Rae Jean Proeschold-Bell

Home smoking restrictions and adolescent smoking

The prevention of adolescent smoking has focused on peer influences to the relative neglect of parental influences. Parents socialize their children about many behaviors including smoking, and parental rules about their childs smoking have been related to lower levels of adolescent smoking. Moreover, among adults, indoor smoking restrictions have been associated with decreased smoking. Accordingly, the current study tested the relation of adolescent smoking to home smoking policy (rules regulating where adults are allowed to smoke in the home). Results showed that restrictive home smoking policies were associated with lower likelihood of trying smoking for both middle and high school students. However, for high school students this relation was restricted to homes with non-smoking parents. Home smoking policies were not associated with current regular smoking for either middle or high school students. Home smoking policies may be useful in preventing adolescent smoking experimentation, although longitudinal and experimental research is necessary to confirm this hypothesis.

Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders.

Objective:To examine the effects of race/ethnicity, insurance, and type of substance abuse (SA) diagnosis on utilization of mental health (MH) and SA services among triply diagnosed adults with HIV/AIDS and co-occurring mental illness (MI) and SA disorders. Data Source:Baseline (2000 to 2002) data from the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study. Study Design:A multiyear cooperative agreement with 8 study sites in the United States. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered by trained interviewers to determine whether or not adults with HIV/AIDS had co-occurring MI and SA disorders. Data Collection/Extraction Methods:Subjects were interviewed in person about their personal characteristics and utilization of MH and SA services in the prior 3 months. Data on HIV viral load were abstracted from their medical records. Principal Findings:Only 33% of study participants received concurrent treatment for MI and SA, despite meeting diagnostic criteria for both: 26% received only MH services, 15% received only SA services, and 26% received no services. In multinomial logistic analysis, concurrent utilization of MH and SA services was significantly lower among nonwhite and Hispanic participants as a group and among those who were not dependent on drugs and alcohol. Concurrent utilization was significantly higher for people with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage. Two-part models were estimated for MH outpatient visits and 3 SA services: (1) outpatient, (2) residential, and (3) self-help groups. Binary logistic regression was estimated for any use of psychiatric drugs. Nonwhites and Hispanics as a group were less likely to use 3 of the 5 services; they were more likely to attend SA self-help groups. Participants with insurance were significantly more likely to receive psychiatric medications and residential SA treatment. Those with Medicaid were more likely to receive MH outpatient services. Participants who were alcohol dependent but not drug dependent were significantly less likely to receive SA services than those with dual alcohol and drug dependence. Conclusion:Among adults with HIV/AIDS and co-occurring MH and SA disorders, utilization of MH and SA services needs to be improved.

A Theoretical Model of the Holistic Health of United Methodist Clergy

Culturally competent health interventions require an understanding of the population’s beliefs and the pressures they experience. Research to date on the health-related beliefs and experiences of clergy lacks a comprehensive data-driven model of clergy health. Eleven focus groups with 59 United Methodist Church (UMC) pastors and 29 UMC District Superintendents were conducted in 2008. Participants discussed their conceptualization of health and barriers to, and facilitators of, health promotion. Audiotape transcriptions were coded by two people each and analyzed using grounded theory methodology. A model of health for UMC clergy is proposed that categorizes 42 moderators of health into each of five levels drawn from the Socioecological Framework: Intrapersonal, Interpersonal, Congregational, United Methodist Institutional, and Civic Community. Clergy health is mediated by stress and self-care and coping practices. Implications for future research and clergy health interventions are discussed.

Childhood trauma and health outcomes in HIV-infected patients: An exploration of causal pathways

Objective:Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. Methods:In 611 outpatient people living with HIV/AIDS, we tested whether traumas influence on later health and behaviors was mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. Results:In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), pasttrauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex [odds ratio (OR) = 1.17 per each additional type of trauma, 95% confidence interval = 1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to 1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22), and HIV disease progression (hazard ratio = 1.10, 0.98 to 1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (eg, OR for hospitalization changed from 1.12 to 1.07), whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (eg, OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. Conclusions:These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.

High rates of obesity and chronic disease among United Methodist clergy.

We used self‐reported data from United Methodist clergy to assess the prevalence of obesity and having ever been told certain chronic disease diagnoses. Of all actively serving United Methodist clergy in North Carolina (NC) 95% (n = 1726) completed self‐report height and weight items and diagnosis questions from the Behavioral Risk Factor Surveillance Survey (BRFSS). We calculated BMI categories and diagnosis prevalence rates for the clergy and compared them to the NC population using BRFSS data. The obesity rate among clergy aged 35–64 years was 39.7%, 10.3% (95% CI = 8.5%, 12.1%) higher than their NC counterparts. Clergy also reported significantly higher rates of having ever been given diagnoses of diabetes, arthritis, high blood pressure, angina, and asthma compared to their NC peers. Health interventions that address obesity and chronic disease among clergy are urgently needed.

