bar, recent STI diagnosis, and engaging in transactional sex, but not protected intercourse or number of partners. In South Africa where heavy drinking is prevalent women may be at particular risk of physical abuse from intimate partners as well as higher sexual risk. Interventions that aim to reduce gender-based violence and sexual risk behaviors must directly work to reduce drinking behavior.
gender-based violence; intimate partner violence; alcohol; sexual risk; HIV risk
Past studies have suggested that weight loss history is associated with subsequent weight loss. However, questions remain whether method and amount of weight lost in previous attempts impacts current weight loss efforts. This study utilized data from the Weight Loss Maintenance Trial to examine the association between weight loss history and weight loss outcomes in a diverse sample of high-risk individuals. Multivariate regression analysis was conducted to determine which specific aspects of weight loss history predict change in weight during a 6-month weight loss intervention. Greater weight loss was predicted by fewer previous weight loss attempts with assistance (p = 0.03), absence of previous dietary/herbal weight loss supplement use (p = 0.01), and greater maximum weight loss in previous attempts (p <0.001). Future interventions may benefit from assessment of weight loss history and tailoring of interventions based on past weight loss behaviors and outcomes.
Weight loss history; Previous weight; Weight loss method; Behavioral; Lifestyle; Greatest weight loss
Research samples are not often compared to broader community samples to evaluate their representativeness, a critical factor in determining the generalizability of study findings. This study evaluated the use of voter-registration records for recruiting a representative sample of community-dwelling, older, and overweight participants for research on improving measures of diet and physical activity. County voter-registration records were used to identify individuals between 45 and 75 years of age and living in the two cities closest to the research lab. The data were collected from July, 2007 through November, 2008. Prospective participants were mailed an introductory letter and opt-out postcard, and received a follow-up recruitment phone call in which they underwent further screening if interested in participating. The representativeness of the final voter-recruited sample (N = 191) was evaluated by comparisons of demographic variables with Behavioral Risk Factor Surveillance System (BRFSS) data at the county and state levels. The voter-recruited sample was only partially comparable to that of the BRFSS sample, with expected differences in variables related to race/ethnicity, the proportion of women, employment status, and educational attainment. Voter-registration records are a relatively low-cost ($75 per participant) method of recruiting a community sample that avoids some biases of other recruitment methods, but may not achieve a fully representative sample.
Research recruitment; Voter registration; Reach; Sample representativeness
Research has found that weight-teasing is associated with disordered eating in adolescents. This study expands on the existing research by examining associations between hurtful weight comments by family and a significant other and disordered eating in young adults.
Data come from 1,902 young adults (mean age 25) who completed surveys in 1998, 2003 and 2009. Correlations were examined between receiving hurtful comments from family and significant others, and four disordered eating behaviors in young adulthood, adjusting for prior disordered eating and prior teasing.
Disordered eating behaviors were common in young adulthood, and were associated with hearing hurtful weight-related comments from family members and a significant other, for both females and males.
Disordered eating prevention activities, which include messages about the potential harm associated with hurtful weight-related comments, should be expanded to address young adults, and programs may want to target relationship partners.
young adults; disordered eating; teasing; weight comments
Benefits of anti-retroviral therapy (ART) depend on consistent HIV care attendance. However, appointment non-adherence (i.e. missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care. Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months, records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74, P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health, time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression and low appointment expectancy and self-efficacy may be targets to increase care engagement.
HIV; Missed appointments; Adherence; Depression; PTSD; Patient perceptions
In general, social support from family members affects chronic illness outcomes, but evidence on which specific family behaviors are most important to adult patient outcomes has not been summarized. We systematically reviewed studies examining the effect of specific family member behaviors and communication patterns on adult chronic illness self-management and clinical outcomes. Thirty studies meeting inclusion criteria were identified, representing 22 participant cohorts, and including adults with arthritis, chronic cardiovascular disease, diabetes, and/or end stage renal disease. Family emphasis on self-reliance and personal achievement, family cohesion, and attentive responses to symptoms were associated with better patient outcomes. Critical, overprotective, controlling, and distracting family responses to illness management were associated with negative patient outcomes. Study limitations included cross-sectional designs (11 cohorts), however results from longitudinal studies were similar. Findings suggest that future interventions aiming to improve chronic illness outcomes should emphasize increased family use of attentive coping techniques and family support for the patient’s autonomous motivation.
