Joel Milam

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.

Sitting-Meditation Interventions Among Youth: A Review of Treatment Efficacy

OBJECTIVE: Although the efficacy of meditation interventions has been examined among adult samples, meditation treatment effects among youth are relatively unknown. We systematically reviewed empirical studies for the health-related effects of sitting-meditative practices implemented among youth aged 6 to 18 years in school, clinic, and community settings. METHODS: A systematic review of electronic databases (PubMed, Ovid, Web of Science, Cochrane Reviews Database, Google Scholar) was conducted from 1982 to 2008, obtaining a sample of 16 empirical studies related to sitting-meditation interventions among youth. RESULTS: Meditation modalities included mindfulness meditation, transcendental meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy. Study samples primarily consisted of youth with preexisting conditions such as high-normal blood pressure, attention-deficit/hyperactivity disorder, and learning disabilities. Studies that examined physiologic outcomes were composed almost entirely of African American/black participants. Median effect sizes were slightly smaller than those obtained from adult samples and ranged from 0.16 to 0.29 for physiologic outcomes and 0.27 to 0.70 for psychosocial/behavioral outcomes. CONCLUSIONS: Sitting meditation seems to be an effective intervention in the treatment of physiologic, psychosocial, and behavioral conditions among youth. Because of current limitations, carefully constructed research is needed to advance our understanding of sitting meditation and its future use as an effective treatment modality among younger populations.

Posttraumatic Growth among Adolescents

This study examined posttraumatic growth (PTG), the construing of benefits from a traumatic event, in a sample of 435 mostly Hispanic adolescentswho experienced a major life event within the previous 3 years. Levels of PTG did not differ between experienced negative life events. The relationship between PTG and sociodemographics, substance use, religiosity, and depression was explored. Age and religiosity were positively associated with PTG, whereas substance use was inversely associated with PTG. Only age and substance use remained associated with PTG after adjusting for all other variables in a multiple regression analysis. These results demonstrate the existence of PTG among an adolescent population and suggest that PTG can be related to important health behaviors such as substance use.

Parental stress increases the effect of traffic-related air pollution on childhood asthma incidence

Exposure to traffic-related pollution (TRP) and tobacco smoke have been associated with new onset asthma in children. Psychosocial stress-related susceptibility has been proposed to explain social disparities in asthma. We investigated whether low socioeconomic status (SES) or high parental stress modified the effect of TRP and in utero tobacco smoke exposure on new onset asthma. We identified 2,497 children aged 5–9 years with no history of asthma or wheeze at study entry (2002–2003) into the Childrens Health Study, a prospective cohort study in southern California. The primary outcome was parental report of doctor-diagnosed new onset asthma during 3 years of follow-up. Residential exposure to TRP was assessed using a line source dispersion model. Information about maternal smoking during pregnancy, parental education (a proxy for SES), and parental stress were collected in the study baseline questionnaire. The risk of asthma attributable to TRP was significantly higher for subjects with high parental stress (HR 1.51 across the interquartile range for TRP; 95% CI 1.16–1.96) than for subjects with low parental stress (HR 1.05, 95% CI 0.74–1.49; interaction P value 0.05). Stress also was associated with larger effects of in utero tobacco smoke. A similar pattern of increased risk of asthma was observed among children from low SES families who also were exposed to either TRP or in utero tobacco smoke. These results suggest that children from stressful households are more susceptible to the effects of TRP and in utero tobacco smoke on the development of asthma.

Posttraumatic Growth and HIV Disease Progression.

The relationship between posttraumatic growth (PTG; perceiving positive changes since diagnosis) and disease status, determined by changes in viral load and CD4 count over time, was examined among 412 people living with HIV. In controlled multiple regression models, PTG was not associated with disease status over time for the entire sample. However, there were significant associations for certain subgroups. PTG was positively associated with CD4 counts for Hispanic participants (vs. non-Hispanic) and those with low (vs. high) levels of optimism. PTG was inversely associated with viral load among those low (vs. high) in pessimism. Although PTG was inversely associated with depressive symptoms, alcohol, and illicit drug use, these factors did not account for the findings.

Are HIV care providers talking with patients about safer sex and disclosure?: A multi-clinic assessment

Objectives: To examine HIV-positive patients’ reports of whether HIV care providers ever talked with them about practicing safer sex and disclosing seropositive status to sex partners. Design: Cross-sectional survey (1998–1999) of HIV-positive men and women sampled randomly at six public HIV clinics in California. Methods: Participants were interviewed and asked whether applicable clinic providers (physician, physician assistant, nurse practitioner, nurse, social worker, health educator, psychologist, psychiatrist) ever talked with them about safer sex or disclosure. Responses were analyzed by clinic site, HIV medical status (viral load), demographic, and behavioral variables (unprotected intercourse, non-disclosure). Results: The sample (n = 839) included heterosexual men (n = 127), men who have sex with men (MSM; n = 607), and women (n = 105). Thirty-nine percent were white, 36% Hispanic, 17% black, and 8% other/mixed ethnicity. Overall, 71% reported that an applicable provider had talked with them at least once about safer sex (range across clinics, 52–94%); 50% reported discussion of disclosure (range across clinics, 31–78%). Discussion of safer sex was more prevalent with physicians than with other clinic staff. In multivariate analyses, in addition to significant clinic differences, MSM (versus heterosexual men) and whites (versus blacks or Hispanics) were less likely to receive prevention messages on these topics. Patients’ behaviors (unsafe sex, non-disclosure) and HIV medical status were not independently associated with provider communication. Conclusions: HIV clinics differed substantially in the percentage of patients who reported that they received prevention messages from clinic staff. Care providers should assess and overcome barriers to providing prevention messages to patients.

