Donald B. Chambers

A validity and reliability study of the coping self‐efficacy scale

OBJECTIVES Investigate the psychometric characteristics of the coping self-efficacy (CSE) scale, a 26-item measure of ones confidence in performing coping behaviors when faced with life challenges. DESIGN Data came from two randomized clinical trials (N1=149, N2=199) evaluating a theory-based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. METHODS The 348 participants were HIV-seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre- and post-intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well-being. RESULTS Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13-item reduced form of the CSE scale with three factors: Use problem-focused coping (6 items, alpha=.91), stop unpleasant emotions and thoughts (4 items, alpha=.91), and get support from friends and family (3 items, alpha=.80). Internal consistency and test-retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self-efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem- and emotion-focused coping skills were predictive of reduced psychological distress and increased psychological well-being over time. CONCLUSIONS The CSE scale provides a measure of a persons perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.

Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention.

Objective This randomized clinical trial was designed to compare the effects of a theory-based coping effectiveness training (CET) intervention with an active informational control (HIV-Info) condition and a waiting-list control (WLC) condition on psychological distress and positive mood in HIV-seropositive gay men. Materials and Methods The authors recruited 149 self-identified gay or bisexual men who were 21 to 60 years of age, reported depressed mood, and had CD4 levels of 200 to 700 cells/mm3. CET and HIV-Info participants attended 10 90-minute group sessions during the 3-month intervention phase and six maintenance sessions over the remainder of the year. Participants were assessed at baseline and at 3, 6, and 12 months. Data were collected 1992 to 1994, before the introduction of HAART. Analyses were based on the 128 participants who completed the 3-month assessment. Results After the 3-month intervention phase, when compared with HIV-Info, CET participants showed significantly greater decreases in perceived stress and burnout, and regression analyses indicated that significant increases in coping self-efficacy mediated the improvements in perceived stress and burnout. Compared with WLC, CET participants also showed significantly greater decreases in anxiety, and regression analyses indicated that significant increases in positive states of mind mediated the improvements in anxiety. Significant treatment group differences for positive morale were maintained at 6 and 12 months. In addition, optimism continued to increase in the CET and HIV-Info treatment groups during the maintenance phase. Conclusions CET can be an effective strategy for managing psychological distress and improving positive psychological states in patients confronting chronic illness.

Feasibility of Postexposure Prophylaxis (PEP) against Human Immunodeficiency Virus Infection after Sexual or Injection Drug Use Exposure: The San Francisco PEP Study

The feasibility of providing postexposure prophylaxis (PEP) after sexual or injection drug use exposures to human immunodeficiency virus (HIV) was evaluated. PEP was provided within 72 h to individuals with exposures from partners known to have or to be at risk for HIV infection. PEP consisted of 4 weeks of antiretroviral medications and individually tailored risk-reduction and medication-adherence counseling. Among 401 participants seeking PEP, sexual exposures were most common (94%; n=375). Among sexual exposures, receptive (40%) and insertive (27%) anal intercourse were the most common sexual acts. The median time from exposure to treatment was 33 h. Ninety-seven percent of participants were treated exclusively with dual reverse-transcriptase inhibitors, and 78% completed the 4-week treatment. Six months after the exposure, no participant developed HIV antibodies, although a second PEP course for a subsequent exposure was provided to 12%. PEP, after nonoccupational HIV exposure, is feasible for persons at risk for HIV infection.

Coping effectiveness training for men living with HIV: preliminary findings.

The estimated 12 million people worldwide who are infected with HIV face a chronic and debilitating disease that can create profound psychological distress. Each individual living with HIV confronts uncertainties about their future personal health and prognosis. In the developed world, advances in medical management and treatment of HIV have altered the trajectory of this disease to one of longterm illness. As a result, many individuals with HIV disease live more than a decade with the threat of increasing disability, loss of employment, and premature death. Many HIV-infected persons cope effectively with their condition and continue to lead productive, meaningful lives. Unfortunately, others have dif® culty managing the stresses associated with their condition. The Of® ce of AIDS Research and the National Institute of Mental Health (NIMH), both at the National Institutes of Health, have called for research on interventions to assist HIV-infected individuals to cope with the distress that often accompanies HIV disease and that can interfere with quality of life and adherence to care. While the majority of behavioural research and interventions in the area of HIV/AIDS have focused on the primary prevention of HIV transmission, a number of investigators have been conducting research designed to develop and evaluate interventions to increase coping and decrease distress in persons living with HIV1± 5. This paper describes one such intervention, Coping Effectiveness Training6,7, and reports on preliminary data from a randomized clinical trial that is being conducted to evaluate the training’s impact on HIV-related distress. In the face of the worldwide epidemic, some might argue that interventions are a luxury that we cannot afford. We believe that there are a number of compelling reasons to help those who are infected. First and foremost, there is the humanitarian imperative. If we have the capacity to deliver treatments that can ease pain and suffering and provide support, we have a responsibility to make these available. Second, assisting HIV-infected persons to cope with their disease will reduce distress, which is associated with non-adherence to care. Thus, coping interventions may increase adherence and reduce health care costs associated with HIV. Third, to the extent that distress has been associated with high-risk sexual behaviour8, assisting HIV-infected persons to cope with distress may reduce high-risk behaviour and reduce the likelihood of HIV transmission.