Family Relations; Social Support; Chronic Disease; Self-Care; Outcomes
To date, no studies have validated the Medication Adherence Self-Efficacy Scale (MASES) in an independent sample of hypertensive African Americans.
The purpose of this study was to revise and assess the validity of the MASES.
Study sample included 168 African Americans followed in primary care practices. Mean age was 54 (SD = 12.36); 86% was female; and 76% reported high school education or greater. Participants provided demographic information; completed the MASES, self-report and electronic measures of medication adherence for prescribed antihypertensive medications at baseline and three months.
Confirmatory (CFA), exploratory (EFA) factor analyses, and classical test theory (CTT) analyses, suggested that MASES is a unidimensional and internally reliable measure with relatively stable scores over 3 months. Results of item response theory (IRT) analyses led to revision of the scale to a 13-item version: the MASES-R. EFA, CTT, and IRT results for the MASES-R supported its reliability and validity.
Findings suggest that the MASES-R is a brief scale that is quick to administer and can capture useful data on adherence self-efficacy for African Americans. Research examining its psychometric properties in other ethnic groups will improve generalizability of findings and utility of the scale in diverse groups.
Past studies show that optimism and social support are associated with better adjustment following breast cancer treatment. Most studies have examined these relationships in predominantly non-Hispanic White samples. The present study included 77 African American women treated for nonmetastatic breast cancer. Women completed measures of optimism, social support, and adjustment within 10-months of surgical treatment. In contrast to past studies, social support did not mediate the relationship between optimism and adjustment in this sample. Instead, social support was a moderator of the optimism-adjustment relationship, as it buffered the negative impact of low optimism on psychological distress, well-being, and psychosocial functioning. Women with high levels of social support experienced better adjustment even when optimism was low. In contrast, among women with high levels of optimism, increasing social support did not provide an added benefit. These data suggest that perceived social support is an important resource for women with low optimism.
social support; optimism; breast cancer; African American; psychological adjustment
While defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of two default policies on parents’ consent to have their adolescent sons hypothetically receive HPV vaccine at school. A national sample of 404 parents of adolescent sons participated in an online 3×2 between-subjects factorial experiment. Factors varied the default consent policy (opt-in, opt-out, or neutral) and the number of vaccines sons would receive (HPV vaccine alone or along with two other recommended adolescent vaccines). Among parents wanting to get their sons HPV vaccine in the next year, consent was higher in the opt-in condition (compared to the opt-out condition) or if other recommended adolescent vaccines would be included. Default policies had no effect among parents undecided about HPV vaccination. Parents’ consent for school-located HPV vaccination may be higher when presented as an opt-in decision and other vaccines are included.
HPV; vaccine; males; default; policy
We examined whether people who tend to catastrophize about pain and who also attempt to regulate negative thoughts and feelings through suppression may represent a distinct subgroup of individuals highly susceptible to pain and distress. Ninety-seven healthy normal participants underwent a 4-min ischemic pain task followed by a 2-min recovery period. Self-reported pain and distress was recorded during the task and every 20 s during recovery. Participants completed the Pain Catastrophizing Scale and the White Bear Suppression Inventory. Repeated measures multiple regression analysis (using General Linear Model procedures) revealed significant 3-way interactions such that participants scoring high on the rumination and/or helplessness subscales of the Pain Catastrophizing Scale and who scored high on the predisposition to suppress unwanted thoughts and feelings reported the greatest pain and distress during recovery. Results suggest that pain catastrophizers who attempt to regulate their substantial pain intensity and distress with maladaptive emotion regulation strategies, such as suppression, may be especially prone to experience prolonged recovery from episodes of acute pain. Thus, emotion regulation factors may represent critical variables needed to understand the full impact of catastrophic appraisals on long-term adjustment to pain.
Pain catastrophizing; Suppression; Emotion regulation; Acute pain
A chronically elevated white blood cell (WBC) count is a risk factor for morbidity and mortality. The present research tests whether facets of impulsivity – impulsiveness, excitement-seeking, self-discipline, and deliberation – are associated with chronically elevated WBC counts. Community-dwelling participants (N=5,652) from Sardinia, Italy, completed a standard personality questionnaire and provided blood samples concurrently and again three years later. Higher scores on impulsivity, in particular impulsiveness and excitement-seeking, were related to higher total WBC counts and higher lymphocyte counts at both time points. Impulsiveness was a predictor of chronic inflammation: For every standard deviation difference in this trait, there was an almost 25% higher risk of elevated WBC counts at both time points (OR=1.23, 95% CI=1.10–1.38). These associations were mediated, in part, by smoking and body mass index. The findings demonstrate that links between psychological processes and immunity are not limited to acute stressors; stable personality dispositions are associated with a chronic inflammatory state.
