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Rutledge SE, Zhang J, Icard LD, Jemmott JB. Do syndemic conditions predict HIV medication adherence among urban African American men? AIDS Care 2024; 36:781-789. [PMID: 38387445 DOI: 10.1080/09540121.2024.2305149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024]
Abstract
Much progress has been made in advancing antiretroviral (ART) adherence, yet disparities remain. To explore relationships of syndemic conditions - co-occurring health conditions caused by combinations of biological, social, and structural factors - to ART adherence among African American men, we used data from longitudinal assessments of 302 African American men enrolled in a study designed to increase physical activity and healthy eating. Syndemic conditions included alcohol dependency, drug dependency, depression, post-traumatic stress disorder, and unstable housing. A syndemic conditions variable was operationalized to indicate the presence of 0-5 conditions. About 55% of participants had 1 or more syndemic conditions. Age and marriage were positively associated with ART adherence, whereas number of syndemic conditions was negatively associated with adherence during the 12-month period. The interaction of being married and the syndemic conditions variable significantly predicted greater adherence. Similarly, the interaction of more education and the syndemic conditions variable predicted greater adherence. In multiple regression models, the syndemic conditions variable remained significant (-0.018) in predicting adherence; however, there was no significant interaction among the 5 conditions. This study lends evidence to syndemics literature indicating deleterious consequences of negative life experiences on health outcomes.
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Affiliation(s)
| | - Jingwen Zhang
- Department of Communication, University of California, Davis, CA, USA
| | - Larry D Icard
- School of Social Work, Temple University, Philadelphia, PA, USA
- Centre for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa
| | - John B Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Baiocco R, Antoniucci C, Pistella J, Alessandri G, Alivernini F, Borghi AM, Chirico A, Filosa L, Fini C, Palombi T, Rosati F, Tavolucci S, Lucidi F. Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults. Front Psychol 2024; 15:1369021. [PMID: 38860050 PMCID: PMC11163588 DOI: 10.3389/fpsyg.2024.1369021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults. Methods Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%). Results ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories. Conclusion These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.
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Affiliation(s)
- Roberto Baiocco
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Antoniucci
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Jessica Pistella
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Alessandri
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabio Alivernini
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna M. Borghi
- Department of Dynamic, Clinical Psychology and Health, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Chirico
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Filosa
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Fini
- Department of Dynamic, Clinical Psychology and Health, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Palombi
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Fau Rosati
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Simone Tavolucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Wippold GM, Frary SG, Abshire DA, Wilson DK. Improving Recruitment, Retention, and Cultural Saliency of Health Promotion Efforts Targeting African American Men: A Scoping Review. Ann Behav Med 2021; 56:605-619. [PMID: 34473823 DOI: 10.1093/abm/kaab079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND When health promotion efforts intend to include African American men, they experience challenges with recruitment and retention, in addition to limited cultural saliency-interventions that do not align the cultural preferences and experiences of the target population produce less effective results. PURPOSE This scoping review provides an understanding of (a) how health promotion efforts among African American men are developed and implemented, in addition to the (b) main outcomes, (c) retention rates, and (d) methodological rigor of those efforts. METHODS The following databases were used: PubMed, EMBASE (Ovid), PsycINFO (EBSCO), CINAHL (EBSCO), Web of Science (Clarivate), and ProQuest. Included studies were restricted to those: (a) conducted among African American men and (b) reported the effects of a health promotion intervention. Interventions using single-group pre-post study, post-test-only study, non-randomized controlled trial, and randomized controlled trial (RCT) study designs were included. RESULTS The results indicate that varying degrees of customization in the design and implementation of health promotion efforts targeting African American can improve recruitment, retention, and health-related outcomes. Results draw attention to the need for community input when designing and implementing efforts targeting these men. CONCLUSIONS These results indicate that opportunities exist to innovate health promotion efforts among African American men, such as the intentional incorporation of the community's values, perspectives, and preferences in the effort (i.e., cultural saliency) and explicitly indicating how the efforts were culturally tailored to improve saliency. Opportunities also exist to innovate health promotion efforts among African American men based on literature-derived best practices.