Risk behavior for HIV infection in participants in preventive HIV vaccine trials: a cautionary note.

We conducted a longitudinal study of participants in phase I and II HIV vaccine safety and immunogenicity trials to examine changes in sexual risk behavior that are associated with risk of HIV transmission. The participants were 48 HIV-negative men and women enrolled in one of two placebo-controlled HIV vaccine trials conducted at San Francisco General Hospital. There was a significant increase in insertive unprotected anal intercourse (UAI) from 9% at baseline (trial entry), to 13% at the month 6 assessment, to 20% at the month 12 assessment (p = .02). The primary predictor of either insertive or receptive UAI during the vaccine trials was having engaged in this behavior prior to entry (p = .001). Higher-risk behavior was also seen among participants who were younger and had multiple sexual partners (each, p = .06) and who indicated that one of their reasons for participation in the vaccine trial was hope of protection from HIV infection (p = .07). These findings indicate that despite instructions otherwise, participants with a history of high-risk behavior or who express hope of protection from HIV infection by enrolling in vaccine trials may be candidates for more intensive risk-behavior counseling prior to and during their participation.

Social support, distress, and well-being in older men living with HIV infection

Summary: Older men with HIV infection/AIDS, having often lived with the condition longer, are more likely to confront the stress of managing more advanced HIV disease than their younger counterparts. Meanwhile, they also are more likely to have less social support and experience more distress than younger persons with HIV infection. The moderating effect of social support on health functioning and distress is unknown for persons with HIV infection, particularly those who are older. Study objectives were to assess whether the association between perceived health functioning and psychological distress and well‐being is moderated (or influenced) by social support and age and if the impact of social support on distress and well‐being is more pronounced for older than for younger men living with HIV infection/AIDS. In this cross‐sectional study of HIV‐positive adult men (n = 199) who have sex with men, participants completed self‐report assessments of perceived health functioning, social support, and psychological distress and well‐being. Measures of health functioning and overall social support were significantly associated with outcome measures of distress and positive affect (all p < .05). However, the main effect for social support was qualified by a significant age‐by‐social support interaction for both outcomes (&bgr; = ‐.190, p < .01 for distress; &bgr; = .172, p < .05 for positive affect), indicating that the impact of social support on decreasing distress and increasing well‐being was more pronounced in older men. The relationships between perceived health functioning and distress and well‐being were not moderated by social support or age. The influence of social support on negative and positive moods in this population of HIV‐infected men who have sex with men was significantly greater among older than among younger participants. With an increasing number of older people with HIV infection/AIDS, special efforts to create effective and sustainable social support interventions may be particularly beneficial to older persons living with HIV infection.

CANCER SCREENING IN HOMELESS WOMEN: ATTITUDES AND BEHAVIORS

Little is known about the use of cancer-screening services in homeless women and their attitudes about early detection programs. Face-to-face interviews were conducted with homeless women in San Francisco to determine rates of clinical breast exams, mammograms, and Pap smears. A total of 105 women were randomly selected from two homeless shelters. By self-report, 51 percent were current on clinical breast exams, 47 percent on mammograms, and 54 percent on Pap smears. These women had very positive attitudes toward receiving cancer-screening exams. In multivariate analyses, discussion about cancer prevention with a health care provider predicted current clinical breast exams and mammograms. More medical visits predicted being current on mammograms and Pap smears. Although homeless women represent a unique group of the urban poor, they are accessing cancer-screening exams at rates comparable to the general population.

Value on Health, Health Concerns and Practices of Women Who Are Homeless

ABSTRACT The fastest growing segment of the homeless population is women, many of whom have inadequately addressed health needs. Descriptive studies have captured the realities of homeless life that these women face from acquiring food and shelter to caring for their health. Few studies have examined the factors that are associated with the health-related behaviors of homeless women. This study adds to the homeless health behavior literature by investigating the importance of competing values in determining health-related practices in 105 homeless women. Health concerns (but not global value on health) were associated with basic health practices and health preventive/protective behaviors (e.g., brushing teeth, showering, being up-to-date on Pap smears). Women who reported greater importance attached to health concerns were more likely to report basic health practices and some preventive health behaviors. Implications for intervention and future research are discussed.

Survey of Geriatric Nurse Practitioners in the West: Scope of Practice and Effectiveness

&NA; This survey research conducted during a 3‐year period was designed to describe the scope of practice and effectiveness of the geriatric nurse practitioner (GNP) in providing health care to older adults in a variety of settings. The University of California, San Francisco, in collaboration with three other GNP programs surveyed graduates (n= 123). Also surveyed were administrators, directors of nursing, and the primary medical consultant where the GNPs were employed. A high degree of agreement among the professional groups was found. Some comparisons are made with the results of previous studies.