Personality; Impulsivity; White blood cells; Inflammation; Neuroticism; Conscientiousness
Lesbians, gay men, and bisexuals are a sexual minority experiencing elevated cancer risk factors and health disaparites, e.g., elevated tobacco use, disproportionate rates of infection with human immunodeficiency virus. Little attention has been paid to cancer prevention, education, and control in sexual minorities. This study describes cancer risk perceptions and their correlates so as to generate testable hypotheses and provide a foundation for targeting cancer prevention and risk reduction efforts in this high risk population. A cross-sectional survey of affiliates of a large urban community center serving sexual minority persons yielded a study sample of 247 anonymous persons. The survey assessed demographics, absolute perceived cancer risk, cancer risk behaviors, desired lifestyle changes to reduce cancer risk, and psychosocial variables including stress, depression, and stigma. Univariate and multivariate nonparametric statistics were used for analyses. The sample was primarily white non-Hispanic, middle-aged, and > 80% had at least a high school education. Mean values for absolute perceived cancer risk (range 0–100% risk), were 43.0 (SD = 25.4) for females, and for males, 49.3 (SD = 24.3). For females, although the multivariate regression model for absolute perceived cancer risk was statistically significant (P < .05), no single model variable was significant. For men, the multivariate regression model was significant (P < .001), with endorsement of “don't smoke/quit smoking” to reduce personal cancer risk (P < .001), and greater number of sexual partners (P = .054), positively associated with absolute perceived risk for cancer. This study provides novel data on cancer risk perceptions in sexual minorities, identifying correlates of absolute perceived cancer risk for each gender and several potential foci for cancer prevention interventions with this at-risk group.
Cancer risk perception; Cancer risk factors; Sexual minority; Health disparities
Suboptimal antiretroviral adherence is associated with poorer HIV outcomes. Psychosocial factors, including life stress, depression and coping, may influence adherence behavior. This prospective investigation sought to examine the impact of life stress (acute life events, chronic stress, and perceived stress), depression, and coping style on adherence to HIV treatment regimes over time. Participants were 87 treatment-seeking HIV-infected individuals recruited from an urban HIV clinic. They completed clinician-administered interviews and self-report questionnaires at baseline and 3-month follow-up. Acute life events and chronic stress prospectively predicted decreases in treatment adherence more strongly among individuals in a major depressive episode (n =21) compared to non-depressed individuals (n =66). Coping style did not appear to be the mechanism by which life stress influenced adherence among depressed HIV-infected individuals. These findings demonstrate that life stress has toxic effects for depressed individuals and suggest that treatment adherence interventions with depressed individuals could be enhanced via development of stress management skills.
HIV/AIDS; Antiretrovirals; Treatment adherence; Depression; Life stress; Coping
This study examined the relationship of post-traumatic and depressive symptom severity with measures of health-related quality of life (HRQOL), and health care utilization in a sample of 503 HIV-infected men who have sex with men (MSM) recruited in their primary HIV care setting. Participants completed computer assisted assessments of mood and anxiety, HRQOL, and HIV treatment. Peripheral blood CD4 (T helper) lymphocyte count, plasma HIV RNA concentration, and number of medical appointments were extracted from an electronic medical record. Controlling for demographics, disease stage, and antiretroviral medication, post-traumatic stress and depression symptoms accounted for significant variation in general health estimates, and in pain, role, and work-related impairment. Additionally, in multivariable models, post-traumatic stress and depression severity accounted for significant variation in health care utilization whereas symptoms and indices of HIV disease progression did not. These results extend the current research by providing evidence of the relationship between post-traumatic stress and depression symptom severity with measures of functional impairment and health care utilization in a relatively healthy, urban cohort of HIV-infected MSM.