Psychometric Assessment of the Mindful Attention Awareness Scale (MAAS) Among Chinese Adolescents

The Mindful Attention Awareness Scale (MAAS) has the longest empirical track record as a valid measure of trait mindfulness. Most of what is understood about trait mindfulness comes from administering the MAAS to relatively homogenous samples of Caucasian adults. This study rigorously evaluates the psychometric properties of the MAAS among Chinese adolescents attending high school in Chengdu, China. Classrooms from 24 schools were randomly selected to participate in the study. Three waves of longitudinal data (N = 5,287 students) were analyzed. MAAS construct, nomological, and incremental validity were evaluated as well as its measurement invariance across gender using latent factor analyses. Participants’ mean age was 16.2 years (SD = 0.7), and 51% were male. The 15-item MAAS had adequate fit to the one-dimensional factor structure at Wave 1, and this factor structure was replicated at Wave 2. A 6-item short scale of the MAAS fit well to the data at Wave 3. The MAAS maintained reliability (Cronbach’s α = .89-.93; test–restest r = .35-.52), convergent/discriminant validity, and explained additional variance in mental health measures beyond other psychosocial constructs. Both the 15- and 6-item MAAS scales displayed at least partial factorial invariance across gender. The findings suggest that the MAAS is a sound measure of trait mindfulness among Chinese adolescents. To reduce respondent burden, the MAAS 6-item short-scale provides an option to measure trait mindfulness.

Atazanavir Concentration in Hair Is the Strongest Predictor of Outcomes on Antiretroviral Therapy

BACKGROUND Adequate exposure to antiretrovirals is important to maintain durable responses, but methods to assess exposure (eg, querying adherence and single plasma drug level measurements) are limited. Hair concentrations of antiretrovirals can integrate adherence and pharmacokinetics into a single assay. METHODS Small hair samples were collected from participants in the Womens Interagency HIV Study (WIHS), a large cohort of human immunodeficiency virus (HIV)-infected (and at-risk noninfected) women. From 2003 through 2008, we analyzed atazanavir hair concentrations longitudinally for women reporting receipt of atazanavir-based therapy. Multivariate random effects logistic regression models for repeated measures were used to estimate the association of hair drug levels with the primary outcome of virologic suppression (HIV RNA level, <80 copies/mL). RESULTS 424 WIHS participants (51% African-American, 31% Hispanic) contributed 1443 person-visits to the analysis. After adjusting for age, race, treatment experience, pretreatment viral load, CD4 count and AIDS status, and self-reported adherence, hair levels were the strongest predictor of suppression. Categorized hair antiretroviral levels revealed a monotonic relationship to suppression; women with atazanavir levels in the highest quintile had odds ratios (ORs) of 59.8 (95% confidence ratio, 29.0-123.2) for virologic suppression. Hair atazanavir concentrations were even more strongly associated with resuppression of viral loads in subgroups in which there had been previous lapses in adherence (OR, 210.2 [95% CI, 46.0-961.1]), low hair levels (OR, 132.8 [95% CI, 26.5-666.0]), or detectable viremia (OR, 400.7 [95% CI, 52.3-3069.7]). CONCLUSIONS Antiretroviral hair levels surpassed any other predictor of virologic outcomes to HIV treatment in a large cohort. Low antiretroviral exposure in hair may trigger interventions prior to failure or herald virologic failure in settings where measurement of viral loads is unavailable. Monitoring hair antiretroviral concentrations may be useful for prolonging regimen durability.

The September 11th 2001 Terrorist Attacks and Reports of Posttraumatic Growth among a Multi-Ethnic Sample of Adolescents

Correlates of posttraumatic growth (PTG), the construing of benefits from a traumatic event, attributed to the September 11th terrorist attacks were examined among 513 middle school adolescents (mean age=13.5 years; 63% female; 44% Hispanic/Latino, 25% Asian, 16% White, 10% multiethnic/other, and 4% Persian; all residing in California). One-third of the participants, on average, reported experiencing positive changes post- 9/11 in the following areas: appreciation of life, life priorities, spirituality, relationships, and self-reliance. Hispanic and White, compared to Persian (largely Iranian), participants had significantly higher PTG scores. Discussion of the terrorist attacks, identification with a religion, and optimism were positively associated with PTG, while alcohol use, depressive symptoms, and anxiety were inversely associated with PTG. Ethnicity, discussion of the terrorist attacks, identification with a religion, optimism, anxiety, and alcohol use remained associated with PTG after adjusting f...

The roles of dispositional optimism and pessimism in hiv disease progression

Relationships between dispositional optimism and pessimism and the course of HIV infection, determined by changes in viral load and CD4 counts, were studied in a longitudinal cohort of 412 patients on antiretroviral therapy (ART). Multiple regression analyses controlling for baseline levels of disease status, ethnicity, and depressive symptoms demonstrated that higher pessimism at baseline was associated with higher viral load at follow-up (average of 18 months later). Optimism at baseline had a curvilinear relationship with CD4 counts at follow-up. Moderate levels of optimism at baseline predicted the highest CD4 counts at follow-up. Although optimism and pessimism were associated with specific health behaviors (e.g., ART adherence, cigarette use, drug use, dietary practices), none of these behaviors mediated the optimism/pessimism effects. The biologic and behavioral mediators of associations of personality variables with the course of treated HIV infection deserve continued investigation.