Methodological considerations in the use of name generators and interpreters

Abstract With data from the Clergy Health Initiative Longitudinal Survey, we look for interviewer effects, differences between web and telephone delivery, and panel conditioning bias in an “important matters” name generator and interpreter, replicated from the U.S. General Social Survey. We find evidence of phone interviewers systematically influencing the number of confidants named, we observe that respondents assigned to the web survey reported a larger number of confidants, and we uncover strong support for panel conditioning. We discuss the possible mechanisms behind these observations and conclude with a brief discussion of the implications of our findings for similar studies.

HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: Effects on HIV testing and risk behaviors

OBJECTIVE To investigate relationships between institutional mistrust (systematic discrimination, organizational suspicion, and conspiracy beliefs), HIV risk behaviors, and HIV testing in a multiethnic sample of men who have sex with men (MSM), and to test whether perceived susceptibility to HIV mediates these relationships for White and ethnic minority MSM. METHOD Participants were 394 MSM residing in Central Arizona (M age = 37 years). Three dimensions of mistrust were examined, including organizational suspicion, conspiracy beliefs, and systematic discrimination. Assessments of sexual risk behavior, HIV testing, and perceived susceptibility to HIV were made at study entry (T1) and again 6 months later (T2). RESULTS There were no main effects of institutional mistrust dimensions or ethnic minority status on T2 risk behavior, but the interaction of systematic discrimination and conspiracy beliefs with minority status was significant such that higher levels of systematic discrimination and more conspiracy beliefs were associated with increased risk only among ethnic minority MSM. Higher levels of systematic discrimination were significantly related to lower likelihood for HIV testing, and the interaction of organizational suspicion with minority status was significant such that greater levels of organizational suspicion were related to less likelihood of having been tested for HIV among ethnic minority MSM. Perceived susceptibility did not mediate these relationships. CONCLUSION Findings suggest that it is important to look further into the differential effects of institutional mistrust across marginalized groups, including sexual and ethnic minorities. Aspects of mistrust should be addressed in HIV prevention and counseling efforts.

Do Gay and Bisexual Men Share Researchers' Definitions of Barebacking?

Abstract Despite pervasive discussion of “barebacking” in the HIV prevention literature, inconsistencies exist in how the term is defined. Moreover, little is known about whether gay and bisexual men concur with any of the definitions in the literature. In this study, gay and bisexual men (n = 398) were provided with four scenarios, describing various circumstances in which someone has unprotected anal intercourse. Participants were asked to indicate whether the man in each scenario was “barebacking.” Sixty-four percent did not discriminate in defining the term, indicating that barebacking includes any unprotected anal intercourse with any kind of sexual partner. Men were also asked whether they had ever tried barebacking, and if so, why. The most common reasons provided were (1) having sex with a steady partner, and (2) increased physical sensation. These findings suggest that mens definitions of “barebacking” vary widely and do not necessarily coincide with those of researchers and HIV prevention advocates.

A randomized controlled trial of health information exchange between human immunodeficiency virus institutions.

CONTEXT In order for patients to benefit from a multidisciplinary treatment approach, diverse providers must communicate on patient care. OBJECTIVE We sought to examine the effect of information exchange across multidisciplinary human immunodeficiency virus (HIV) care providers on patient health outcomes. DESIGN Randomized controlled trial, randomized at the patient level. SETTING Six infectious disease clinics paired with 9 ancillary care settings (eg, HIV case management). PARTICIPANTS Two hundred fifty-four patients with HIV receiving care at the infectious disease clinics. INTERVENTION Health information was exchanged for 2 years per patient between medical and ancillary care providers using electronic health records and printouts inserted into charts. Medical care providers gave ancillary care providers HIV viral loads, CD4 values, current medications, and appointment attendance. Ancillary care providers gave medical providers the information on medication adherence and major changes (eg, loss of housing). MAIN OUTCOME MEASURES We abstracted from medical records HIV viral loads, CD4 counts, and antiretroviral medication prescriptions before and during the intervention. From 0-, 12-, and 24-month patient surveys, we assessed hospitalizations, emergency department use, and health-related quality of life measured by the Medical Outcomes Study Short Form-36 (SF-36). RESULTS No statistically significant differences between cases and controls were found across time for the following: proportion with suppressed viral load, changes in viral load or CD4 values, patients being prescribed antiretroviral medication, hospitalizations, emergency department visits, or any scale of the SF-36. Trends were mixed but leaned toward better health for control participants. CONCLUSIONS The exchange of this specific set of information between HIV medical and ancillary care providers was neutral on a variety of patient health outcomes.

A Cross-Site, Comparative Effectiveness Study of an Integrated HIV and Substance Use Treatment Program

Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.