HIV; Health related quality of life; Health care utilization; Depression; Post-traumatic stress
African Americans are overrepresented on the organ transplant waiting list because they are disproportionately impacted by certain health conditions that potentially warrant a life-saving transplant. While the African American need for transplantation is considerably high, organ and tissue donation rates are comparatively low, resulting in African Americans spending more than twice the amount of time on the national transplant waiting list as compared to people of other racial/ethnic backgrounds. There are a multitude of factors that contribute to the reluctance expressed by African Americans with respect to organ donation. This study proposes the use of an adaptation of the Organ Donation Model to explore the ways in which knowledge, trust in the donation/allocation process, and religious beliefs impact African American donation decision making. Bivariate and path analyses demonstrated that alignment with religious beliefs was the greatest driving factor with respect to attitudes towards donation; attitudes were significantly associated with donation intentions; and knowledge is directly associated with intentions to serve as a potential deceased organ donor. The significance of these variables speaks to the importance of their inclusion in a model that focuses on the African American population and offers new direction for more effective donation education efforts.
organ donation; African American; theory of reasoned action; religion; trust
We examined the joint trajectories of violent victimization and marijuana use from emerging adulthood to the early thirties and their health consequences in the early thirties among urban African American and Puerto Rican men. Data were collected from a community sample of young men (N=340) when they were 19, 24, 29, and 32 years old. The joint trajectories of violent victimization and marijuana use were extracted using growth mixture modeling. Three distinct joint trajectory groups of violent victimization and marijuana use were identified: high violent victimization/consistently high marijuana use; low violent victimization/increasingly high marijuana use, and low violent victimization/low marijuana use. Group comparisons using regression analyses showed that men who had experienced high levels of violent victimization and were high frequency marijuana over time users experienced the most adverse psychological and physical health outcomes, including more health problems, psychological maladjustment, and substance use disorders.
marijuana use; violence; ethnicity; longitudinal studies; mental health
The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed.
Religion; Spirituality; Cancer coping; Mechanisms; Mediation; African Americans
Many college women are at risk for pregnancy, and binge drinking college women are often at risk for alcohol-exposed pregnancy. Brief interventions with sustainable outcomes are needed, particularly for college women who are binge drinking, at risk for pregnancy, and at increased risk of alcohol-exposed pregnancy. Two-hundred-twenty-eight women at a Mid-Atlantic urban university at risk for alcohol-exposed pregnancy enrolled in the randomized clinical trial, and 207 completed the 4 month follow-up. The BALANCE intervention used Motivational Interviewing plus feedback to target drinking and contraception behaviors. Main outcome measures included (1) the rate of risk for alcohol-exposed pregnancy, (2) the rate of risk drinking, and (3) the rate of pregnancy risk. At 4-month follow-up, the rate of alcohol-exposed pregnancy risk was significantly lower in the intervention (20.2%) than the control condition (34.9%), (P < .02). Assignment to the intervention condition halved the odds of women remaining at risk for alcohol-exposed pregnancy, while not receiving the intervention doubled the odds of continued alcohol-exposed pregnancy risk (OR = 2.18; 95% CI = 1.16–4.09). A baseline history of blackouts, continued high blood alcohol drinking days at 1 month, and continued risk for pregnancy at 1 month independently contributed to a multivariate model of continued alcohol-exposed pregnancy risk at 4 month follow-up. BALANCE reduced alcohol-exposed pregnancy risk, with similar outcomes to longer interventions. Because early response predicted sustained alcohol-exposed pregnancy risk reduction, those who fail to achieve initial change could be identified for further intervention. The BALANCE intervention could be adopted into existing student health or university alcohol programs. The risks of unintended pregnancy and alcohol-exposed pregnancy among binge drinking women in college merit greater prevention efforts.
Alcohol-exposed pregnancy; Motivational interviewing; Personalized feedback; College binge drinking; Contraception; Unintended pregnancy
Chronic diseases are the leading cause of death and disability in the United States and have significant behavioral origins. African Americans suffer a disproportionate burden of chronic disease relative to other US racial/ethnic groups. Previous research supports an association between both general and religious social support and health behaviors that impact the risk of chronic disease. The present study examined the relative contributions of these constructs to a variety of health behaviors in a national probability sample of African American men and women (N=2,370). A telephone interview assessing fruit and vegetable consumption, physical activity, alcohol consumption, and current cigarette use was completed by participants. Results showed that several dimensions of religious social support predicted fruit and vegetable consumption, moderate physical activity, and alcohol use over and above the role of general social support. Findings highlight the unique role of religious support in this population in the context of health behaviors. Implications for health promotion interventions are discussed.
