Krista W. Ranby

Mental health and HIV sexual risk behavior among patrons of alcohol serving venues in Cape Town, South Africa

Background:Alcohol-serving venues in South Africa provide a location for HIV prevention interventions due to risk factors of patrons in these establishments. Understanding the association between mental health and risk behaviors in these settings may inform interventions that address alcohol use and HIV prevention. Methods:Participants (n = 738) were surveyed in 6 alcohol-serving venues in Cape Town to assess post-traumatic stress disorder (PTSD) and depression symptoms, traumatic experiences, sexual behavior, and substance use. Logistic regression models examined whether traumatic experiences predicted PTSD and depression. Generalized linear models examined whether substance use, PTSD, and depressive symptoms predicted unprotected sexual intercourse. Men and women were analyzed separately. Results:Participants exhibited high rates of traumatic experiences, PTSD, depression, alcohol consumption, and HIV risk behaviors. For men, PTSD was associated with being hit by a sex partner, physical child abuse, sexual child abuse and HIV diagnosis; depression was associated with being hit by a sex partner, forced sex and physical child abuse. For women, both PTSD and depression were associated with being hit by a sex partner, forced sex, and physical child abuse. Unprotected sexual intercourse was associated with age, frequency and quantity of alcohol use, drug use, and PTSD for men and frequency and quantity of alcohol use, depression, and PTSD for women. Conclusion:Mental health in this setting was poor and was associated with sexual risk behavior. Treating mental health and substance-use problems may aid in reducing HIV infection. Sexual assault prevention and treatment after sexual assault may strengthen HIV prevention efforts.

Long-term effects of a worksite health promotion program for firefighters.

OBJECTIVE To describe effects of 2 worksite health promotion programs for firefighters, both immediate outcomes and the long-term consequences for 4 years following the interventions. METHODS At baseline, 599 firefighters were assessed, randomized by fire station to control and 2 different intervention conditions, and reevaluated with 6 annual follow-up measurements. RESULTS Both a team-centered peer-taught curriculum and an individual motivational interviewing intervention demonstrated positive effects on BMI, with team effects on nutrition behavior and physical activity at one year. Most differences between intervention and control groups dissipated at later annual assessments. However, the trajectory of behaviors across time generally was positive for all groups, consistent with lasting effects and diffusion of program benefits across experimental groups within the worksites. CONCLUSIONS Although one-year programmatic effects did not remain over time, the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions.

Perceived susceptibility measures are not interchangeable: absolute, direct comparative, and indirect comparative risk.

OBJECTIVE To provide an explanation of perceived susceptibility judgment that accounts for both inconsistencies among commonly used measures of perceived susceptibility (i.e., absolute risk, direct comparative risk, and indirect comparative risk) and their inconsistent relationships to disease risk factors. Inconsistencies are attributed to differential processing of general versus personal risk factors, coupled with the method of computation of the risk measures. DESIGN AND MEASURES Study 1 characterized risk factors as general versus personal. In Studies 2 and 3, community-residing adult women (ns = 432 and 147, respectively) rated perceived susceptibility to osteoporosis, breast cancer, heart disease, and diabetes, rated risk factors, and reported personal medical history. RESULTS Correlations and regression analyses mainly supported our characterization of the source of inconsistencies among susceptibility measures and their relationships to risk factors. CONCLUSION Perceived susceptibility measures are not interchangeable and can lead to opposite conclusions about correlates of perceived susceptibility. Researchers are cautioned against using indirect comparative measures, computed as difference scores, and are encouraged to use other methods to compel participants to consider the risk of others when making comparative judgments.

Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse.

OBJECTIVE To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress. METHOD In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects. RESULTS As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = -.20, p < .02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = -.22, p < .05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p < .001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress. CONCLUSIONS The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA.

A Mediation Analysis of the ATHENA Intervention for Female Athletes: Prevention of Athletic-Enhancing Substance Use and Unhealthy Weight Loss Behaviors

OBJECTIVE To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. METHODS In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. RESULTS ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior. CONCLUSIONS ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.

Influence in Relationships: A Meta-Analysis on Health-Related Social Control

People in close relationships influence the health behavior of their significant others. Recent research has explored one form of influence—social control—and produced results that suggest varying relationships between social control, health outcomes, and psychological well-being. For the present article, we conducted a meta-analysis to compare three predominant models of social control. We observed that measures of social control that distinguish between positive and negative forms of social control demonstrated stronger associations with health outcomes than did general measures of social control. Furthermore, measures of positive and negative social control were related to proposed psychological mediators.

Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample

BACKGROUND Characterizing smoking behavior is important for informing etiologic models and targeting prevention efforts. This study explored the effects of both individual- and community-level variables in predicting cigarette use vs. non-use and level of use among adolescents as they transition into adulthood. METHODS Data on 14,779 youths (53% female) were drawn from the National Longitudinal Study of Adolescent Health (Add Health); a nationally representative longitudinal cohort. A cohort sequential design allowed for examining trajectories of smoking typologies from age 13 to 32 years. Smoking trajectories were evaluated by using a zero-inflated Poisson (ZIP) latent growth analysis and latent class growth analysis modeling approach. RESULTS Significant relationships emerged between both individual- and community-level variables and smoking outcomes. Maternal and peer smoking predicted increases in smoking over development and were associated with a greater likelihood of belonging to any of the four identified smoking groups versus Non-Users. Conduct problems and depressive symptoms during adolescence were related to cigarette use versus non-use. State-level prevalence of adolescent smoking was related to greater cigarette use during adolescence. CONCLUSIONS Individual- and community-level variables that distinguish smoking patterns within the population aid in understanding cigarette use versus non-use and the quantity of cigarette use into adulthood. Our findings suggest that efforts to prevent cigarette use would benefit from attention to both parental and peer smoking and individual well-being. Future work is needed to better understand the role of variables in the context of multiple levels (individual and community-level) on smoking trajectories.

Risk Patterns Preceding Diagnosis Among Newly HIV-Diagnosed Men Who Have Sex with Men in New York City

Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤

Understanding the Phenotypic Structure of Adult Retrospective ADHD Symptoms During Childhood in the United States

30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.

Willingness to provide support for a quit attempt: A study of partners of smokers.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heterogeneous disorder, and the phenotypic structure comprising inattentive and hyperactive-impulsive type symptoms has been the focus of a growing body of recent research. Methodological studies are needed to better characterize phenotypes to advance research as well as clinical practice. A large U.S. population-based sample of young adults (N = 14,307, aged 17–28 years, 52.8% female) retrospectively reported their experiences of childhood ADHD symptoms. Factor analysis, latent class analysis, and factor mixture modeling of ADHD symptoms were compared to determine which underlying structure best fit the data. Fit statistics as well as substantive criteria compared models within and across model subtypes. Analyses supported a two-factor two-class structure for both male and female subjects. The two latent factors represented inattentive and hyperactive-impulsive symptom dimensions. The two latent classes divided people into a smaller affected class and a larger unaffected class. Individuals who reported having been diagnosed with ADHD were more likely to be in the affected class (OR male subjects = 4.03, 95% CI [2.65, 6.13]; OR female subjects = 5.65, 95% CI [3.15, 10.10]). This work aids in the understanding of ADHD symptomatology within the population; a majority of people experience very low symptom severity, whereas a minority of people experience high symptom severity. Within this high symptom group, however, variability in symptom experiences exists. Empirical models can be helpful in clarifying ADHD phenotypic structure that has the potential to advance research on the etiology and consequences of ADHD symptoms.