Chih-Ping Chou

Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment.

Objective: To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits. Setting: Six HIV clinics in California. Design: Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention. Participants: Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment. Interventions: Prevention counseling from medical providers supplemented with written information. Two clinics used a gain-framed approach (positive consequences of safer-sex), two used a loss-frame approach (negative consequences of unsafe sex), and two were attention-control clinics (medication adherence). Interventions were given to all patients who attended the clinics. Outcome measure: Self-reported unprotected anal or vaginal intercourse (UAV). Results: Among participants who had two or more sex partners at baseline, UAV was reduced 38% (P < 0.001) among those who received the loss-frame intervention. UAV at follow-up was significantly lower in the loss-frame arm [odds ratio (OR), 0.42; 95% confidence interval (CI), 0.19–0.91; P = 0.03] compared with the control arm. Using generalized estimating equations (GEE) to adjust for clustering did not change the conclusions (OR, 0.34; 95% CI, 0.24–0.49; P = 0.0001). Similar results were obtained in participants with casual partners at baseline. No effects were seen in participants with only one partner or only a main partner at baseline. No significant changes were seen in the gain-frame arm. Conclusions: Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.

Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial

Background Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people. Methods A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <

Parallel developmental trajectories of sensation seeking and regular substance use in adolescents.

12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area. Results Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US

Physical Activity in US Youth: Effect of Race/Ethnicity, Age, Gender, and Weight Status

41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures. Conclusions A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people. Trial Registration clinicaltrials.gov identifier: NCT0078634.

Adolescent Affiliations and Adiposity: A Social Network Analysis of Friendships and Obesity

This study applied piecewise latent growth modeling to longitudinal survey data from 2 different samples of adolescents (N=1,002 and N=1,206) to examine the hypothesis that development of sensation seeking in middle school would predict development of substance use (cigarettes, alcohol, and marijuana) in middle school and high school. Results showed that sensation seeking had strong predictive value for both concurrent and distal marijuana and alcohol use in both samples; however, initial level of sensation seeking predicted initial level of cigarette use during high school in 1 sample only. White participants scored consistently higher on both initial level and rate of increase in sensation seeking than did participants of other ethnicities. Advantages of this methodology are discussed in the context of substance use research.

Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial.

PURPOSE To describe physical activity (PA) levels by race/ethnicity, age, gender, and weight status in a representative sample of US youth. METHODS Cross-sectional data from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey were combined and analyzed. Youth aged 6-19 yr with at least four 10-h days of PA measured by accelerometry were included (n = 3106). Outcomes included mean counts per minute and minutes spent in moderate-to-vigorous PA (MVPA). RESULTS Among the groups, the 6- to 11-yr-olds spent more time (88 min·d) in MVPA than the 12- to 15-yr-olds (33 min·d) and 16- to 19-yr-olds (26 min·d; P < 0.001 for both). Females spent fewer minutes per day in MVPA than males (P < 0.001). Overall, obese youth spent 16 fewer minutes per day in MVPA than normal-weight youth. However, non-Hispanic white males spent three to four fewer minutes per day in vigorous PA than Mexican American (MA; P = 0.004) and non-Hispanic black (P < 0.001) males but had lower obesity rates and obese 12- to 15-yr-old MA recorded similar minutes in MVPA per day as normal-weight MA (P > 0.050). There was a significant three-way age-body mass index-race/ethnicity interaction for mean minutes per day in MVPA (P < 0.001). Adjustment for total energy intake did not qualitatively alter these results. CONCLUSIONS Females and older youth were the least active groups. Obese youth were generally less active, but this did not hold uniformly across race/ethnic groups. Cultural or biological factors could moderate the association between PA and obesity in youth.

Reliability and Validity of Retrospective Behavioral Self-Report by Narcotics Addicts.

Friendship choices and BMI were measured for 617 adolescents 11-15 years of age. Overweight youth were twice as likely to have overweight friends. There was a weak association between social position and weight status. Overweight youth nominated more friends but were nominated as friends less frequently than their normal weight peers.

Perceived stress, depression and food consumption frequency in the college students of China seven cities

OBJECTIVE To determine whether evidence-based socioculturally adapted collaborative depression care improves receipt of depression care and depression and diabetes outcomes in low-income Hispanic subjects. RESEARCH DESIGN AND METHODS This was a randomized controlled trial of 387 diabetic patients (96.5% Hispanic) with clinically significant depression recruited from two public safety-net clinics from August 2005 to July 2007 and followed over 18 months. Intervention (INT group) included problem-solving therapy and/or antidepressant medication based on a stepped-care algorithm; first-line treatment choice; telephone treatment response, adherence, and relapse prevention follow-up over 12 months; plus systems navigation assistance. Enhanced usual care (EUC group) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list. RESULTS INT patients had significantly greater depression improvement (≥50% reduction in Symptom Checklist-20 depression score from baseline; 57, 62, and 62% vs. the EUC groups 36, 42, and 44% at 6, 12, and 18 months, respectively; odds ratio 2.46–2.57; P < 0.001). Mixed-effects linear regression models showed a significant study group–by–time interaction over 18 months in diabetes symptoms; anxiety; Medical Outcomes Study Short-Form Health Survey (SF-12) emotional, physical, and pain-related functioning; Sheehan disability; financial situation; and number of social stressors (P = 0.04 for disability and SF-12 physical functioning, P < 0.001 for all others) but no study group–by–time interaction in A1C, diabetes complications, self-care management, or BMI. CONCLUSIONS Socioculturally adapted collaborative depression care improved depression, functional outcomes, and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics.

Adolescent to Emerging Adulthood Smoking Trajectories: When Do Smoking Trajectories Diverge, and Do They Predict Early Adulthood Nicotine Dependence?

Issues related to the reliability and validity of self-reported behavior within a deviant population are examined using data obtained from narcotics addicts in two face-to-face interviews conducted 10 years apart. The same measures of behavioral self-report for an overlapping period of 4-5 years were collected at each interview and were analyzed within a test-retest design. Agreement between measures obtained at the two recall points was reasonably good except for low-frequency behaviors and for measures of income and monetary costs. The correlation coefficients of the intervariable relationships measured at each interview increased as the constituent item reliabilities increased. Urinalyses conducted at each interview generally validated recent self-reported narcotics use.

BMI as a Moderator of Perceived Stress and Emotional Eating in Adolescents

The aim of the study was to explore the association between perceived stress, depression and food consumption frequency. A self-administered questionnaire that included the perceived stress scale, the depression scale and dietary intake was used in the baseline survey of a cohort study of 2579 local college students over 7 cities in China. Gender and city differences were found in perceived stress scores and depression scores. There were also significant differences among diverse smoking levels and among perceived weight categories in perceived stress and depression scores. Stepwise logistic regression models found that frequency of consumption of fresh fruit, ready-to-eat food and snack food had apparently independent effects on perceived stress, whereas the intake level of fresh fruit, ready-to-eat food and fast food was significantly associated with depression. The link between food consumption frequency, perceived stress and depression suggests that diet intervention may be considered a mediate strategy integrated in psychology prevention program among normal population of the college.