Greater dispositional optimism has been related to less severe pain; however, whether optimism is associated with endogenous pain modulation has not yet been examined. The beneficial effects of dispositional optimism often vary according to cultural dynamics. Thus, assessing optimism-pain relationships across different ethnic groups is warranted. This study sought to examine the association between optimism and conditioned pain modulation (CPM), and test whether this association differs according to ethnicity. Optimism and CPM were assessed in a sample of healthy, ethnically diverse young adults. CPM was determined by comparing pressure pain thresholds obtained before and during exposure to a cold pressor task. All participants completed a validated measure of dispositional optimism. Greater reported optimism was significantly associated with enhanced CPM, and the strength of this association did not vary according to individuals’ ethnic background. These findings suggest that an optimistic disposition may potentiate endogenous pain inhibition.
Dispositional optimism; Pain inhibition; Conditioned pain modulation; Ethnic differences
Although neurocognitive impairment is an established risk factor for medication non-adherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one’s ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.
chronic disease treatment; medication adherence; episodic memory; neuropsychological assessment; review
The association between racism and the physical health of native U.S. populations has yet to be examined despite their high risk for stress-related disorders and a history of discrimination toward them. We examined the correlation between perceived racism and the two physiological stress indices of cortisol level and blood pressure in 146 adult Native Hawaiians. Attributed and felt racism were assessed with a 10-item shortened version of the Oppression Questionnaire. Height, weight, blood pressure (BP), and salivary cortisol samples (AM and PM) were collected and analyzed along with information on Hawaiian ancestry, BMI, age, sex, marital status, education level, general psychological stress, and ethnic identity. The results indicated that Native Hawaiians reporting more attributed racism had significantly (p < .05) lower average cortisol levels than those reporting less attributed racism, after adjusting for socio-demographic, biological, and psychosocial confounders. Native Hawaiians reporting more felt racism had a significantly higher systolic BP than those reporting less, but this association was not significant after adjusting for the aforementioned confounders. Racism appears to be a chronic stressor that can “get under the skin” of Native Hawaiians by affecting their physical health and risk for stress-related diseases, possibly, through mechanisms of cortisol dysregulation.
Native Hawaiian; racism; discrimination; physiological stress; salivary cortisol; blood pressure
Current measures of internalized weight bias assess factors such as responsibility for weight status, mistreatment because of weight, etc. A potential complementary approach for assessing internalized weight bias is to examine the correspondence between individuals’ ratings of obese people, normal weight people, and themselves on personality traits. This investigation examined the relationships among different measures of internalized weight bias, as well as the association between those measures and psychosocial maladjustment. Prior to the beginning of a weight loss intervention, 62 overweight/obese adults completed measures of explicit and internalized weight bias as well as body image, binge eating, and depression. Discrepancies between participants’ ratings of obese people in general and ratings of themselves on both positive and negative traits predicted unique variance in measures of maladjustment above a traditional assessment of internalized weight bias. This novel approach to measuring internalized weight bias provides information above and beyond traditional measures of internalized weight bias and begins to provide insights into social comparison processes involved in weight bias.
Internalized weight bias; Weight stigma; Body image; Binge eating; Depression
In a stepped-care approach to treatment, patients are transitioned to more intensive treatments when less intensive treatments fail to meet treatment goals. Self-help programs are recommended as an initial, low intensity treatment phase in stepped-care models. This investigation examined the effectiveness of a self-help, stepped-care weight loss program. Fifty-eight overweight/obese adults (BMI ≥ 27 kg/m2) participated in a weight loss program. Participants were predominately Caucasian (93.1%) and female (89.7%) with a mean BMI of 36.6 (SD = 7.1). Of those completing the program, 57% of participants (N = 21) who remained in self-help maintained an 8% weight loss at follow-up. Participants who were stepped-up self-monitored fewer days and reported higher daily caloric intake than self-help participants. Once stepped-up, weight loss outcomes were equivalent between individuals who remained in self-help compared to those who were stepped-up. Individuals who were stepped-up benefited from early intensive intervention when unsuccessful at losing weight with self-help.
Weight loss treatment; Obesity; Stepped-care; Self-help