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Affiliation(s)
- Guillermo M Wippold
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
| | | | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
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Kelly TA, Woko C, Jemmott LS, Icard L, Chittamuru D, Jemmott JB. Reasoned Action Approach Correlates of Physical Activity Among African American Men Living With HIV: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2021; 32:47-56. [PMID: 32675644 DOI: 10.1097/jnc.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Physical activity (PA) is associated with a reduced incidence of chronic diseases. However, little is known about the predictors of PA among African American men living with HIV. We report secondary analyses examining the strength of the relationships between the reasoned action approach constructs, attitude, subjective norm, descriptive norm, and self-efficacy and intention to exercise and self-reported adherence to Department of Health and Human Services PA guidelines using baseline data from a trial of a PA intervention with 302 African American men, between 40 and 88 years of age (M = 53.9; SD = 7.2) living with HIV. Multiple regression revealed that attitude, subjective norm, and self-efficacy were positively associated with intention. Logistic regression revealed higher odds of meeting PA guidelines as self-efficacy increased. Self-efficacy and descriptive norm predicted meeting the aerobic guideline. Self-efficacy predicted meeting the muscle-strengthening guideline. Interventions targeting reasoned action approach variables may contribute to efforts to improve PA among African American men living with HIV.
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Affiliation(s)
- Terri-Ann Kelly
- Terri-Ann Kelly, PhD, RN, is an Assistant Professor, School of Nursing, Rutgers University-Camden, Camden, New Jersey, USA. Chioma Woko, BS, is a Doctoral Student, Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Loretta S. Jemmott, PhD, RN, FAAN, is Vice President, Health and Health Equity; and Professor, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA. Larry Icard, PhD, DSW, is an Honorary Professor, Center for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa; and Professor Emeritus, College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA. Deepti Chittamuru, PhD, is a Post-Doctoral Student, School of Social Sciences, Humanities and Arts, University of California, Merced, California, USA. John B. Jemmott III, PhD, is Director, Center for Health and Communication Research; and Professor, Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barriers and Facilitators to Engaging African American Men Who Have Sex With Men in the HIV Care Continuum: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2020; 30:352-361. [PMID: 31021964 DOI: 10.1097/jnc.0000000000000087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
African American men who have sex with men (MSM) have high rates of HIV, but interventions are needed to address their low rates of engagement in the HIV care continuum. To identify modifiable factors potentially affecting such engagement, we conducted qualitative interviews guided by the Theory of Planned Behavior with 27 African American MSM who had participated in an HIV risk-reduction intervention trial. Qualitative analyses resulted in four overarching themes: stigma, concerns with health care providers (HCPs), social support, and logistical issues. Facilitators of care continuum engagement included reassurance about health, feeling and looking better, receiving treatment, avoiding infecting others, good relations with HCP, and social support. Barriers included HIV stigma, concerns about confidentiality, negative perceptions of HCP, convenience and availability of testing/treatment facilities, cost, and lack of social support. Efforts to improve African American MSM HIV care continuum engagement should focus on individual and health care system changes.
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Zhang J, O’Leary A, Jemmott JB, Icard LD, Rutledge SE. Syndemic conditions predict lower levels of physical activity among African American men who have sex with men: A prospective survey study. PLoS One 2019; 14:e0213439. [PMID: 30865694 PMCID: PMC6415907 DOI: 10.1371/journal.pone.0213439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/21/2019] [Indexed: 01/15/2023] Open
Abstract
African American men are disproportionately affected by, not only HIV/AIDS, but also chronic non-communicable diseases. Despite the known benefits of physical activity for reducing chronic non-communicable diseases, scant research has identified factors that may influence physical activity in this population. A growing literature centers on the syndemic theory, the notion that multiple adverse conditions interact synergistically, contributing to excess morbidity. This secondary data analysis examined two primary questions: whether syndemic conditions prospectively predicted physical activity, and whether, consistent with the syndemic theory, syndemic conditions interacted to predict physical activity. Participants were 595 African American men who have sex with men (MSM), a population underrepresented in health research, enrolled in a health-promotion intervention trial from 2008-2011. We used generalized-estimating-equations models to test the associations of syndemic conditions and resilience factors measured pre-intervention to self-reported physical activity 6 and 12 months post-intervention. As hypothesized, reporting more syndemic conditions pre-intervention predicted reporting less physical activity 6 and 12 months post-intervention, adjusting for the intervention. However, contrary to the syndemic theory, we did not find evidence for the interaction effects of syndemic conditions in predicting physical activity. Receiving high school education and having greater social network diversity predicted more physical activity whereas older age predicted less physical activity. To our knowledge, this is the first study to examine the syndemic theory in relation to physical activity. Although reporting a greater number of syndemic conditions was related to reduced physical activity, there was no evidence for synergy among syndemic conditions.
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Affiliation(s)
- Jingwen Zhang
- Department of Communication, University of California, Davis, Davis, California, United States of America
| | - Ann O’Leary
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John B. Jemmott
- Annenberg School for Communication and Department of Psychiatry of Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Larry D. Icard
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Scott E. Rutledge
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
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